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Andrew C. Novick - One of the best experts on this subject based on the ideXlab platform.
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Management of Atherosclerotic Renal Artery Disease in Younger Patients
The Journal of Urology, 2017Co-Authors: Amr Fergany, Andrew C. Novick, David A. GoldfarbAbstract:AbstractFrom 1970 to 1990, 57 patients 50 years old or younger were treated for hypertension caused by atherosclerotic Renal Artery Disease. Predisposing factors for atherosclerosis included smoking in 43 cases, hyperlipidemia in 15, diabetes in 8 and hyperuricemia in 8. Of the patients 47 had a family history of atherosclerotic vascular Disease or a significant related disorder. Evidence of generalized atherosclerosis was present in 55 patients. Atherosclerotic Renal Artery Disease was present unilaterally in 16 cases, bilaterally in 39 and in a solitary kidney in 2.Of the patients 34 were treated surgically, 20 medically and 2 by percutaneous angioplasty. Surgically treated patients experienced significant postoperative improvement in blood pressure (p = 0.001) and Renal function (p = 0.05). Medically treated patients experienced significant improvement in blood pressure (p = 0.03) but Renal function deteriorated. Younger patients with atherosclerotic Renal Artery Disease suffer from a more severe and a...
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Stenosing Renal Artery Disease in children: clinicopathologic correlation and results of surgical treatment.
Nephron, 2008Co-Authors: Andrew C. Novick, Sanford P. Benjamin, Ralph A. StraffonAbstract:From 1955 to 1977, 27 pediatric patients underwent surgical treatment for renovascular hypertension. Renal Artery Disease was most commonly caused by intimal or perimedial fibroplasia and occurred bil
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Percutaneous transluminal angioplasty and surgery of the Renal Artery.
European Journal of Vascular Surgery, 2005Co-Authors: Andrew C. NovickAbstract:The management of patients with Renal Artery Disease has changed in recent years. This has occurred due to the advent of PTA as an effective method of treatment for certain patients, an enhanced appreciation of advanced atherosclerotic Renal Artery Disease as a correctable cause of Renal failure, and improved results of surgical revascularisation in both older patients with severe aortic atherosclerosis and younger patients with branch Renal Artery Disease. PTA currently yields excellent results and is the treatment of choice for patients with fibrous dysplasia of the main Renal Artery and non-ostial atherosclerotic lesions. Most reports in the literature indicate that surgical revascularisation provides more effective therapy for patients with ostial atherosclerotic lesions. Surgical revascularisation also remains the treatment of choice for the majority of patients with branch Renal Artery Disease, a Renal Artery aneurysm, Renal Artery occlusion, and recurrent Renal Artery stenosis after failed PTA or surgery. Excellent clinical results can be achieved with both PTA and surgical revascularisation in properly selected patients.
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Long-term results of surgical revascularization for Renal Artery Disease
Urologic Clinics of North America, 2001Co-Authors: Andrew C. NovickAbstract:This article discusses the different operative techniques used for treatment of patients with significant atherosclerotic Renal Artery Disease. The authors then review the results and success rates of these procedures.
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Contemporary management of Renal cell carcinoma with coexistent Renal Artery Disease: update of the Cleveland Clinic experience.
Urology, 2000Co-Authors: Khaled S. Hafez, Steven C. Campbell, Venkatesh Krishnamurthi, Andrew C. NovickAbstract:Objectives. To treat concurrent Renal cell carcinoma (RCC) and Renal Artery Disease (RAD), which pose an unusual and challenging management dilemma. Methods. Before June 1998, 48 patients presented with localized RCC and RAD affecting all the functioning Renal parenchyma. These patients were grouped into four distinct categories: group 1, a solitary kidney with RCC and RAD (n = 8); group 2, bilateral RCC and coexistent RAD (n = 9); group 3, unilateral RCC and contralateral RAD (n = 15); and group 4, unilateral RCC and bilateral RAD (n = 16). The most common cause of RAD was atherosclerosis (n = 40), followed by medial fibroplasia (n = 5), Renal Artery aneurysm (n = 2), and arteriovenous malformation (n = 1). Results. All patients underwent complete surgical excision of RCC. A nephron-sparing operation was performed preferentially (44 patients), and bilateral Renal cancer operations were staged. Eleven patients underwent surgical Renal vascular reconstruction in conjunction with either partial (n = 9) or radical (n = 2) nephrectomy. In 2 patients, Renal revascularization was accomplished by percutaneous transluminal angioplasty before tumor excision. No perioperative deaths occurred. Postoperatively, preservation of Renal function was achieved in 47 patients; 1 patient required chronic dialysis. The overall and cancer-specific 5-year patient survival rates in this series were 66% and 90%, respectively. At a mean follow-up of 58 months, 28 patients were alive with no evidence of malignancy. Six patients died of metastatic RCC, and 14 died of unrelated causes with no evidence of malignancy. Conclusions. Nephron-sparing surgery combined with selective Renal arterial reconstruction can yield gratifying results in this complex patient population.
