China
Africa
Explore chapters and articles related to this topic
Chronic hypertension and acute hypertensive crisis
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
William F. Rayburn, Lauren Plante
Many women with chronic hypertension are under the care of a primary care physician and already have been evaluated for causes of secondary hypertension, such as primary aldosteronism, pheochromocytoma, or Cushing’s disease (3). Women with paroxysmal hypertension, frequent “hypertensive crisis,” seizure disorders, or anxiety attacks should be evaluated for pheochromocytoma with measurements of 24-hour urine vanillylmandelic acid, metanephrines, or unconjugated catecholamines (10). Primary aldosteronism is rare in pregnancy, but may present with hypokalemia. Imaging studies (magnetic resonance imaging or computed tomography) may be helpful in demonstrating or localizing an adrenal tumor. Doppler flow studies or magnetic resonance angiography can reveal renal artery stenosis (3).
Complications of open repair of renal artery aneurysms
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Most renal artery aneurysms are asymptomatic and typically found incidentally on imaging for unrelated conditions.4 Of those that develop symptoms, hypertension is the most common.7 The relationship between renal artery aneurysms and hypertension is ill-defined; however, there are many hypotheses. Hypertension may be the result of renin-mediated vasoconstriction in the setting of renal artery stenosis, which can cause post-stenotic fusiform aneurysms. Other mechanisms for hypertension include distal thrombus embolization or propagation and the resultant artery occlusion leading to segmental parenchymal ischemia, compression of adjacent renal artery branch leading to renin-mediated hypertension, or flow turbulence altering hemodynamics. Other symptoms include flank pain and hematuria. The most dreaded manifestation of renal artery aneurysm is rupture resulting in life-threatening hemorrhage. These patients typically present with acute flank or abdominal pain and hypotension.5,8 The associated mortality in renal artery aneurysm rupture is about 10%. Among survivors of aneurysm rupture, 90% have a loss of the kidney. The mortality of aneurysm rupture is significantly greater in the pregnant population where it is associated with a 50% maternal mortality and 75% fetal mortality.
Spinal Cord Disease
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Embolism: Embolism from the heart.Atherothromboembolism from the aorta or origin of the intercostal and lumbar arteries.Air embolism: nitrogen bubbles lodge in spinal veins (decompression sickness).Fibrocartilaginous embolism from intervertebral disc rupture.Therapeutic renal artery embolization.
Combined endovascular and surgical treatment of a giant celiac artery aneurysm with consequent gastric outlet obstruction: a case report and literature review
Published in Acta Chirurgica Belgica, 2023
Nick Smet, Thijs Buimer, Tim Van Meel
The reported mortality of a ruptured visceral artery aneurysm varies from 8 to 40% in more recent studies and up to 70% in older literature. Rupture rates up to 70% are described for splanchnic artery aneurysms of more than 30 mm [5]. Due to these high rupture rates, giant visceral artery aneurysms are rarely encountered. Ruptured visceral artery aneurysms are life-threatening and should be urgently treated. Due to the rarity of these aneurysms, current literature consists of case reports and small observational studies. Based on the available literature, recently published guidelines (2020) by the Society of Vascular Surgeons suggest treatment upon diameter, origin of visceral artery aneurysm, growth, symptoms and true or false aneurysms. Visceral aneurysms in pregnant women, women of childbearing age and pseudoaneurysms always need treatment due to high risk of rupture. Jejunal, ileal, hepatic and celiac artery aneurysms larger than 20 mm warrant treatment. The threshold for treatment of splenic and renal artery aneurysms is set at 30 mm. All other VAAs and in general symptomatic VAAs need treatment regardless of size [8]. Symptoms can consist of abdominal pain, nausea, vomiting, pulsatile mass or obstructive complaints. Only 5–17% of visceral artery aneurysms are truly asymptomatic [5].
Repair of renal artery aneurysm with stent angiography and coil embolization
Published in Baylor University Medical Center Proceedings, 2021
Lauren Dinh, Mohanad Hamandi, William Shutze
A renal artery aneurysm (RAA) is dilatation of the renal artery >2 times the normal diameter, making it susceptible to rupture, stroke, and uncontrolled bleeding. The incidence rate is about 1%.1 Most cases are found incidentally after a workup involving an abdominal computed tomography scan or following an assessment for hypertension.2 Repair is usually undertaken when the RAA is >2.0 mm in diameter.3 Rundback et al established a classification system for RAAs based on their anatomical features. Saccular aneurysms that originate from the main renal artery or one of its large branches are categorized as type 1, while aneurysms that are fusiform shaped are classified as type 2.4 Intralobar aneurysms originating from smaller segmental arteries off of the main renal artery are type 3 RAAs. Fusiform aneurysms that are >20 mm in diameter (type 2) are better suited for open surgical therapy.1,2,5 Type 1 or type 3 aneurysms are better suited for endovascular repair.1 While their application is anatomically restricted, endovascular repairs are gradually becoming more popular because they are minimally invasive, require only local anesthesia, and result in shorter hospital stays. Here, we present two cases of type 1 RAAs in hypertensive patients that were successfully treated endovascularly with renal artery stent angiography and coil embolization.
Clinical characteristics of concurrent primary aldosteronism and renal artery stenosis: A retrospective case–control study
Published in Clinical and Experimental Hypertension, 2021
Xu Meng, Yan-Kun Yang, Yue-Hua Li, Peng Fan, Ying Zhang, Kun-Qi Yang, Hai-Ying Wu, Xiong-Jing Jiang, Jun Cai, Xian-Liang Zhou
In the PA with RAS group, RAG or CT renal angiography confirmed that the degree of RAS was greater than 70% in at least one lesion. Six lesions were present in left renal arteries and four in right renal arteries. The most frequently involved vessel was the ostial renal artery (n = 7). Two other lesions were present in proximal renal arteries, and diffuse involvement of the entire artery was noted in one patient. Analysis of the radiological findings for the lesions showed that peripheral atherosclerosis was diagnosed in eight patients and was the most common cause among the 10 patients. The remaining two patients received diagnoses of Takayasu arteritis and fibromuscular dysplasia (n = 1, each). Adrenal adenoma and adrenal hyperplasia were the most common types of adrenal mass diagnosed by at least two experienced radiologists. Eight lesions were present on the left side and three on the right side (one patient had bilateral adrenal hyperplasia). AVS was performed in five patients, four of which had positive results that met the surgical indications for unilateral adrenalectomy. The remaining five patients declined to undergo AVS. The results of RAG and CT renal angiography are shown in Table 2.