ESTENOSIS ARTERIA RENAL

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ESTENOSIS ARTERIA RENAL

  1. 1. ESTENOSIS ARTERIA RENAL
  2. 2. • INCIDENCIA: 0.5-5% • HTA REFRACTARIA: <10-15% • MAYOR RX DE ACV, CCI Y SOBREVIDA MENOR
  3. 3. ASTRAL (ANGIOPLASTY AND STENTING FOR RENAL ARTERY LESIONS) TRIAL27
  4. 4. Serious complications associated with revascularization occurred in 23 patients, including 2 deaths and 3 amputations of toes or limbs.
  5. 5. STAR (STENT PLACEMENT AND BLOOD PRESSURE AND LIPID-LOWERING FOR THE PREVENTION OF PROGRESSION OF RENAL DYSFUNCTION CAUSED BY ATHEROSCLEROTIC OSTIAL STENOSIS OF THE RENAL ARTERY)
  6. 6. Undeniable indications for revascularization (Am Heart J 2009;158:154-62.) (Am Heart J 2009;158:154-62.)
  7. 7. • Hemodynamically significant asymptomatic (incidental) RAS (is defined as: 1. 50% to 70% diameter stenosis by visual estimation with a peak translesional gradient (measured with a ≤5F catheter or pressure wire) of 20 mm Hg or higher or a mean gradient of 10 mm Hg orhigher; OR 2. any stenosis with 70% or larger diameter by visual estimation; OR 3. stenosis with 70% or larger diameter by intravascular ultrasound measurement
  8. 8. • HTA resistente: HTA CON TTO MAS DE TRES DROGAS A DOSIS MAXIMA Q INCLUYE UN DIURETICO • HTA ACELERADA: SUBITO Y RAPIDO DETERIORO. • HTA CON DAÑO AGUDO DE UN ORGANO: IRA, INS CARD AGUDA; NUEVo DISTURBIO NEUROLOGICO U OFTALMOLOGICO .Y /O GRADO IIi/IV DE RETINOPATIA.
  9. 9. • noted that the National Kidney Foundation defines chronic kidney disease as a decrease in estimated glomerular filtration rate to less than 60 mL/min per 1.73 m2 (modified Modification of Diet in Renal Disease formula) that persists for at least 3 months • Studios with a baseline serum creatinine between 1.5 and 4.0 mg per dL (751). • Several factors may argue against – proteinuria greater than 1 g every 24 hours renal atrophy, – severe renal parenchymal diseas disease, and severe diffuse – intrarenal arteriolar disease. • renal function can deteriorate after renal arteryangioplasty, especially in patients with stable renal functionprior to the intervention
  10. 10. Referencias • Atherosclerotic renal artery stenosis: Current therapy and future developments Am Heart J 2009;158:154-62 • Management of Renal Artery Stenosis Progress in Cardiovascular Disease 52 (2009) 229–237 • Primary stenting for atherosclerotic renal artery stenosis J Vasc Surg 2010;51:1574-80.) • STAR Revascularization versus Medical Therapy for Renal-Artery Stenosis N Engl J Med 2009;361:1953-62. • RAS renal function: a randomized trial. Ann Intern Med • 2009;150:840-8.

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