Kenneth Rosenfield - One of the best experts on this subject based on the ideXlab platform.
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atherosclerotic peripheral vascular Disease symposium ii intervention for Renal Artery Disease
Circulation, 2008Co-Authors: Krishna J Rochasingh, Andrew C Eisenhauer, Stephen C Textor, Christopher J Cooper, Walter A Tan, Alan H Matsumoto, Kenneth RosenfieldAbstract:The primary goal of this American Heart Association Renal intervention writing group was to discuss current controversies related to Renal interventions and to recommend important areas of clinical research and advocacy initiatives in this peripheral arterial bed. The 4 areas covered in this section include (1) management of asymptomatic Renal Artery Disease, (2) treatment of ischemic nephropathy, (3) prevention and treatment of atheroembolism in Renal Artery interventions, and (4) treatment of Renal in-stent restenosis (ISR). Atherosclerotic Renal Artery Disease is an often unrecognized contributor to refractory hypertension, Renal insufficiency, and increased risk of cardiovascular death.1,2 Renal Artery Disease is associated with increased cardiovascular events (myocardial infarction, stroke, and death), and when associated with symptomatic coronary Artery Disease, it independently doubles the risk of death.3 Additionally, the presence of bilateral Renal Artery stenoses is associated with a reduced 4-year survival rate when compared with unilateral Disease (47% versus 59%, P <0.001).3 Hypertension, Renal insufficiency, and multisystem atherosclerosis are common entities, and the independent occurrence of these conditions is frequent. Thus, the physician must distinguish between association and causation in the evaluation of patients with atherosclerotic Renal Artery Disease and critically appraise the potential for clinical improvement in selecting patients for Renal Artery intervention. In contrast to other regional manifestations of atherosclerosis, it is impractical to classify patients with atherosclerotic Renal Artery Disease into symptomatic or asymptomatic categories. Two of the cardinal manifestations of Renal Artery Disease, hypertension and Renal insufficiency, are frequently “silent” with regard to clinical manifestations until end-organ damage or uremia occurs. Thus, the majority of patients may be deemed asymptomatic. A more appropriate classification of patients with atherosclerotic Renal Artery Disease may be to classify them in relation to potential clinical consequences. We propose the following classification scheme in patients with Renal Artery Disease:
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Atherosclerotic Peripheral Vascular Disease Symposium II Intervention for Renal Artery Disease
Circulation, 2008Co-Authors: Krishna J. Rocha-singh, Andrew C Eisenhauer, Stephen C Textor, Christopher J Cooper, Walter A Tan, Alan H Matsumoto, Kenneth RosenfieldAbstract:The primary goal of this American Heart Association Renal intervention writing group was to discuss current controversies related to Renal interventions and to recommend important areas of clinical research and advocacy initiatives in this peripheral arterial bed. The 4 areas covered in this section include (1) management of asymptomatic Renal Artery Disease, (2) treatment of ischemic nephropathy, (3) prevention and treatment of atheroembolism in Renal Artery interventions, and (4) treatment of Renal in-stent restenosis (ISR). Atherosclerotic Renal Artery Disease is an often unrecognized contributor to refractory hypertension, Renal insufficiency, and increased risk of cardiovascular death.1,2 Renal Artery Disease is associated with increased cardiovascular events (myocardial infarction, stroke, and death), and when associated with symptomatic coronary Artery Disease, it independently doubles the risk of death.3 Additionally, the presence of bilateral Renal Artery stenoses is associated with a reduced 4-year survival rate when compared with unilateral Disease (47% versus 59%, P
Thomas M Bashore - One of the best experts on this subject based on the ideXlab platform.
