Vascular and Endovascular Surgery
Renal (Kidney) Artery Disease
Renal vascular disease is the name given to a variety of complications that affect the arteries and veins of the kidneys. These complications affect the blood circulation of the kidneys, and may cause damage to the tissues of the kidneys, kidney failure, and/or high blood pressure.
Vascular conditions affecting the renal arteries and veins include the following:
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Renal artery stenosis is a blockage of an artery to the kidneys. It may cause kidney failure and hypertension (high blood pressure).
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Renal artery thrombosis is the formation of a clot in a renal artery. A thrombosis of a renal artery may cause kidney failure because of blocked blood flow to the kidney.
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A renal artery aneurysm is a bulging, weakened area in the wall of an artery to the kidney. Most of these aneurysms are small (less than two centimeters, or about three-quarters of an inch) and without symptoms.
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Atheroembolic renal disease occurs when a piece of plaque from the aorta and/or other large arteries breaks off and travels through the bloodstream, blocking small arteries such as the renal arteries. Atheroembolic renal disease is becoming a common cause of renal insufficiency (poor kidney function) in the elderly.
renal vein thrombosis
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A renal vein thrombosis is the formation of a clot in a vein to the kidney.
Renal vascular disease is often associated with hypertension (high blood pressure). Hormones which influence blood pressure are affected by kidney function. Decreased blood flow to the kidney(s) as a result of renal vascular disease may cause an excessive amount of renin to be produced. Renin is a powerful hormone that increases blood pressure.
How is renal vascular disease diagnosed?
In addition to a complete medical history and physical examination, diagnostic procedures for renal vascular disease may include any, or a combination, of the following:
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Arteriogram (also called an angiogram) - an x-ray image of the blood vessels used to evaluate various conditions, such as aneurysm, stenosis (narrowing of the blood vessel), or blockages.
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Duplex Ultrasound - a type of vascular ultrasound procedure done to assess blood flow and the structure of the leg veins. The term "duplex" refers to the fact that two modes of ultrasound are used - Doppler and B-mode.
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Renography - a specialized radiology procedure used to assess the function and structure of the kidneys.
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Magnetic Resonance Angiography (MRA) - a noninvasive diagnostic procedure that uses a combination of magnetic resonance technology (MRI) and intravenous (IV) contrast dye to visualize blood vessels.
Treatment for renal vascular disease:
Specific treatment will be determined by your physician based on: your age, overall health, medical history. extent of the disease, your signs and symptoms, your tolerance for treatment and other factors.
Renal Artery Stenosis - Medical Treatment:
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Angiotensin-converting enzyme (ACE) inhibitor medication may be prescribed to treat hypertension in patients with fibromuscular dysplasia
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Antihypertensive medications may be used to treat high blood pressure
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In stenosis caused by atherosclerosis, medications to lower cholesterol may be prescribed
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Treatment of related medical conditions such as diabetes
Renal Artery Stenosis - Surgical Treatment:
- Endovascular procedures such as angioplasty (the opening of a renal artery using a balloon or other method) or placement of a stent (a tiny expandable metal coil placed inside an artery to keep the artery open)
- Open surgical procedures to bypass the occluded renal artery. There are several variations of such procedures.
Renal Artery Thrombosis
Treatment of a renal artery thrombosis depends on the type (acute or chronic) of thrombosis, and the length of time since the thrombosis occurred. In acute situations, thrombolytic ("clot-busting") medication may be infused into the renal artery for several hours to several days to break up the clot. Surgery to remove the clot or bypass the artery may be performed in some situations.
Renal Artery Aneurysm
Treatment of a renal artery aneurysm depends on factors such as size and location of the aneurysm and whether or not symptoms are present. Certain types of small (less than two centimeters, or about three-quarters of an inch) aneurysms may not be treated, but may be observed for growth or development of other complications.
Larger aneurysms (greater than two centimeters or three-quarters of an inch), dissecting aneurysms, aneurysms causing kidney ischemia (lack of blood flow to the kidney tissue) and hypertension, aneurysms that are growing larger, and aneurysms causing symptoms may be treated surgically.
Because of the increased risk for rupture (bursting), a renal artery aneurysm in a pregnant woman or a woman of child-bearing age will generally be treated surgically.
Atheroembolic Renal Disease
Treatment of atheroembolic renal disease depends on the extent of the disease and the individual situation.
Medical treatment may include medications to reduce cholesterol, blood pressure, and other related medical conditions, such as diabetes.
Surgical treatment may include:
- Endovascular procedures such as angioplasty (the opening of a renal artery using a balloon or other method) or placement of a stent (a tiny expandable metal coil placed inside an artery to keep the artery open)
- Open surgical procedures to bypass the occluded renal artery. There are several variations of such procedures.
Renal Vein Thrombosis
Renal vein thrombosis is generally treated medically with anticoagulant (keeps the blood from clotting) medication. Anticoagulants may be given intravenously (IV) for several days, then given orally for several weeks up to an indefinite period of time.
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