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Titolo:
Management of renovascular disease: a review of renal artery stenting in ten studies
Autore:
Isles, CG; Robertson, S; Hill, D;
Indirizzi:
Dumfries & Galloway Royal Infirm, Renal Unit, Dumfries DG1 4AP, Scotland Dumfries & Galloway Royal Infirm Dumfries Scotland DG1 4AP 4AP, Scotland Dumfries & Galloway Royal Infirm, Dept Radiol, Dumfries DG1 4AP, Scotland Dumfries & Galloway Royal Infirm Dumfries Scotland DG1 4AP 4AP, Scotland
Titolo Testata:
QJM-MONTHLY JOURNAL OF THE ASSOCIATION OF PHYSICIANS
fascicolo: 3, volume: 92, anno: 1999,
pagine: 159 - 167
SICI:
1460-2725(199903)92:3<159:MORDAR>2.0.ZU;2-D
Fonte:
ISI
Lingua:
ENG
Soggetto:
RECURRENT PULMONARY-EDEMA; SURGICAL REVASCULARIZATION; WALLSTENT ENDOPROSTHESIS; NATURAL-HISTORY; PALMAZ STENT; FOLLOW-UP; ANGIOPLASTY; PLACEMENT; STENOSIS; HYPERTENSION;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
39
Recensione:
Indirizzi per estratti:
Indirizzo: Isles, CG Dumfries & Galloway Royal Infirm, Renal Unit, Dumfries DG1 4AP, Scotland Dumfries & Galloway Royal Infirm Dumfries Scotland DG1 4AP and
Citazione:
C.G. Isles et al., "Management of renovascular disease: a review of renal artery stenting in ten studies", QJM-MON J A, 92(3), 1999, pp. 159-167

Abstract

To evaluate the efficacy and safety of renal artery stents in renovasculardisease, we identified 10 descriptive studies containing sufficient information for systematic evaluation. No randomized comparisons of stenting withangioplasty or with surgery were found. Overall, stents were placed in 416renal arteries in 379 patients, mean age 64 years (range 27-84), 56% male. Of the stenoses, 97% were atheromatous (inter-study range 71-100%), 80% ostial (22-100%) and 31% bilateral (12-87%). The clinical indication for stenting was usually hypertension with or without mild renal impairment. Radiological indications for stenting were: narrowing of greater than or equal to50% (in 9/10 studies) as a result of elastic recoil (58%) or dissection (2%) at the time of angioplasty; restenosis some time after angioplasty (15%); or as a primary procedure (25%). Technical success was reported in 96-100% of procedures. Restenosis (greater than or equal to 50% narrowing), evaluated in 312/416 (75%) arteries, generally between 6 and 12 months, was 16% overall. Hypertension was cured by stenting (DBP less than or equal to 90 mmHg on no treatment) in 34/379 (9%) overall and in 34/207 (16%) of those whose renal function was normal initially. Six of 379 (1.6%) patients died within 30 days of stenting, but in only two (0.5%) was death judged to be procedure-related. Complications, other than those which led to dialysis, occurred in 42/379 (13%) patients, one third requiring intervention, ranging from blood transfusion to a surgical bypass procedure. Renal function as judged by serum creatinine concentration (SCC) improved in 26%, stabilized in 48% and deteriorated in 26% of patients whose renal function was impaired initially (SCC >133 mu mol/l). In one study, with average baseline SCC >200 mu mol/l, successful stenting slowed the rate of progression of renal failure when renal function was deteriorating beforehand. Nine of 379 (2.4%) patients, including 7/14 (50%) whose SCC was greater than or equal to 400 mu mol/l initially, required dialysis after stenting. Stenting should be offeredby specialist centres as a secondary procedure for unsuccessful angioplasty, or restenosis following angioplasty, to patients with renovascular disease and uncontrolled hypertension, advancing renal failure or pulmonary oedema.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 20/09/20 alle ore 10:39:23