RESUMEN
PURPOSE: To investigate whether a contrast agent containing gadodiamide can reduce the incidence of contrast-induced nephropathy associated with renal artery stenting in patients with preexisting renal insufficiency. METHODS: Between 1999 and 2002, gadodiamide-based arteriography was used in 20 patients (12 men; mean age 69 years) with significant baseline renal insufficiency (creatinine > or =1.7 mg/dL) undergoing renal artery stenting for > or =70% stenoses in 25 renal arteries. Baseline creatinine levels were compared to postprocedure and midterm follow-up levels. RESULTS: Procedural success was 100%. An average of 74 mL of gadodiamide contrast was used per case. Four patients received an additional 30 mL (mean) of iodinated contrast due to poor image quality with gadodiamide alone. There was no significant change in mean creatinine levels at discharge (2.9 mg/dL) compared to baseline (3.0 mg/dL, p=0.72). At midterm follow-up, mean creatinine levels (2.4 mg/dL) were significantly lower compared to baseline (p=0.004). CONCLUSIONS: Gadodiamide-based arteriography can be effectively used during RAS in patients with baseline renal insufficiency. This technique may enhance the renal-protective effect of renal artery stenting in this high-risk population with renal artery stenosis.
Asunto(s)
Implantación de Prótesis Vascular , Medios de Contraste , Gadolinio DTPA , Obstrucción de la Arteria Renal/cirugía , Arteria Renal/diagnóstico por imagen , Insuficiencia Renal/cirugía , Anciano , Angiografía/métodos , Angioplastia , Femenino , Humanos , Masculino , Arteria Renal/cirugía , Obstrucción de la Arteria Renal/complicaciones , Obstrucción de la Arteria Renal/diagnóstico por imagen , Insuficiencia Renal/complicaciones , Insuficiencia Renal/diagnóstico por imagen , Estudios Retrospectivos , StentsRESUMEN
Radial access and closure devices are associated with improved quality of life (QOL) after cardiac catheterization. Whether this is related to the access site or time to ambulation is unknown. Seventy-five patients undergoing cardiac catheterization were randomized to femoral 6 Fr with AngioSeal closure (F+C), femoral 4 Fr without closure, and radial (R) access. All patients were ambulated at 1 hr. QOL was measured utilizing visual analogue scales and Short Form-36 at baseline, 1 day, and 1 week. Time to ambulation and discharge were equivalent, as was postprocedure QOL. However, angiographic quality was lower in the 4 Fr group (P < 0.0001) and catheterization costs were higher in the F+C group (P < 0.0001). Ambulation 1 hr after catheterization can be accomplished utilizing radial, femoral 6 Fr with closure device, or femoral 4 Fr access with equivalent outcomes and QOL. However, this is achieved at a higher cost with a closure device, or lesser angiographic quality with 4 Fr catheters.
Asunto(s)
Cateterismo Cardíaco , Ambulación Precoz , Arteria Femoral/fisiopatología , Arteria Femoral/cirugía , Arteria Radial/fisiopatología , Arteria Radial/cirugía , Anciano , Angioplastia Coronaria con Balón , Cateterismo Cardíaco/economía , Cateterismo Cardíaco/instrumentación , Angiografía Coronaria , Enfermedad Coronaria/diagnóstico por imagen , Enfermedad Coronaria/terapia , Ambulación Precoz/economía , Diseño de Equipo/economía , Femenino , Arteria Femoral/diagnóstico por imagen , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico por imagen , Infarto del Miocardio/terapia , Enfermedades Vasculares Periféricas/diagnóstico por imagen , Enfermedades Vasculares Periféricas/fisiopatología , Enfermedades Vasculares Periféricas/cirugía , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Calidad de Vida , Arteria Radial/diagnóstico por imagen , Perfil de Impacto de Enfermedad , Resultado del TratamientoRESUMEN
Hypertension is an important clinical endpoint after renal artery revascularization for renal artery stenosis (RAS). Medication compliance is a critical determinant of blood pressure control. Although factors influencing compliance are known in essential hypertension, they have not been evaluated in studies investigating renal artery revascularization. The aim of this study was to assess the determinants of compliance to antihypertensive therapy in patients with RAS following renal artery stent placement (RASP). A cross-sectional study evaluating blood pressure, antihypertensive medications, quality of life, compliance, and determinants of compliance to antihypertensive therapy was undertaken in 112 patients undergoing RASP. Additionally, cardiovascular risk factors, antihypertensive medications, and cardiovascular history were reported. Self-reported compliance was 79% +/- 24% (scale of 0% [none] to 100% [complete] compliance) in patients after RASP. Determinants of compliance by multivariate analysis included physical symptoms, which correlated negatively to compliance and included loss of appetite (r2 = 0.26, P < 0.0001), dizziness (r2 = 0.06, P < 0.01), and cough (r2 = 0.03, P < 0.05). Systolic blood pressure correlated positively with compliance (r2 = 0.03, P < 0.05). The number or class of antihypertensive medications did not influence compliance. Patients' physical symptoms and level of systolic blood pressure, rather than the number or class of medications, influence compliance in patients with continued hypertension after RASP. Attention to physical symptoms may help to improve blood pressure control in this population.