Role of drug-eluting stent on Takayasu arteritis with renal artery stenosis (original) (raw)
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Journal of Indian College of Cardiology, 2017
Renovascular hypertension contributes 5-25% of the causes of hypertension in paediatric population and Takayasu's aortoarteritis is one of the common aetiology in the Asian countries. Renal artery stenosis is amenable for revascularization and can lead to cure of hypertension in this age group. The only limitation in patients of Takayasu's aortoarteritis is the higher restenosis rate, which leads to rebound hypertension and repeat revascularization. The use of drug eluting stents has been well documented to reduce restenosis rate in coronary interventions. Hence, drug eluting stents were used for renal intervention in a relatively grown up paediatric age to reduce restenosis in the subset of Takayasu's aortoarteritis.
Renal revascularization in Takayasu arteritis–induced renal artery stenosis
Journal of Vascular Surgery, 2004
This study was undertaken to define the long-term effects of renal revascularization on blood pressure, and renal and cardiac function in patients with Takayasu arteritis-induced renal artery stenosis (TARAS). Methods: Twenty-seven patients (25 women; mean age, 27 years) with TARAS underwent intervention. Primary, primary assisted, and secondary patency rates were determined, and the late effects on blood pressure, renal and cardiac function, and survival were analyzed. Results: All patients had hypertension (mean blood pressure, 167/99 mm Hg; 2.5 antihypertensive medications per patient). Mean estimated glomerular filtration rate in patients not receiving hemodialysis was 76 mL/min, and in five patients serum creatinine concentration was greater than 1.5 mg/dL. Three patients were hemodialysis-dependent, and two had intractable congestive heart failure. Forty interventions were performed, including 32 aortorenal bypass procedures, two repeat implantations, four nephrectomies, and two transluminal angioplasty procedures. Postoperative morbidity was 19%. There were no deaths. During follow-up (mean, 68 months), three graft stenoses, all due to intimal hyperplasia, and three graft occlusions occurred. Two of three graft stenoses were successfully revised. At 1, 3, and 5 years of follow-up, primary patency was 87%, 79%, and 79%, respectively; primary assisted patency was 93%, 89%, 89%, respectively; and secondary patency was 93%, 89%, and 89%, respectively. Intervention resulted in a decrease in blood pressure to a mean of 132/79 mm Hg (P < .0001), and the need for antihypertensive medications was reduced to one per patient (P < .01). Mean glomerular filtration rate increased to 88 mL/min (P < .005), and two patients no longer required hemodialysis. Congestive heart failure resolved in both patients, and did not recur. There were three deaths during follow-up, with 5-year and 10-year actuarial survival of 96% and 80%, respectively. Conclusions: Renal revascularization to treat TARAS is durable, has a salutary effect on blood pressure, and enhances long-term renal and cardiac function. This response establishes renal revascularization as a successful and durable intervention for TARAS, and a benchmark to which other therapies should be compared.
Efficacy and Safety of Primary Stenting in Takayasu Arteritis: Report of Four Cases
The Internet Journal of Cardiology, 2009
Background-Takayasu arteritis (TA), an inflammatory disease of unknown origin, frequently affects major aortic branch vessels and causes many symptoms, including brain and retinal ischemia and hypertension. Methods-Four patients with Takayasu arteritis (TA) underwent angioplasty and stent placement in the renal arteries due to uncontrolled hypertension. Complications of the procedure include transient bradycardia and mild hypotension, probably due to contrast agent; however, there was no major complication. Results-No restenosis has been reported in the six-month follow up of the patients with angiography. Serum creatinine levels remained unchanged in the four patients. The difference between pre-and post-interventional arterial blood pressures was measured. Mean systolic blood pressure changed from 227.5 mmHg to 150mmHg and mean diastolic pressure dropped from 122mmHg to 85 mmHg. Conclusion-The stenotic lesions in TA can be managed successfully with angioplasty and stent placement. Short-term follow up showed stenting had increased the success rate of the procedure, achieved larger luminal diameters and it seemed to decrease the incidence of restenosis. However long-term follow up is suggested to determine the restenosis rate.
Pediatric Nephrology, 2015
Background Surgery for reno-vascular hypertension (RVH) is complex, and the techniques utilized vary with anatomical presentations of the disease. The long-term outcome of revascularization on RVH in children with Takayasu's arteritis (TA)-induced renal artery stenosis (RAS) at our centre was reviewed. Methods This study was a 21-year retrospective review of pre-and post-intervention RVH in children with angiographically confirmed RAS. The outcome of hypertension was defined as follows: (1) cured (normotensive off anti-hypertensives), (2) improved (normotensive on same or reduced number of medications), or (3) failure (no cure or improvement in number of medications). Results The medical histories of 59 children (median age 9.98 years) were reviewed, of whom 20 (44 %) had revascularization procedures. All were hypertensive, with a mean systolic and diastolic blood pressure of 161.5 ± 36 and 106.5 ± 31 mmHg, respectively. RAS was present in 45 (76.3 %) children. Twenty-four revascularization procedures were performed in 20 children (44 %), of whom five had contralateral nephrectomies. Outcome was available for 17 patients at the 3-and 6-months follow-up, with cure, improvement and failure rates at 3 months of 2/17 (11.8 %), 7/17 (41.2 %) and 8/19 (47 %), respectively, and similar rates at 6 months. Associations between outcome and age (p=0.51), sex (p= 0.32), number of pre-surgery anti-hypertensives (p=0.18) and stenosis sites (p=0.22) were not statistically significant. Conclusions Revascularization was beneficial to the management of blood pressure control in about half of our RVH patients.
