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Endovascular Versus Medical Management of Atherosclerotic Renovascular Disease: Update and Emerging Concepts.
Pappaccogli, Marco; Robberechts, Tom; Lengelé, Jean-Philippe; Van der Niepen, Patricia; Sarafidis, Pantelis; Rabbia, Franco; Persu, Alexandre.
Afiliación
  • Pappaccogli M; Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Turin, Italy (M.P., F.R.).
  • Robberechts T; Department of Nephrology and Hypertension, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium (T.R., P.V.d.N.).
  • Lengelé JP; Division of Cardiology, Cliniques Universitaires Saint-Luc (J.-P.L., A.P.), Université Catholique de Louvain, Brussels, Belgium.
  • Van der Niepen P; Department of Nephrology, Grand Hôpital De Charleroi, Belgium (J.-P.L.).
  • Sarafidis P; Department of Nephrology and Hypertension, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium (T.R., P.V.d.N.).
  • Rabbia F; Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Greece (P.S.).
  • Persu A; Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Turin, Italy (M.P., F.R.).
Hypertension ; 80(6): 1150-1161, 2023 06.
Article en En | MEDLINE | ID: mdl-36919595
Atherosclerotic renovascular disease is the most frequent cause of renovascular hypertension and its prevalence increases with age and in specific subset of patients, such as those with end-stage chronic kidney disease, heart failure, and coronary artery disease. Besides hypertension, atherosclerotic renovascular disease is responsible for several clinical manifestations, including life-threatening conditions, such as recurrent flash pulmonary edema, rapidly progressive chronic kidney disease, or acute kidney injury. Atherosclerotic renovascular disease is usually part of a more diffuse atherosclerotic process and requires a combination therapy including antihypertensive, antiplatelet and lipid-lowering agents, as well as optimization of antidiabetic treatment, if needed. Besides medical therapy, percutaneous renal angioplasty was supposed to be the most effective therapy for atherosclerotic renovascular disease, by leading to blood flow restoration. However, despite an apparently solid rationale, several randomized clinical trials failed to confirm the favorable effects of percutaneous renal angioplasty on blood pressure control, kidney function, cardiovascular and renal outcomes, previously reported in observational, retrospective and single-center cohorts, switching off the enthusiasm for this procedure. Several studies' limitations may partly account for this failure, including heterogeneity of diagnostic techniques, overestimation of the degree of renal artery stenosis, inappropriate timing of revascularization, multiple protocol revisions, frequent crossovers, and most importantly exclusion of patients at higher likelihood to respond to angioplasty. The purpose of this review is to summarize studies' potential weaknesses and provide guidance to the clinician for identification of patients who may benefit most from revascularization.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Obstrucción de la Arteria Renal / Aterosclerosis / Hipertensión Renovascular / Fallo Renal Crónico Tipo de estudio: Clinical_trials / Diagnostic_studies / Etiology_studies / Guideline / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: Hypertension Año: 2023 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Obstrucción de la Arteria Renal / Aterosclerosis / Hipertensión Renovascular / Fallo Renal Crónico Tipo de estudio: Clinical_trials / Diagnostic_studies / Etiology_studies / Guideline / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: Hypertension Año: 2023 Tipo del documento: Article Pais de publicación: Estados Unidos