ABSTRACT: To demonstrate the sustained efficacy of stent-graft exclusion of a pelvic arteriovenous fistula (AVF) in a woman who became pregnant after treatment.
An iatrogenic iliac arteriovenous fistula caused by redo surgery for a herniated disk in a 23-year-old woman was successfully treated with percutaneous endoluminal exclusion. Intravascular ultrasound was particularly useful for localization of the fistula during the procedure. The patient subsequently became pregnant, and serial Doppler studies were used to monitor the stent-graft until the uneventful delivery of twins by Caesarian section. At 36 months after endograft implantation, the patient has no complaints relative to the device.
Uncomplicated twin pregnancy following stent-graft repair of an AVF in the pelvis appears feasible.
Journal of Endovascular Therapy 11/2002; 9(5):699-702. · 2.86 Impact Factor
ABSTRACT: To assess the usefulness of indexes derived from renal vein renin measurements.
A 12-year prospective study.
A tertiary institutional referral centre.
Between 1988 and 2000, we studied 152 consecutive hypertensive patients with a high pre-test probability of renovascular hypertension (RVH). RVH was diagnosed retrospectively on the basis of reduction in blood pressure after correction of ischaemia at follow-up. Renal vein renin measurements were used to calculate the ratios: Visch/Vctl (renal vein renin ratio; RVRR); Vctl/Viivc; (Visch - Viivc)/Viivc; (Vctl - Viivc)/Viivc, where Visch and Vctl indicate plasma renin activity (PRA) in the ischaemic and contralateral renal veins, respectively, and Viivc denotes PRA in the infrarenal inferior vena cava. A receiver operator characteristics (ROC) curve analysis was used to determine the cut-off value of renal vein renin measurement indexes that provided the best discrimination between patients with and without RVH and to identify patients with RVH caused by total occlusion of the renal artery.
Sixty-seven patients were diagnosed as having RVH: 51 had significant renal artery stenoses (RVH non-occluded) and 16 had total renal artery occlusion (RVH occluded). Of the remaining 85 patients in whom RVH was excluded (non-RVH group), 27 had reno-parenchymal hypertension and 58 had essential hypertension. Of the renal vein renin measurement indexes, only RVRR and (Visch - Viivc)/Viivc in RVH-occluded patients differed significantly (P < 0.005) from those in the non-RVH group and showed the best performance by ROC curve analysis. This analysis also showed that, at any cut-off value, RVRR was far more accurate for identification of RVH-occluded patients than for identification of RVH non-occluded patients, both in the subgroup with unilateral and, even more so, in those with bilateral renal artery lesions. The best trade-off between sensitivity and false-positive rate was provided by cut-off values of 1.55 and 1.70 of the RVRR for identification of non-occluded and occluded RVH, respectively.
RVRR is more useful for establishing an indication for nephrectomy in patients with renal artery occlusion than for identifying those patients with renal artery stenosis who will benefit from revascularization. In patients with RVH with bilateral renal artery lesions, lateralization of renin secretion occurs only in the presence of total renal artery occlusion. Different cut-off values are necessary for identification of non-occluded and occluded RVH.
Journal of Hypertension 05/2002; 20(5):975-84. · 4.02 Impact Factor
ABSTRACT: PurposeHigh renin or renovascular hypertension (RVH) has been associated with a higher risk of stroke than low-to-normal renin hypertension. Our present purpose was to investigate the angiographic prevalence and distribution of lesions of the supraaortic arteries in a series of consecutive patients with RVH compared with control patients with low-to-normal renin primary hypertension (PH).MethodsThirty-two consecutive hypertensives (21 females, 11 males, aged 23–72 years) were investigated by renal and aortic arch digital subtraction arteriography (DSA). None of them had any history or symptoms of cerebrovascular disease. In each, the presence and severity of lesions at 17 different segments of the supraaortic arteries were evaluated and a score for supraaortic lesions was then calculated based on the number and severity of lesions. RVH was diagnosed in 16 patients with renal artery stenoses and normalization of blood pressure after percutaneous transluminal renal angioplasty (PTRA) (n=12) or surgery (n=4). The cause of renal artery obstruction was fibrodysplasia in 5 patients (31%) and atherosclerosis in 11 (69%). PH was diagnosed in 16 patients based on a normal renal DSA and exclusion of all other possible causes of hypertension.ResultsThe RVH and PH groups were similar with respect to age, sex, body mass index, diabetes, smoking habits, serum triglycerides, cholesterol, and blood pressure values, and differed only in plasma renin activity (6.01.7 ng AngI/ml/h in RVH vs. 1.40.3 in PH, meanSEM, p=0.008). The score for supraaortic arterial lesions was significantly higher in RVH than in PH (18132 vs. 179, p=0.001). This difference was also evident when the five patients with fibrodysplasia were compared with five age- and sex-matched PH patients. The sites most frequently involved were the carotid artery bulb and the internal carotid artery sinus. At each affected site the score was higher for RVH than for PH.ConclusionFor the same demographic features and risk profile, RVH was associated with a higher prevalence and severity of supraaortic artery lesions than PH.
CardioVascular and Interventional Radiology 08/1994; 17(5):264-270. · 2.09 Impact Factor