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Atherosclerotic renovascular disease.
Sheldon W Tobe1, Ellen Burgess, Marcel Lebel
1Sunnybrook and Women's College Health Science Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada. sheldon.tobe@sunnybrook.ca
The Canadian Journal of Cardiology
|June 7, 2006
Summary
Atherosclerotic renovascular disease, linked to hypertension and diabetes, involves renal artery stenosis and ischemia. Patient outcomes depend more on kidney damage than stenosis degree, with revascularization not yet outperforming medical treatment.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Vascular Surgery
Background:
- Atherosclerotic renovascular disease (ARVD) combines renal artery stenosis and ischemia.
- Hypertension rises with stenosis >60%, impacting glomerular filtration rate.
- Risk factors include hypertension, diabetes, smoking, and dyslipidemia.
Purpose of the Study:
- To review current understanding and management of ARVD.
- To evaluate diagnostic methods and treatment outcomes.
- To discuss future directions in ARVD screening and treatment.
Main Methods:
- Review of existing literature on ARVD diagnosis and treatment.
- Analysis of diagnostic modalities: MRA, CTA, captopril renal scan, Doppler ultrasonography.
- Evaluation of revascularization versus medical management outcomes.
Main Results:
- No ideal screening test exists; Doppler ultrasonography with renal resistance index shows promise.
- Renal parenchymal disease, not stenosis degree, best predicts patient outcomes.
- Renal revascularization has not shown improved renal survival over medical treatment alone.
Conclusions:
- ARVD management is guided by blood pressure and renal function, potentially incorporating renal resistance index in the future.
- Revascularization considered for uncontrollable hypertension or deteriorating renal function.
- Medical management includes antihypertensives and lipid-lowering therapy.