Renal artery stenosis resident survival guide: Difference between revisions
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{{familytree | | | C01 | | | | C02 | C01= <div style="float: left; text-align: left; height: 5em; width: 25em; padding:1em;">❑ [[Duplex ultrasound]] | {{familytree | | | C01 | | | | C02 | C01= <div style="float: left; text-align: left; height: 5em; width: 25em; padding:1em;">❑ [[Duplex ultrasound]] | ||
❑ [[ | ❑ Gadolinium enhanced [[MRA]] | ||
❑ [[CT angiography]] </div>| C02= <div style="height: 3em; width: 25em;">❑ [[Abdominal aortography]] to assess the renal arteries during coronary and peripheral [[angiography]]</div>}} | ❑ [[CT angiography]] </div>| C02= <div style="height: 3em; width: 25em;">❑ [[Abdominal aortography]] to assess the renal arteries during coronary and peripheral [[angiography]]</div>}} | ||
{{familytree | | | |!| | | | | |!| | | | | }} | {{familytree | | | |!| | | | | |!| | | | | }} | ||
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{{familytree | C01 | | C02 | | C03 | C01= <div style="height: 5em; width: 10em;">Negative noninvasive test but with high clinical suspicion </div>| C02= <div style="height: 3em; width: 10em;">Evidence of RAS </div>| C03= <div style="height: 3em; width: 10em;">Evidence of RAS </div>}} | {{familytree | C01 | | C02 | | C03 | C01= <div style="height: 5em; width: 10em;">Negative noninvasive test but with high clinical suspicion </div>| C02= <div style="height: 3em; width: 10em;">Evidence of RAS </div>| C03= <div style="height: 3em; width: 10em;">Evidence of RAS </div>}} | ||
{{familytree | |!| | | |!| | | |!| | | | | }} | {{familytree | |!| | | |!| | | |!| | | | | }} | ||
{{familytree | C01 | | |!| | | |!| C01= <div style="height: 2em; width: 10em; padding:1em;">[[ | {{familytree | C01 | | |!| | | |!| C01= <div style="height: 2em; width: 10em; padding:1em;">Renal [[angiography]]</div>}} | ||
{{familytree | |!| | | |!| | | |!| | | | | }} | {{familytree | |!| | | |!| | | |!| | | | | }} | ||
{{familytree | C01 | | |!| | | |!| C01= <div style="height: 2em; width: 10em; padding:1em;">Evidence of RAS</div>}} | {{familytree | C01 | | |!| | | |!| C01= <div style="height: 2em; width: 10em; padding:1em;">Evidence of RAS</div>}} |
Revision as of 14:49, 6 January 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Karol Gema Hernandez, M.D. [2]
Definition
This section provides a short and straight to the point definition of the disease or symptom in one sentence.
Causes
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
Common Causes
Clinical Clues to the Diagnosis of RAS
❑ Determine if one or more of the above is present | |||||||||||||||||||||||||||||||||||||
| |||||||||||||||||||||||||||||||||||||
❑If one or more of the above are present, proceed to further diagnostic testing | |||||||||||||||||||||||||||||||||||||
Noninvasive Imaging
| Invasive Imaging
| ||||||||||||||||||||||||||||||||||||
❑ Abdominal aortography to assess the renal arteries during coronary and peripheral angiography | |||||||||||||||||||||||||||||||||||||
Negative noninvasive test but with high clinical suspicion | Evidence of RAS | Evidence of RAS | |||||||||||||||||||||||||||||||||||
Renal angiography | |||||||||||||||||||||||||||||||||||||
Evidence of RAS | |||||||||||||||||||||||||||||||||||||
Confirmed RAS, proceed to treatment | |||||||||||||||||||||||||||||||||||||
Algorithm based on the 2013 AHA Guidelines Recommendations for Management of Patients with PAD.[1]
Indications for Renal Revascularization
Indication | Level of evidence |
---|---|
1.Hemodynamically significant RAS with recurrent, unexplained CHF or sudden, unexplained pulmonary edema | Class I; LOE B |
2. RAS with:
| Class IIa; LOE B |
3.RAS and CRI with bilateral RAS or RAS to solitary functioning kidney | Class IIa; LOE B |
4. RAS and unstable angina | Class IIa; LOE B |
5. Asymptomatic bilateral or solitary viableʰ kidney with a hemodynamically significant RAS | Class IIb; LOE C |
6. Asymptomatic unilateral hemodynamically significant RAS in a viable* kidney | Class IIb; LOE C |
7. RAS and CRI with unilateral RAS (2 kidneys present) | Class IIb; LOE C |
ʰViable means kidney linear length greater than 7 cm
❑ When any of the indications are met: | |||||||||||||||||||||||||||||||||
❑Renal Angioplasty/Stent | ❑ Renal artery surgery | ||||||||||||||||||||||||||||||||
Atherosclerotic RAS
| Fibromuscular dysplasia RAS
| ||||||||||||||||||||||||||||||||
Renal stent placement is indicated for ostial atherosclerotic RAS lesions that meet the clinical criteria for intervention | Balloon angioplasty with bailout stent placement if necessary is recommended for fibromuscular dysplasia lesions | ||||||||||||||||||||||||||||||||
Algorithm based on the 2013 AHA Guidelines Recommendations for Management of Patients with PAD.[1]
References
- ↑ 1.0 1.1 Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH; et al. (2013). "Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA guideline recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". Circulation. 127 (13): 1425–43. doi:10.1161/CIR.0b013e31828b82aa. PMID 23457117.