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Renal Artery stenosis prevalence and associated risk factors in patients undergoing routine cardiac catheterization
Journal of The American Society of Nephrology, 1992Co-Authors: Michael B Harding, L R Smith, Stevan I Himmelstein, Kevin J Harrison, Harry R Phillips, Steven J Schwab, James B Hermiller, Charles J Davidson, Thomas M BashoreAbstract:The purposes of this study were to determine the prevalence of angiographically significant Renal Artery stenosis in a patient population referred for diagnostic cardiac catheterization and to develop a model that predicts the highest-risk subset of patients who have significant Renal Artery narrowing. A prospective validation cohort study was undertaken in a referral-based university hospital. After left ventriculography, abdominal aortography was performed to screen for the presence of Renal Artery Disease. A convenience sample of 1,302 of 1,651 consecutive patients undergoing diagnostic cardiac catheterization were enrolled in the study. Of the 1,302 abdominal aortograms performed, 1,235 (95%) were deemed of adequate quality for the evaluation of Renal Artery anatomy. Renal Artery Disease was identified in 30% of the patients. Insignificant Renal Artery stenosis was found in 187 (15%) and significant (greater than or equal to 50% diameter narrowing) stenosis was found in 188 (15%). Significant unilateral Disease was present in 11%, and bilateral Disease was present in 4%. By univariable and multivariable logistic regression analysis, the association of both clinically and catheterization-derived variables with Renal Artery Disease was assessed. Multivariable predictors included age, severity of coronary Artery Disease, congestive heart failure, female gender, and peripheral vascular Disease. Hypertension was not an associated variable. These data reveal the previously undetected high prevalence of Renal Artery Disease in patients undergoing cardiac catheterization and provide clinical and angiographic features that assist in predicting its presence.
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Renal Artery Stenosis: Prevalence and Associated Risk Factors in Patients Undergoing Routine Cardiac
1992Co-Authors: Michael B Harding, L R Smith, Stevan I Himmelstein, Kevin J Harrison, Harry R Phillips, Steven J Schwab, James B Hermiller, Charles J Davidson, Thomas M BashoreAbstract:The purposes of this study were to determine the prevalence of angiographically significant Renal ortery stenosis in a patient population referred for diagnostic cardiac catheterization and to develop a model that predicts the highest-risk subset of patients who have significant Renal Artery narrowing. A prospective validation cohort study was undertaken in a referral-based university hospital. After left ventriculography, abdominal aortography was performed to screen for the presence of Renal Artery Disease. A convenience sample of 1,302 of 1,651 consecutive patients undergoing diagnostic cardiac catheterizatlon were enrolled In the study. Of the 1,302 abdominal aortograms performed, I .235 (95%) were deemed of adequate quality for the evaluation of Renal Artery anatomy. Renal Artery Disease was identlfled In 30% of the patients. Insignificant Renal Artery stenosis was found in 187 (15%) and significant (�50% diameter narrowing) stenosis was found in I 88 (15%). Significant unilateral Disease was present in I 1%, and bilateral Disease was present in 4%. By unlvariable and multivariable logistic regression analysis, the association of both clinically and catheterlzatlon-derived variables with Renal Artery Disease was assessed. Multivariable predictors included age, severity of coronary Artery Disease, congestive heart failure, female gender, and peripheral vascular Disease. Hypertension was not an as
Stephen C Textor - One of the best experts on this subject based on the ideXlab platform.