Emergency renal artery stenting in acute anuric renal failure in children with Takayasu's arteritis
Indian Heart Journal, 2013
We report on emergency percutaneous renal artery stenting in two children who developed acute anuria due to bilateral renal artery stenosis and near-total occlusion. In both children, urine output could be reestablished following the procedure. One patient died from persistent severe cardiac failure. Emergency stenting is feasible, and may buy time for future procedures.
American Journal of Roentgenology, 1992
Takayasu disease). The utility of percutaneous transluminal renal angioplasty in managing this disease has been reported infrequentiy, and technical problems in using this treatment method have not been described. We retrospectively evaluated the resufts of renal angioplasty in treating 33 stenoses in 20 patients. Each patient's diagnosis was based on the criteria established by the Aortftis Syndrome Research Committee of Japan. Criteria for selection of patients for angioplasty were (1) severe hypertension uncontrolled by single-drug therapy, (2) angiographic evidence of at least 70% stenosis of the renal artery with a pressure gradient of more than 20 mm Hg, and (3) a normal sedimentation rate. The transfemoral route was used to treat all 33 stenoses. Follow-up examinations included blood pressure and medication evaluation I day, I week, and 4-6 weeks after treatment, and thereafter at 6-month intervals. Technical success was obtained in 28 lesions (85%) in 17 patients (85%). All failures occurred in the presence of coexistent abdominal aortic disease and tight, proximal stenosis of the renal artery. Technical difficulties were attributed to the tough, noncompliant nature of the stenoses, which were difficuft to cross and resisted repeated, prolonged balloon inflations. These patients experienced backache and a fall in systemic blood pressure during balloon inflation. In one patient, the ipsilateral renal vein was injured during angioplasty and required surgery. Clinical success was obtained in 14 (82%) of the 17 patients in whom technical success was achieved and included cure in six patients and improvement in eight others. Follow-up 1-18 months (mean, 8 months) after treatment showed restenosis in six (21%) of 28 lesions. We conclude that renal angioplasty in nonspecific arteritis is associated with technical difficulties; however, the short-term results are good and the complication rate is acceptable.
Aorto-renal Bifurcation Stenting in a Juvenile Non-specific Aorto-Arteritis: case report
Acta Angiologica, 2018
Takayasu Arteritis (TA) is a granulomatous inflammation of unknown aetiology affecting the aorta and its major branches with usual affliction among patients younger than 50 years and rarely among children. We present a 7-years old boy referred for evaluation of hypertension. He had a significant blood pressure difference between right arm, left arm and lower limbs. Computed tomography imaging of thorax and abdomen showed stenosis of left subclavian artery, left renal artery and juxtarenal aorta which was subsequently confirmed on aortogram. He underwent percutaneous endovascular therapy with aorto-renal bifurcation stenting with reduction of blood pressure and gradient. Renal angioplasty with stenting remains a challenging procedure in patients with tight ostial lesion, and juxtarenal aortic involvement in lieu of precise stent placement and avoiding side branch occlusion.
2021
Arterial hypertension (AH) in children up to 13 years old is defined as systolic blood pressure, diastolic blood pressure, or both above the 95th percentile for their age, sex, weight, and height by percentile. In children older than 13, it is defined by values greater than or equal to 130 × 80 mmHg. A diagnosis of Takayasu's arteritis is only established as set forth in the EULAR/PRINTO/PRES diagnostic criteria (2008) the mandatory criterion is an angiography of the aorta and its main branches or of the pulmonary arteries showing an aneurysm, dilatation, stenosis, occlusion, or thickening of the vessel wall, while discarding other possibilities. Additionally, at least one of these minor criteria must be present pulse deficit or claudication; blood pressure (BP) discrepancy in any of the four limbs; cardiac or arterial murmurs, systemic arterial hypertension; and acute-phase laboratory reactions (erythrocyte sedimentation rate > 20 mm or C-reactive protein above the reference...
Takayasu's Arteritis: An Uncommon Cause of Renal Artery Stenosis and Therapeutic Considerations
The Open Urology & Nephrology Journal, 2013
Takayasu's arteritis is a rare disorder characterized by granulomatous and necro-inflammatory disease of the aorta and its major branches. Its etiology remains unknown. We report a young woman with Takayasu's arteritis affecting the aortic arch, carotid, mesenteric, celiac and bilateral renal arteries resulting in severe hypertension, unilateral renal atrophy and renal insufficiency. The immunosuppressive therapy did not halt the progression of her vascular disease, which required revascularization procedures on numerous occasions. Here, the clinical manifestations and histopathological features of Takayasu's arteritis are reviewed. In addition, the available medical treatment options including glucocorticoids, cytotoxic agents and TNF-alpha inhibitors are discussed. Furthermore, current revascularization procedures such as percutaneous transluminal angioplasty and reconstructive vascular surgery in the treatment of occlusive vasculopathy due to Takayasu's arteritis are discussed. Although the prognosis of this debilitating disease has improved over the past two decades, a better understanding of its etiology and pathogenesis will facilitate the discovery of effective target-specific treatment strategies with a narrow adverse effects profile.