Page 7 - Carotid and peripheral vascular interventions textbook
P. 7


                 or to clarify inconclusive results from noninvasive study.   (ARBs)]  are  effective  for  managing  hypertension
                 Venous renin measurements, plasma renin measurements   associated with renal artery disease and can cause slowing
                 before and after angiotensin converting enzymes inhibitor   of its progression. In two observational studies ARBs and
                 (ACEI) provocation, and renal scintigraphy are no longer   ACEIs have shown advantages in decreasing morbidity and
                 used for diagnosing atherosclerotic RAS (1,23,27).  mortality in RAS patients (32,33). However, these drugs
                                                                 may decrease glomerular capillary hydrostatic pressure
                 TREATMENT                                       and result in a transient reduction in eGFR and increase
                                                                 serum creatinine. From the 2017 ESC guidelines (23),
                     Patients with RAS with or without end-stage CKD   ACEIs or ARBs are recommended for hypertension
                 have a shortened life expectancy (28). Most of them   treatment related to unilateral RAS. ARBs or ACEIs can
                 died from acute CV events (29). Risk factor assessment,   also be administered in bilateral severe RAS as well as
                 life-style modif cation, and medications (e.g., antiplatelet    a single functioning kidney stenosis if well-tolerated with
                 and statin) are important and should follow current   close observation. Nearly all patients having signif cant
                 guidelines of primary prevention for CAD (30,31). Most   RAS tolerate ARBs or ACEIs without any problem.
                 antihypertensive drugs [diuretics, beta-blockers, calcium   However, optimal target blood pressure (BP) for the setting
                 channel blockers, and ACEIs, angiotensin renin blockers     of RAS, is still unknown.

                 A                                               B


                  C                                              D

                 Figure 10-5. Doppler ultrasound of right renal artery stenosis. A: Color doppler image showing a color bruit of the post stenotic turbulence.
                 B: Doppler waveform obtained near the renal artery origin showing velocities over 600 cm/s in systole and over 300 cm/s in diastole consistent with
                 a high-grade stenosis. C: Doppler waveform obtained from the segmental renal arteries within the right kidney showing delayed systolic acceleration
                 with absence of the early systolic peak. The calculated renal resistive index (RRI) is normal (=0.48) with good prognosis. D: Subsequent digital
                 subtraction angiogram before undergoing renal stenting revealed a high-grade stenosis of proximal right renal artery.
   2   3   4   5   6   7   8   9   10   11