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International Angiology 2003 December;22(4):333-9


language: English

A clinical approach to the management of a patient with suspected renovascular disease who presents with leg ischemia

Plouin P. F. 1, Clement D. L. 2, Boccalon H. 3, Dormandy J. 4, Durand-Zaleski I. 5, Fowkes G. 6, Norgren L. 7, Brown T. 8

1 Hypertension Unit, Georges Pompidou European Hospital, Paris, France 2 University Hospital, Department of Cardiovascular Diseases, Gent, Belgium 3 CHU Rangueil, Unit of Angiology, Toulouse, France 4 Department of Vascular Surgery, St George’s Hospital, London, UK 5 Henri Mondor Hospital, Creteil, France 6 Wolfson Unit for Prevention of Peripheral Vascular Diseases, University of Edinburgh, Edinburgh, UK 7 Lund University Hospital, Lund, Sweden 8 Merck Lipha S.A., Lyon, France


Ath­e­ros­cle­rot­ic renal ­artery sten­o­sis (ARAS) may cause hyper­ten­sion, pro­gres­sive renal fail­ure, and recur­rent pul­mo­nary edema. It typ­i­cal­ly ­occurs in high risk ­patients with coex­is­tent vas­cu­lar dis­ease else­where. Most ­patients with ARAS are like­ly to die from cor­o­nary heart dis­ease or ­stroke ­before end-stage renal fail­ure ­occurs. ­Recent con­trolled ­trials have shown that most ­patients under­go­ing angio­plas­ty to treat ren­o­vas­cu­lar hyper­ten­sion still need anti­hy­per­ten­sive ­agents 6 or 12 ­months after the pro­ce­dure. Nev­er­the­less, the num­ber of anti­hy­per­ten­sive ­agents ­required to con­trol blood pres­sure ade­quate­ly is lower fol­low­ing angio­plas­ty than for med­i­ca­tion alone. ­Trials assess­ing the value of revas­cu­lar­iza­tion for pre­serv­ing renal func­tion or pre­vent­ing clin­i­cal ­events are only in the early recruit­ment phase. Revas­cu­lar­iza­tion ­should be under­tak­en in ­patients with ARAS and resist­ant hyper­ten­sion or heart fail­ure, and prob­ably in those with rap­id­ly dete­ri­orat­ing renal func­tion or with an ­increase in plas­ma crea­ti­nine lev­els dur­ing angio­ten­sin-con­vert­ing ­enzyme inhi­bi­tion. With or with­out revas­cu­lar­iza­tion, med­i­cal ther­a­py using anti­hy­per­ten­sive, hypo­lip­i­dem­ic and anti­plate­let ­agents is nec­es­sary in ­almost all cases.

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