1/38. Successful Wallstent implantation for extensive iatrogenic renal artery dissection in a patient with fibromuscular dysplasia.PURPOSE: To describe a case of renal artery stenosis with fibromuscular dysplasia (FMD) and extensive iatrogenic dissection treated with Wallstent implantation. methods AND RESULTS: An 83-year-old woman with a history of coronary artery disease and hypertension presented at another facility with exertional angina and poorly controlled hypertension. Renal arteriography uncovered a critical right renal artery stenosis with severe FMD. However, angioplasty resulted in extensive dissection of the renal artery, for which the patient was referred to our institution. The renal artery was recanalized via the left brachial approach with restoration of flow using a Wallstent and a Palmaz stent. The patient's blood pressure was controllable after this procedure, and follow-up duplex imaging with flow velocities at 6 months showed patent right renal artery stents. CONCLUSIONS: Owing to its length and flexibility, the Wallstent endoprosthesis was a useful treatment modality in this case of extensive renal artery dissection.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/38. fibromuscular dysplasia of the external iliac artery.A 47-year-old female with fibromuscular dysplasia of both external iliac arteries was treated by percutaneous balloon catheter angioplasty. The immediate result was unsatisfactory. On discharge from hospital, the patient was only able to walk one kilometer, and had reduced ankle:arm blood pressure indices. Conservative treatment with anticoagulants for three months, followed by ticlopidine, and exercise for six months led to complete recovery.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/38. The hyponatraemic hypertensive syndrome in a 2-year-old child with behavioural symptoms.In this case report we present a 2-year-old girl with the classical signs of the hyponatraemic hypertensive syndrome. She initially presented with a history of behavioural abnormalities and hyponatraemia (126 mmol/l) and her blood pressure was as high as 220/160 mmHg. After admission, somnolence developed. Intravenous anti-hypertensive therapy was started immediately. The hyponatraemia was treated with i.v. sodium supplementation. The cause of this syndrome proved to be fibromuscular dysplasia of the left renal artery. Finally, a left nephrectomy was performed. With this therapy, blood pressure and serum sodium normalised and the girl promptly regained normal consciousness and behaviour. CONCLUSION: Behavioural abnormalities in the history of a child without any other neurological symptoms might be one of the first signs of hypertensive encephalopathy. In combination with hyponatraemia, these symptoms should alert the physician to consider the hyponatraemic hypertensive syndrome.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
4/38. Successful treatment of intimal hyperplasia in renal arteries by endovascular brachytherapy.PURPOSE: The present study shows the possibility of preventing restenosis of renal arteries by endovascular brachytherapy. methods AND MATERIALS: We present a patient suffering from rapid restenosis of both renal arteries with decreasing renal function. Percutaneous transluminal angioplasty (PTA) and stent implantation were unable to stop hypertension and to stabilize renal function. Both renal arteries and the right pole artery were treated by endovascular brachytherapy in one session. RESULTS: Six months after intervention, intraarterial digital subtraction angiography (DSA) showed no evidence of recurrence, and the blood pressure remained normal without medical treatment. CONCLUSION: Endovascular brachytherapy can help to prevent restenosis in renal arteries. It is possible to treat both renal arteries and one pole artery in one session without any disadvantage.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/38. Common iliac artery aneurysm due to fibromuscular dysplasia in infants.A seven-month old female with a huge aneurysm of the right common iliac artery and multiple stenoses of her bilateral renal arteries is described. At surgery, a Gore-Tex graft was interposed between the proximal common iliac artery and the external iliac artery. A histological examination of the aneurysmal wall was compatible with medial fibromuscular dysplasia (FMD). After surgery, her blood pressure was controlled in the normal range on medical treatment. This case would be the first case of a huge common iliac artery aneurysm due to FMD in infants.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/38. A large unilateral renal artery aneurysm in a young child.The case of a 13-month-old boy with fibromuscular dysplasia (FMD) presenting with a large saccular aneurysm of the left renal artery and renovascular hypertension is reported. Renal and intrarenal arteries showed numerous small aneurysms alternating with stenoses. All arterial lesions were localized to the left kidney. After left nephrectomy, the patient's blood pressure normalized. Histopathologic examination of the arteries disclosed changes typical of medial fibroplasias, the most frequently described form of FMD in children. This diagnosis is rewarding as it represents a surgically curable cause of severe hypertension.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/38. A young man with a renal colic.We report the case of a 35-year-old man with no cardiovascular morbidity, presenting with acute flank pain, microscopic haematuria and normal blood pressure. Initially diagnosed as a ureteral colic, the patient was recovered 6 weeks later with severe hypertensive crisis. Further investigations revealed a massive renal infarction secondary to medial fibromuscular dysplasia (FMD). Several aspects of this presentation are intriguing. Renal infarcts are usually seen in older patients having cardiac problems and/or major atheromatous plaques. In addition, FMD is mainly observed in young females and rarely progresses to renal artery occlusion. Furthermore, in this case, FMD remained silent until the acute renal infarction occurred, despite a significant kidney size reduction at the time of diagnosis. Finally, the observation of a delayed hypertensive response to a major renovascular insult provides incentives to discuss possible pathophysiological mechanisms involved in renovascular hypertension.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
8/38. Primary intimal fibroplasia in a child with Down's syndrome.A 14-year-old girl known to have trisomy 21 and who came to us with weight loss followed by hypertension proved to have diffuse arterial dysplasia involving the intimal layer (primary intimal fibroplasia). This is a rare cause of elevated blood pressure in children and has not been previously reported in a child with Down's syndrome. Unusual features of this case also include the widespread distribution of the lesions limited to the large muscular distributing arteries, the rapidly progressive course, and the predominance of abdominal signs and symptoms.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
9/38. renal artery stenosis due to fibromuscular dysplasia in an 18-week pregnant woman.BACKGROUND: hypertension is a frequent medical complication of pregnancy. Renovascular hypertension is present in 5-10% of cases of severe hypertension during pregnancy. CASE: In this report we describe a 36-year-old woman with severe hypertension caused by bilateral renal artery stenosis due to fibromuscular dysplasia. Guided by the patient's ultrasound findings, only 1 side was treated with angioplasty. Continued labile blood pressure resulted in arteriography of the contralateral renal artery, which confirmed renal artery stenosis was present on the other side. CONCLUSION: Clinicians should maintain a high index of suspicion for renovascular hypertension in pregnancy when drug resistance is present. Because the potential for false-negative results with noninvasive testing for renal artery stenosis is present, if clinical suspicion is high, one should consider using invasive testing.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
10/38. Congenital solitary kidney with renovascular hypertension diagnosed by means of captopril-enhanced renography and magnetic resonance angiography.A 24 year-old woman had a congenital solitary kidney with renovascular hypertension due to fibromuscular dysplasia. She had been treated as having essential hypertension until she developed preeclampsia and HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome at 28 weeks of gestation. plasma renin activity and captopril test results did not indicate any abnormalities. However, renography revealed captopril-induced deterioration. magnetic resonance angiography was also useful to detect renal artery stenosis. These findings were confirmed by renal angiography. After successful percutaneous transluminal renal angioplasty, her blood pressure and the pattern of captopril renography normalized.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
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