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atherosclerotic peripheral vascular Disease symposium ii intervention for Renal Artery Disease
Circulation, 2008Co-Authors: Krishna J Rochasingh, Andrew C Eisenhauer, Stephen C Textor, Christopher J Cooper, Walter A Tan, Alan H Matsumoto, Kenneth RosenfieldAbstract:The primary goal of this American Heart Association Renal intervention writing group was to discuss current controversies related to Renal interventions and to recommend important areas of clinical research and advocacy initiatives in this peripheral arterial bed. The 4 areas covered in this section include (1) management of asymptomatic Renal Artery Disease, (2) treatment of ischemic nephropathy, (3) prevention and treatment of atheroembolism in Renal Artery interventions, and (4) treatment of Renal in-stent restenosis (ISR). Atherosclerotic Renal Artery Disease is an often unrecognized contributor to refractory hypertension, Renal insufficiency, and increased risk of cardiovascular death.1,2 Renal Artery Disease is associated with increased cardiovascular events (myocardial infarction, stroke, and death), and when associated with symptomatic coronary Artery Disease, it independently doubles the risk of death.3 Additionally, the presence of bilateral Renal Artery stenoses is associated with a reduced 4-year survival rate when compared with unilateral Disease (47% versus 59%, P <0.001).3 Hypertension, Renal insufficiency, and multisystem atherosclerosis are common entities, and the independent occurrence of these conditions is frequent. Thus, the physician must distinguish between association and causation in the evaluation of patients with atherosclerotic Renal Artery Disease and critically appraise the potential for clinical improvement in selecting patients for Renal Artery intervention. In contrast to other regional manifestations of atherosclerosis, it is impractical to classify patients with atherosclerotic Renal Artery Disease into symptomatic or asymptomatic categories. Two of the cardinal manifestations of Renal Artery Disease, hypertension and Renal insufficiency, are frequently “silent” with regard to clinical manifestations until end-organ damage or uremia occurs. Thus, the majority of patients may be deemed asymptomatic. A more appropriate classification of patients with atherosclerotic Renal Artery Disease may be to classify them in relation to potential clinical consequences. We propose the following classification scheme in patients with Renal Artery Disease:
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Atherosclerotic Peripheral Vascular Disease Symposium II Intervention for Renal Artery Disease
Circulation, 2008Co-Authors: Krishna J. Rocha-singh, Andrew C Eisenhauer, Stephen C Textor, Christopher J Cooper, Walter A Tan, Alan H Matsumoto, Kenneth RosenfieldAbstract:The primary goal of this American Heart Association Renal intervention writing group was to discuss current controversies related to Renal interventions and to recommend important areas of clinical research and advocacy initiatives in this peripheral arterial bed. The 4 areas covered in this section include (1) management of asymptomatic Renal Artery Disease, (2) treatment of ischemic nephropathy, (3) prevention and treatment of atheroembolism in Renal Artery interventions, and (4) treatment of Renal in-stent restenosis (ISR). Atherosclerotic Renal Artery Disease is an often unrecognized contributor to refractory hypertension, Renal insufficiency, and increased risk of cardiovascular death.1,2 Renal Artery Disease is associated with increased cardiovascular events (myocardial infarction, stroke, and death), and when associated with symptomatic coronary Artery Disease, it independently doubles the risk of death.3 Additionally, the presence of bilateral Renal Artery stenoses is associated with a reduced 4-year survival rate when compared with unilateral Disease (47% versus 59%, P
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Managing Renal arterial Disease and hypertension.
Current Opinion in Cardiology, 2003Co-Authors: Stephen C TextorAbstract:Treating patients with renovascular Disease is complex, particularly as imaging and medical techniques become more effective. Atherosclerotic Renal Artery Disease is present in 7% of the general population above age 65 and in 20 to 45% of patients with coronary Disease or aortoiliac Disease. Most patients are treated medically, but when progressive hypertension, Renal insufficiency, or circulatory congestion develops, revascularization should be considered. Endovascular procedures with arterial stents are now widely employed. These procedures sometimes offer major benefits in blood pressure control and stabilization of Renal function. Stent procedures continue to entail hazards, including atheroemboli, arterial dissections, and thrombosis, in addition to restenosis rates of 14 to 20%. Small, randomized trials to date demonstrate no survival benefit to either endovascular or surgical revascularization as compared with medical management. Recognizing Renal Artery Disease and directing revascularization procedures to those with the most benefit remains a premier challenge for the clinician.
