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Diabetic Nephropathy
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
The most important blood pressure medications used for glomerular hypertension include the ACE inhibitors and ARBs. Examples of ACE inhibitors include benazepril, captopril, lisinopril, and ramipril. Examples of ARBs include candesartan, losartan, olmesartan, and valsartan. Procedures that may be helpful include percutaneous transluminal angioplasty, to flatten plaques against the artery walls and insert a stent, allowing blood to flow more freely through the renal arteries. Renal bypass surgery is another surgical option for some patients. When renal artery stenosis can be reversed, the hypertension usually resolves.
Complications of hemodialysis access
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Mia Miller, Prakash Jayanthi, William Oppat
The gold standard for the diagnosis of a stenosis in the hemodialysis circuit is a fistulogram. Additionally, a diagnostic fistulogram provides the ability to intervene if indicated. The basic indication for percutaneous transluminal angioplasty is stenosis > 50% or thrombosis of the AVF or graft. Primary patency within the first year after angioplasty is > 50%, while primary-assisted patency is 80–90% in the same time period. An example of a fistulogram revealing an outflow stenosis and subsequent angioplasty can be seen in Figures 29.1 and 29.2. A cutting balloon can be used as a second-line method, and stents and covered stents are reserved for the management of complications and central outflow stenosis.11 According to a study by Mohjuddin et al., fistula flow rate change was significantly better in native AVFs after fistuloplasty (percent flow increase 88.4%) than that in AVGs (percent flow increase 9.2%). Increase in fistula flow was greatest for valvular lesions (percent increase in flow: 42.6%), followed by lesions at the needling site (40.1%), peripheral outflow vein stenosis (29%), central outflow vein stenosis (25.9%), and at the anastomosis (19.9%).7
Management of peripheral arterial disease in the elderly
Published in Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich, Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
Table 30.7 states that the indications for lower extremity percutaneous transluminal angioplasty or bypass surgery are (1) incapacitating claudication in persons interfering with work or lifestyle; (2) limb salvage in persons with limb-threatening ischemia as manifested by rest pain, nonhealing ulcers, and/or infection or gangrene; and (3) vasculogenic impotence (160). Percutaneous transluminal angioplasty can be performed if there is a skilled vascular interventionalist and the arterial disease is localized to a vessel segment less than 10 cm in length (160). Compared to percutaneous transluminal angioplasty alone, stenting improves 3-year patency by 26% (161) After infrainguinal bypass surgery, oral anticoagulant therapy is preferable in persons with venous grafts, whereas aspirin is preferable in persons with nonvenous grafts (131).
Contemporary review of management techniques for cephalic arch stenosis in hemodialysis
Published in Renal Failure, 2023
Gift Echefu, Shivangi Shivangi, Ramanath Dukkipati, Jon Schellack, Damodar Kumbala
Several studies have compared the patency rates for cutting balloons to conventional percutaneous transluminal angioplasty in the management of autogenous venous graft, ingraft stenosis, intra-graft stenosis with mixed results [59]. Heerwagen et al. in their retrospective review of endovascular outcomes among 17 patients who underwent cutting balloon angioplasty for the management of CAS, with and without conventional PTA reported primary patency rates at 3, 6, 12, and 15 months were 94%, 81%, 38 percent (14%), and 22 percent (15%), respectively. At similar durations, the assisted primary patency rates were 100%, 94%, 77%, and 63 13%, respectively. The mean duration between endovascular interventions was 13 months (SD = 8), with 0.9 interventions required per patient-year of dialysis [14]. Authors found no improvement in the patency rates after CBA compared to what is known in literature about conventional PTA. This study is limited due to the small sample size and no control group.
Comparing treatment options for large vessel vasculitis
Published in Expert Review of Clinical Immunology, 2022
Federica Macaluso, Chiara Marvisi, Paola Castrignanò, Nicolò Pipitone, Carlo Salvarani
However, the evidence for biological agents in TAK is very limited and mostly derived from uncontrolled observations. In refractory cases, we prefer to use TNFi over TCZ because of the more robust evidence in their favor. Surgical procedures are needed in cases of cerebrovascular disease due to cervical vessel stenosis, coronary artery disease, moderate-to-severe aortic regurgitation, severe coarctation of the aorta, renovascular hypertension, limb claudication, or progressive aneurysm enlargement with risk of rupture or dissection. Bypass graft surgeries are associated with a better long-term outcome. Percutaneous transluminal angioplasty provides better results for short lesions than conventional stents. Surgical procedures should be performed whenever possible when the disease is adequately controlled by medications. A multidisciplinary approach is required to best manage large vessel vasculitis.
Endovascular treatment for cerebral venous sinus thrombosis – a single center study
Published in British Journal of Neurosurgery, 2021
Thomas Hasseriis Andersen, Klaus Hansen, Thomas Truelsen, Mats Cronqvist, Trine Stavngaard, Marie Elisabeth Cortsen, Markus Holtmannspötter, Joan L Sunnleyg Højgaard, Jakob Stensballe, Karen Lise Welling, Henrik Gutte
Twenty-six patients received local thrombolysis (93%), 9 patients (32%) also underwent thrombectomy, whereas 2 patients (7%) were treated with thrombectomy only. In 5 patients aspiration was done either by a Penumbra clot aspiration system (Penumbra, CA, USA) or manual aspiration by hand using a large syringe (50cc). In the remaining 6 patients, mechanical thrombectomy was performed using a stent retriever. Two patients underwent percutaneous transluminal angioplasty. One patient (patient 13) underwent supplementary stenting of the thrombosed right transverse and sigmoid sinus with several carotid stents due to possible stenosis of the proximal sigmoid sinus. The median number of endovascular sessions were 2 (range 1–5; sessions where only digital subtraction angiography was performed were excluded), conducted one day apart in all but 4 patients. Complete recanalization of the affected sinus(es) assessed upon completion of the final endovascular session was achieved in 15 patients (54%), partial restoration in 11 patients (39%) and no restoration in 2 patients (7%).