Page 4 - Carotid and peripheral vascular interventions textbook
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                    with ARAS, the major clinical manifestation of renovascular   transluminal angioplasty (PTA) have resulted in a low
                    FMD is hypertension which hardly ever causes recurrent   threshold for intervening in FMD patients (19).
                    pulmonary edema or renal impairment. Although medical      Takayasu’s arteritis is an uncommon systemic vasculitis
                    management of hypertension is frequently successful,    principally effecting the aorta and its major branches,
                    the high rates of procedural success, elimination of    including the renal artery. Nearly half of the Asian Takayasu’s
                    hypertension, and low recurrence rate (10%) of percutaneous    arteritis patients suffer from renal artery involvement (20).

                                                                     Decrease renal blood flow

                                                                                            ! NO and
                                                                             ! Renin       prostacyclin
                           Renal artery stenosis

                                 Aldosterone                              ! Angiotensin II

                              Na and H 2 O retention     Sympathetic nervous   Vasoconstriction  Profibrotic growth
                                                           system activation                factors

                                                                                   Heart   Kidney  Vascular

                                 Decompensated              Uncontrolled                Decreased renal
                                   heart failure            hypertension                excretory function
                                 + preserved EF

                    Figure 10-2. Pathophysiology of renal artery stenosis (Reprinted from Fernando D, Garasic J. Percutaneous intervention for renovascular
                    disease: rational and patient selection. Curr Opin Cardiol. 2004;19:582-588, with permission from Wolters Kluwer Health, Inc.).
                    EF, ejection fraction; H2O, water; Na, sodium; NO, nitric oxide

                     A                                               B

                    Figure 10-3. A: Atherosclerotic renal artery stenosis at the renal ostium (white arrow). B: Fibromuscular dysplasia with ‘string of beads’ stenosis
                    (black arrow) at the mid to distal part of the renal artery.
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