1/47. Reversible renal impairment induced by treatment with the angiotensin ii receptor antagonist candesartan in a patient with bilateral renal artery stenosis.BACKGROUND: It is well established that ACE-inhibitors should be avoided in patients with renal artery stenosis. In recent years it has also been recommended that caution should be demonstrated when angiotensin ii blockers are used in the same type of patients but the evidence is based only on few cases. RESULTS: We describe a case where use of the angiotensin ii antagonist candesartan (Atacand) induced renal failure in a patient with bilateral renal artery stenosis. The course of the case is enlighted by results from sequential renography, selective renal vein catheterisation for measurement of renin, and angiographic findings. CONCLUSIONS: In patients with renal artery stenosis the angiotensin ii antagonist candesartan should be avoided.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
2/47. renal artery dissection: a complication of catheter arteriography.renal artery dissection is a rare complication of catheter arteriography. Predisposing factors include atherosclerosis and fibromuscular dysplasia. Optimum management requires aortographic documentation of the extent of vascular obstruction. Dissections causing incomplete obstruction of blood flow can be treated with systemic anticoagulation to prevent downstream thrombosis and should be followed with serial isotope blood flow studies and LDH measurements. dissection causing complete vascular obstruction usually requires immediate surgery, although spontaneous reestablishment of flow may occur. The 3 patients discussed illustrate a spectrum of findings, including the acute development of renovascular hypertension.- - - - - - - - - - ranking = 5keywords = catheter (Clic here for more details about this article) |
3/47. Acute renal artery thrombosis treated by percutaneous rheolytic thrombectomy.renal artery thrombosis or embolus is a rare condition that may lead to hypertension and renal failure. Treatment options in the past have had limited success. We present a case which demonstrates the use of percutaneous rheolytic therapy with the Angiojet atherectomy catheter to treat this condition in the acute setting.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
4/47. Late aortic dislocation of a stent following stent angioplasty for ostial renal artery stenosis.A patient with left RAS was treated by stent angioplasty followed by a multivessel percutaneous coronary intervention. Six months later, an aortic dislocation of the stent was diagnosed. The fully expanded stent was caught with a balloon catheter and fixed in the left external iliac artery. Stent migration after initially successful stent angioplasty for RAS is possible. Fully expanded, dislocated balloon-expandable stents can be secured by implanting them into the iliac artery.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
5/47. Successful management of a resistant renal artery stenosis in a child using a 4 mm cutting balloon catheter.Percutaneous transluminal renal angioplasty (PTRA) is a well-established method to treat renal artery stenosis (RAS) in children and adults. However, a significant number of stenoses might not be treated by interventional techniques due to the inability to dilate the RAS. Conventional balloon angioplasty with a high-pressure coronary angioplasty balloon at 20 atm was unable to dilate a significant RAS in a 12-year-old child with severe renovascular hypertension (RR 195/125 mm Hg). After using a 4 mm cutting balloon, we achieved wide patency of the renal artery and an instant normalization of blood pressure without further need of antihypertensive therapy. PTRA using the cutting balloon technique may offer an additional therapeutic option for selected patients in whom conventional balloon angioplasty was not able to dilate RAS.- - - - - - - - - - ranking = 4keywords = catheter (Clic here for more details about this article) |
6/47. The VB-1 catheter: a novel catheter for peripheral arterial revascularization.Despite recent advances in catheter-based technologies for peripheral arterial revascularization, adequate guide catheter positioning and support remains a leading procedural challenge. This report describes the adaptation of the Behar Internal Mammary VB-1 catheter for peripheral revascularization procedures in patients with complex anatomy not amendable to other conventional peripheral guide catheters.- - - - - - - - - - ranking = 12keywords = catheter (Clic here for more details about this article) |
