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Cardiology
Renal and Mesenteric Artery Stenosis and Intervention
Built from Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
What’s inside
8 sections · 129 slides
Renal Artery Stenosis
- Definition and etiologies of renal artery stenosis
- Atherosclerotic disease versus fibromuscular dysplasia
- Prevalence of atherosclerotic renal artery stenosis
- Epidemiology of fibromuscular dysplasia
- Pathophysiology: renin-angiotensin-aldosterone activation
- Progression to ischemic nephropathy
- Pathway from renal artery disease to irreversible kidney damage
- Renal artery stenosis and congestive heart failure
Clinical Manifestations and Diagnosis
- Hypertensive clues to renal artery stenosis
- Cardiovascular and renal clues to renal artery stenosis
- Duplex ultrasound criteria for renal artery stenosis
- Renal duplex ultrasound of a significant stenosis
- CT and MR angiography in renal artery stenosis
- Catheter angiography and tests no longer recommended
- Imaging pathway in suspected fibromuscular dysplasia
Evidence for Revascularization
- STAR trial: design and results
- Limitations of the STAR trial
- ASTRAL trial: design and results
- Limitations of the ASTRAL trial
- CORAL trial: design and entry criteria
- CORAL trial: outcomes
- Criticism of the CORAL trial design
- Meta-analyses of the randomized evidence
- Observational blood pressure data: Dorros and ASPIRE-2
- RENAISSANCE and Courand cohorts
- Pressure gradient as a predictor of blood pressure response
- Renal function outcomes after renal artery intervention
- Predictors of renal benefit after revascularization
- Predictors of cardiovascular outcome and mortality
- Patient selection as the governing principle
Indications for Intervention
- Fibromuscular dysplasia: disease definition
- Angiographic patterns of fibromuscular dysplasia
- Clinical clues to fibromuscular dysplasia related hypertension
- Revascularization outcomes in fibromuscular dysplasia
- Heart failure and flash pulmonary edema
- Mechanism of flash pulmonary edema in renal artery stenosis
- Recommendation in heart failure and flash pulmonary edema
- Resistant hypertension: definition and associated renal disease
- Revascularization in resistant hypertension
- Progressive renal failure and rate of decline
- Advanced kidney disease and recovery of glomerular filtration
- Guideline recommendations in progressive chronic kidney disease
Renal Artery Intervention
- Access and catheter selection for renal artery intervention
- The no-touch technique
- No-touch technique for engaging the renal artery
- Intravascular ultrasound before intervention
- Ostial renal artery stenosis with intravascular ultrasound correlation
- Severe ostial stenosis on digital subtraction angiography
- Calcified atherosclerotic plaque on intravascular ultrasound
- Predilatation and stent sizing
- Stent selection in the renal artery
- Post-stent assessment and final angiography
- Intravascular ultrasound after stent placement
- Physiological assessment of intermediate renal lesions
- Sequence of a renal artery intervention
- Challenging anatomy: downward renal artery angulation
- Radial approach technique for the renal artery
- Heavily calcified renal artery lesions
- Technique in fibromuscular dysplasia
- Complications of renal artery intervention
- Management of renal artery perforation
- Follow-up after renal artery stenting
- Renal artery stenosis: conclusion
Acute Mesenteric Ischemia
- Mesenteric ischemia: definition and burden
- Causes of acute mesenteric ischemia
- Arterial embolism and in-situ thrombosis
- Mesenteric venous thrombosis and non-occlusive ischemia
- Tissue injury in mesenteric ischemia
- Epidemiology of acute mesenteric ischemia
- Clinical presentation of acute mesenteric ischemia
- Laboratory findings in acute mesenteric ischemia
- Imaging in acute mesenteric ischemia
- Endovascular versus open revascularization
- Endovascular modalities in acute mesenteric ischemia
- Multidisciplinary decision-making in acute mesenteric ischemia
Chronic Mesenteric Ischemia
- Etiology of chronic mesenteric ischemia
- Collateral circulation and the two-vessel rule
- Non-occlusive chronic mesenteric ischemia
- Median arcuate ligament syndrome
- Management of median arcuate ligament syndrome
- Epidemiology of chronic mesenteric ischemia
- Prevalence of mesenteric artery stenosis
- Clinical presentation of chronic mesenteric ischemia
- Laboratory testing and duplex ultrasound in chronic mesenteric ischemia
- Cross-sectional imaging in chronic mesenteric ischemia
- Functional testing and digital subtraction angiography
- Endovascular outcomes in chronic mesenteric ischemia
- Meta-analysis of endovascular treatment for chronic mesenteric ischemia
- Recommendation for endovascular treatment of chronic mesenteric ischemia
Mesenteric Artery Intervention
- Access and equipment for mesenteric intervention
- Fluoroscopic angulation and initial angiography
- Collateral pathways of the mesenteric circulation
- Choice of target vessel for mesenteric intervention
- Intravascular ultrasound sizing and predilatation
- Stent deployment and final assessment
- Superior mesenteric artery stenosis treated with a drug-eluting stent
- Occluded celiac trunk with severe superior mesenteric artery stenosis
- Heavily calcified mesenteric lesions
- Endovascular treatment of acute mesenteric ischemia in practice
- Complications of mesenteric artery intervention
- Mesenteric intervention: conclusion
- Key points: renal artery stenosis
- Key points: mesenteric ischemia
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- Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
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