Abstract
Renal artery stenosis (RAS) can accelerate or generate progressive hypertension and renal dysfunction. The goals for treating patients with RAS are to reduce cardiovascular morbidity and mortality attributable to elevated arterial pressure and to preserve renal function beyond critical stenosis. Recent, randomized trials with current antihypertensive agents indicate that many patients with RAS can be managed for years without renal artery revascularization. As it does elsewhere, atherosclerotic disease can progress to more severe occlusion in the renal arteries. Rapid advances in endovascular techniques, including stenting, make restoration of renal blood flow possible in more patients than before. Therapeutic goals are achieved by 1) avoidance of tobacco, 2) reducing arterial pressure with antihypertensive drug therapy, particularly those agents capable of blocking the renin-angiotensin system, and 3) renal revascularization, using balloon angioplasty and stent placement, surgical bypass, or endarterectomy. The major clinical challenges are to identify progressive occlusive disease and to determine appropriate timing for vascular intervention.
References
May 1, 1992·Journal of the American Society of Nephrology : JASN·M B HardingT M Bashore
Mar 3, 1990·BMJ : British Medical Journal·L E Ramsay, P C Waller
Feb 1, 1989·Hypertension·V J CanzanelloN E Madias
Mar 1, 1985·Annals of Internal Medicine·S C TextorM Pohl
Nov 1, 1995·Mayo Clinic Proceedings·F S BonelliA Schirger
May 1, 1995·Journal of Vascular Surgery·J W HallettP C Pairolero
Jul 1, 1994·Journal of Vascular Surgery·R P CambriaW M Abbott
Apr 19, 1997·Lancet·P N HardenJ G Moss
Jul 1, 1997·The Journal of Urology·F SteinbachD Dykstra
Mar 12, 1998·Hypertension·P F PlouinA Raynaud
Jul 9, 1998·Journal of Human Hypertension·J WebsterR Wilkinson
Aug 26, 1998·Circulation·G DorrosT He
Sep 15, 1998·Catheterization and Cardiovascular Diagnosis·C J White
Dec 5, 1998·Annals of Internal Medicine·P KrijnenJ D Habbema
Dec 22, 1998·Circulation·M T CapsD E Strandness
Feb 3, 1999·Lancet·P J van de VenW P Mali
Mar 24, 1999·Journal of Endovascular Surgery : the Official Journal of the International Society for Endovascular Surgery·M HenryZ Chati
Jan 20, 2000·The New England Journal of Medicine·UNKNOWN Heart Outcomes Prevention Evaluation Study InvestigatorsG Dagenais
Apr 6, 2000·The New England Journal of Medicine·B C van JaarsveldM A Schalekamp
Apr 6, 2000·The New England Journal of Medicine·E Ritz, J F Mann
Jun 1, 2000·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·J Main
Sep 29, 2000·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·K R Tuttle