7/47. Successful percutaneous balloon catheter treatment of renal artery occlusion and anuria.Progressive renal failure may be due to renal artery stenosis and occlusion. Gradual occlusion of the renal arteries may allow the development of collateral arterial supply sufficient to avoid dialysis. Even when dialysis is required, significant viable renal parenchyma may still be present to allow escape from dialysis following revascularization of one or both kidneys. The chance of success in such cases is thought to be better if the patient still produces a significant amount of urine. We report here a patient who was completely anuric for five days and in whom excellent renal function returned after balloon angioplasty of one of two occluded renal arteries.- - - - - - - - - - ranking = 4keywords = catheter (Clic here for more details about this article) |
8/47. Thrombus aspiration as a bailout procedure during percutaneous renal angioplasty.PURPOSE: To present a case in which thrombus aspiration, urokinase, and abciximab were used to recanalize a sudden acute thrombotic occlusion of the right renal artery during percutaneous renal angioplasty. CASE REPORT: A 72-year-old man with severe arterial hypertension, impaired renal function, and peripheral artery disease was referred for interventional renal revascularization of a proximal stenosis of the right renal artery. Predilation was unsuccessful, and stent placement was followed by immediate occlusion of the distal renal artery, probably due to dislocation of a mural thrombus. Since intra-arterial administration of urokinase (300,000 IU) was ineffective, thrombus aspiration was performed using the 7-F guiding catheter. After successful removal of the thrombus, abciximab was given intravenously. Control angiograms showed recanalization of the stented segment and patency of the distal renal arteries, an outcome confirmed 8 months later by duplex ultrasound. CONCLUSIONS: As demonstrated in our case, thromboembolic complications can be rapidly and successfully treated on the table by combined measures, such as catheter thrombus extraction and pharmacological strategies.- - - - - - - - - - ranking = 2keywords = catheter (Clic here for more details about this article) |
9/47. heparin-induced thrombocytopenia with acute aortic and renal thrombosis in a patient treated with low-molecular-weight heparin.heparin-induced thrombocytopenia is a rare but serious complication of heparin therapy. Most of cases are related to unfractionated heparin, but a few are due to low molecular weight heparin sometimes associated with unfractionated heparin. A patient with pulmonary contusions after chest injury developed a catheter related subclavian vein thrombosis on day 16. He was treated by increasing doses of low molecular weight heparin. Aortic and renal thromboses occurred on day 21. Surgical thrombectomy, performed after starting alternative anticoagulation treatment led to complete arterial recovery. In case of suspicion of heparin-induced thrombocytopenia, with unfractionated or low-molecular-weight heparin, heparin treatment must be discontinued before the results of biological tests become available. Arterial and/or venous thrombosis is a serious complication of heparin-induced thrombocytopenia. The treatment has two aims: first, to restore arterial patency by clot removal by thrombectomy, bypass or thrombolysis, and second, to avoid new thrombosis formation by substitutive anticoagulation treatment: danaparoid may have cross-reaction with heparin, or lepirudin has anaphylactic risks and needs biological follow-up. heparin-induced thrombocytopenia and thrombosis can be complicated by death or disabilities such as amputations, stroke, renal or bowel infarction. Once HIT has been diagnosed heparin should never be given again, but if cardiopulmonary bypass is required, it might be reintroduced during operation only if serum antibodies have disappeared.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
10/47. Percutaneous transluminal angioplasty for renovascular hypertension in a neonate.AIM: To report on the first case of successful percutaneous transluminal renal artery angioplasty in a neonate. methods: Case report: a 5-d-old neonate was admitted with cardiorespiratory failure. Monitoring of blood pressure revealed severe arterial hypertension. Doppler sonography detected stenotic flow in the right renal artery. A (99m)Tc-MAG3 scan revealed highly diminished elimination by the right kidney. Selective renin levels were 23,968 ng/l in the right and 3770 ng/l in the left renal vein and the aorta. Percutaneous transluminal angioplasty using a 2 x 10 mm balloon catheter was performed on the 8th day of life. RESULTS: The patient was discharged from hospital normotensive without anti-hypertensive medication. During 8 mo follow-up the blood pressure remained normal, Doppler sonography revealed no recurrent artery stenosis, and renal function improved. CONCLUSION: Neonatal percutaneous transluminal angioplasty for renal artery stenosis may be feasible in selected patients.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
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