Renal artery stenosis resident survival guide: Difference between revisions
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{{familytree | | | | | | A01 | | | A01= ❑'''Renal Angioplasty/Stent'''}} | {{familytree | | | | | | | | | A01 | | | A01= ❑ '''When any of the indications are met:'''}} | ||
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{{familytree | | | | | | A01 | | | | A02 | | A01= ❑'''Renal Angioplasty/Stent'''| C02= ❑ Renal artery surgery</div>}} | |||
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{{familytree | | | B01 | | | | B02 | B01=<div style="height: 1em; width: 25em; padding:1em;">'''Noninvasive Imaging''' | {{familytree | | | B01 | | | | B02 | B01=<div style="height: 1em; width: 25em; padding:1em;">'''Noninvasive Imaging''' | ||
</div>| B02= <div style="height: 1em; width: 25em; padding:1em;">'''Invasive Imaging''' | </div>| B02= <div style="height: 1em; width: 25em; padding:1em;">'''Invasive Imaging''' |
Revision as of 08:07, 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
| ||||||||||||||||||||||||||||||||||||
❑ Duplex ultrasound
❑ Gadolinium enhanced MRA ❑ CT angiography | ❑ 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 | {{{ A02 }}} | ||||||||||||||||||||||||||||||||
Noninvasive Imaging
| Invasive Imaging
| ||||||||||||||||||||||||||||||||
❑ Duplex ultrasound
❑ Gadolinium enhanced MRA ❑ CT angiography | ❑ Abdominal aortography to assess the renal arteries during coronary and peripheral angiography | ||||||||||||||||||||||||||||||||
References
- ↑ 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.