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Revascularization in atherosclerotic Renal Artery Disease
Kidney International, 1998Co-Authors: Stephen C TextorAbstract:A 69-year-old white male attorney was referred three years ago because of progressive hypertension and declining Renal function. He had smoked two packs of cigarettes daily for the past 55 years. Modest hypertension had been successfully treated with a thiazide diuretic for several years. At age 51, an 8 cm abdominal aortic aneurysm was resected. His blood pressure had risen 4 years ago to levels between 170/108 mm Hg and 205/110 mm Hg despite increased medications: pindolol, 5 mg twice daily; prazosin, 5 mg twice daily; and indapamide, 2.5 mg daily. His serum creatinine rose from 0.9 mg/dl at age 52 to 2.0 mg/dl at age 66. He was aware of several episodes of confusion, which had been attributed to lacunar strokes, but he remained able to work and function normally. He had no history of myocardial infarction or angina; an electrocardiogram disclosed left-ventricular hypertrophy. Hyperlipidemia had been treated with lovastatin, cholestyramine, and niacin. His medical history included resection of cancer of the penis and recently detected adenocarcinoma of the prostate, for which radiation therapy had been planned. Physical examination revealed an alert and functional man. His blood pressure was 205/108 mm Hg; and the pulse was 75 beats/min. The weight was 195 lbs, the height, 69 inches. Ophthalmic examination demonstrated grade II retinopathy. No carotid bruits were heard. Cardiac examination revealed a fourth heart sound. An abdominal scar was present, a result of the abdominal aneurysm surgery. Epigastric and abdominal bruits were detected in every quadrant. Pulses in the lower extremities were diminished. Pitting edema was present at the ankles. Laboratory data disclosed: hematocrit, 42.8; hemoglobin, 14.9 g/dl; serum creatinine, 2.0 mg/dl; sodium, 140 mEq/liter; potassium, 3.8 mEq/ liter; uric acid, 8.4 mg/dl; albumin, 4.2 g/dl; calcium, 9.3 g/dl; PO4, 3.1 mg/dl; and glucose, 122 mg/dl. Total cholesterol was 180 mg/dl; triglycerides, 122 mg/dl; HDL, 38 mg/dl. Urinalysis disclosed 11 proteinuria. A chest radiograph demonstrated an elevated right hemidiaphram, scattered fibrosis, and a tortuous aorta. An electrocardiogram showed left-ventricular hypertrophy with strain pattern and was unchanged from previous tracings. A Renal angiogram demonstrated single Renal arteries bilaterally with high-grade stenoses at their origins (Fig. 1). Severe atheromatous changes were present in the abdominal aorta, as were postoperative changes of a straight graft repair of the infraRenal abdominal aorta. Bilateral common iliac Artery aneurysms were found. High-grade stenosis was present at the origin of the celiac Artery. Renal-vein renin values were as follows: right, 13.2 ng AI/ml/hr; left, 10.0 ng/AI/ml/hr; and inferior vena cava, 6.7 ng AI/ml/hr. Over the three years since he was originally seen, the antihypertensive regimen has comprised indapamide, 2.5 mg daily; pindolol, 5 mg twice daily; and hydralazine, 25 mg, and prazosin, 5 mg each three times daily. He continued to take cholestyramine; lovastatin, 40 mg qd; niacin, 1000 mg; glyburide, 1.25 mg daily, was added a year or so ago. Home blood pressure readings ranged between 140/75 mm Hg and 155/80 mm Hg. Ambulatory blood pressure readings indicated average values of 149/83 mm Hg. Serum creatinine was 2.2 mg/dl; creatinine clearance, 38 ml/min. Amaurosis fugax developed at age 69, which carotid endarterectomy corrected without complications. He continued to smoke. He completed radiation therapy for carcinoma of the prostate, for which he now has no evidence of Disease. A magnetic resonance angiogram (MRA) with gadolinium contrast medium was performed to determine progression (or not) of the vascular lesions (Fig. 2). Aneurysmal dilation above the previous graft remained visible, but no progression in the Renal Artery lesions per se could be seen.
Harry R Phillips - One of the best experts on this subject based on the ideXlab platform.
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progression of Renal Artery stenosis in patients undergoing cardiac catheterization
American Heart Journal, 1998Co-Authors: James J Crowley, Harry R Phillips, Steven J Schwab, Renato M Santos, Robert H Peter, Joseph A Puma, Richard S Stack, Peter J ConlonAbstract:Abstract Background Renal Artery stenosis is potentially correctable by either revascularization surgery or percutaneous methods. However, appropriate use of these techniques has been hampered by a lack of data on the natural history of this Disease. This study assesses the prevalence, risk factors for progression, and effect on Renal function of angiographically demonstrated Renal Artery Disease in patients undergoing cardiac catheterization. Methods The severity of Renal Artery stenosis was quantified in all patients who underwent abdominal aortography as part of a diagnostic cardiac catheterization study at Duke University Medical Center between January 1989 and February 1996. Results There were 14,152 patients in the study (mean age 61 ± 12 years, 62% male). Normal Renal arteries were identified in 12,543 (88.7%) patients, insignificant Disease ( P = .01). Conclusions Renal Artery Disease is frequently progressive in patients who undergo cardiac catheterization for investigation of coronary Artery Disease. Significant stenotic Disease may develop over a short period despite evidence of normal Renal arteries at prior catheterization. (Am Heart J 1998;136:913-8.)
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Renal Artery stenosis prevalence and associated risk factors in patients undergoing routine cardiac catheterization
Journal of The American Society of Nephrology, 1992Co-Authors: Michael B Harding, L R Smith, Stevan I Himmelstein, Kevin J Harrison, Harry R Phillips, Steven J Schwab, James B Hermiller, Charles J Davidson, Thomas M BashoreAbstract:The purposes of this study were to determine the prevalence of angiographically significant Renal Artery stenosis in a patient population referred for diagnostic cardiac catheterization and to develop a model that predicts the highest-risk subset of patients who have significant Renal Artery narrowing. A prospective validation cohort study was undertaken in a referral-based university hospital. After left ventriculography, abdominal aortography was performed to screen for the presence of Renal Artery Disease. A convenience sample of 1,302 of 1,651 consecutive patients undergoing diagnostic cardiac catheterization were enrolled in the study. Of the 1,302 abdominal aortograms performed, 1,235 (95%) were deemed of adequate quality for the evaluation of Renal Artery anatomy. Renal Artery Disease was identified in 30% of the patients. Insignificant Renal Artery stenosis was found in 187 (15%) and significant (greater than or equal to 50% diameter narrowing) stenosis was found in 188 (15%). Significant unilateral Disease was present in 11%, and bilateral Disease was present in 4%. By univariable and multivariable logistic regression analysis, the association of both clinically and catheterization-derived variables with Renal Artery Disease was assessed. Multivariable predictors included age, severity of coronary Artery Disease, congestive heart failure, female gender, and peripheral vascular Disease. Hypertension was not an associated variable. These data reveal the previously undetected high prevalence of Renal Artery Disease in patients undergoing cardiac catheterization and provide clinical and angiographic features that assist in predicting its presence.
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Renal Artery Stenosis: Prevalence and Associated Risk Factors in Patients Undergoing Routine Cardiac
1992Co-Authors: Michael B Harding, L R Smith, Stevan I Himmelstein, Kevin J Harrison, Harry R Phillips, Steven J Schwab, James B Hermiller, Charles J Davidson, Thomas M BashoreAbstract:The purposes of this study were to determine the prevalence of angiographically significant Renal ortery stenosis in a patient population referred for diagnostic cardiac catheterization and to develop a model that predicts the highest-risk subset of patients who have significant Renal Artery narrowing. A prospective validation cohort study was undertaken in a referral-based university hospital. After left ventriculography, abdominal aortography was performed to screen for the presence of Renal Artery Disease. A convenience sample of 1,302 of 1,651 consecutive patients undergoing diagnostic cardiac catheterizatlon were enrolled In the study. Of the 1,302 abdominal aortograms performed, I .235 (95%) were deemed of adequate quality for the evaluation of Renal Artery anatomy. Renal Artery Disease was identlfled In 30% of the patients. Insignificant Renal Artery stenosis was found in 187 (15%) and significant (�50% diameter narrowing) stenosis was found in I 88 (15%). Significant unilateral Disease was present in I 1%, and bilateral Disease was present in 4%. By unlvariable and multivariable logistic regression analysis, the association of both clinically and catheterlzatlon-derived variables with Renal Artery Disease was assessed. Multivariable predictors included age, severity of coronary Artery Disease, congestive heart failure, female gender, and peripheral vascular Disease. Hypertension was not an as