- Email: [email protected]
Noninvasive Screening Tests for Renal Artery Stenosis: Are There Reliable Predictors of Outcomes?
inal aortic aneurysms. J Vasc Surg, 2000; 31(2):32542. 47. Mosorin, M., et al., Use of doxycycline to decrease the growth rate of abdominal aortic aneurysms: a randomized, double-blind, placebo-controlled pilot study. J Vasc Surg, 2001; 34(4):606-10.
8:15 a.m. Endoleaks and Endotension: When Do You Intervene? Richard A. Baum., MD Brigham. and Wom.en's Hospital Boston, A1A 8:30 a.m. Next Wave of Stent GraftDevices Chieh-Min Fan, MD Massachusetts Geneml Hospital Boston, k1A
8:45 a.m. Featured Speaker: Radiation Safety Stephen BalteJ~ PhD New York, NY 9:00 a.m. Thoracie Aneurysms: Seleetion Criteria, Devices, and Outeomes to Date Michael D. Dake, MD Stan/ord University Hospital Palo AILO, CA
9:15 a.m. Stent Grafts for Aortic Dissection: Which Patients Will Benefit? David M. Williams, MD University Hospital Ann Arbol~ MI
Renovascular Disease
Tuesday, April 1, 2003 10:00 a.m.-12:00 p.m. Moderatol~·
Alan H. Matsumoto, MD
10:00 a.m. Natural History of Atherosclerotie Renal Artery Stenosis Marc Pohl, MD Cleveland Clinic Cleveland, OH
P156
10:17 a.m. Noninvasive Sereening Tests for Renal Artery Stenosis: Are There Reliable Predietors of Outeomes? john H Rundback, MD Columbia Presbyterian Medical Center New York, NY 10:34 a.m. Atherosclerotie Renat Artery Stenosis: Does Revaseularization Alter Patient Outeomes? StepheJl Chas Textor, MD lvIayo Clinic RochesteJ~ MN Few areas of vascular intelvention have been associated wit h more controversy" than endovascular procedures for renal artelY stenosis. Intuitively, restoration of the blood supply to the kidney ought to improve the functional disturbances produced by renal artery lesions. It should be emphasized that when applied to the right patients, revascularization of the kidney can, in fact, provide major improvements in both blood pressure and recovelY of renal function. Why, then, is there any ąuestion as to its widespread application? Most clinicians recognize that revascularization is a "double-edged sword". AIrhough most procedures can be achieved with excellent technical success, the risks of atheroemboli, arterial dissection and clinical failure are genuine. Sometimes they produce catasrrophic conseąuences leading ro end-srage renal failure. As a resuJt, it is more important than ever to balance the potential benefits with the potential risks for each patient. The purpose of this discussion is to highlight reasons for ambiguity in this area. Changing Population Demographics The lasr several decades have been characrerized by longer Iifespan. This is likely the resulr of several factors, including major declines in mortality related to stroke and cardiovascular disease. Population groups above age 65 are now among the most rapidly growing segments in the United States (1). One conseąuence of lower mortality from coronary and cerebrovascular events is the delayed appearance of vascular disease affecting other bed~, such as the aorta and kidneys (2). As a result, clinical manifestations of renal altelY stenosis are appearing in older individuals, often combinecl with other comorbid diseases. These features change the clinical presentation and affect the risk/benefit considerations inherent in deciding whether to consider renal revascularization. Series with renal artelY intelvention now routinely include average age values above 70 years, whereas a decade ago the mea n age was between 61 and 63 years and series from the 1970s reported a mean age in the 50s (3,4). Changing Medical Therapy Since the early 1980s, new classes of antihypertensive agents have become available and widely used. These
8:15 a.m. Endoleaks and Endotension: When Do You Intervene? Richard A. Baum., MD Brigham. and Wom.en's Hospital Boston, A1A 8:30 a.m. Next Wave of Stent GraftDevices Chieh-Min Fan, MD Massachusetts Geneml Hospital Boston, k1A
8:45 a.m. Featured Speaker: Radiation Safety Stephen BalteJ~ PhD New York, NY 9:00 a.m. Thoracie Aneurysms: Seleetion Criteria, Devices, and Outeomes to Date Michael D. Dake, MD Stan/ord University Hospital Palo AILO, CA
9:15 a.m. Stent Grafts for Aortic Dissection: Which Patients Will Benefit? David M. Williams, MD University Hospital Ann Arbol~ MI
Renovascular Disease
Tuesday, April 1, 2003 10:00 a.m.-12:00 p.m. Moderatol~·
Alan H. Matsumoto, MD
10:00 a.m. Natural History of Atherosclerotie Renal Artery Stenosis Marc Pohl, MD Cleveland Clinic Cleveland, OH
P156
10:17 a.m. Noninvasive Sereening Tests for Renal Artery Stenosis: Are There Reliable Predietors of Outeomes? john H Rundback, MD Columbia Presbyterian Medical Center New York, NY 10:34 a.m. Atherosclerotie Renat Artery Stenosis: Does Revaseularization Alter Patient Outeomes? StepheJl Chas Textor, MD lvIayo Clinic RochesteJ~ MN Few areas of vascular intelvention have been associated wit h more controversy" than endovascular procedures for renal artelY stenosis. Intuitively, restoration of the blood supply to the kidney ought to improve the functional disturbances produced by renal artery lesions. It should be emphasized that when applied to the right patients, revascularization of the kidney can, in fact, provide major improvements in both blood pressure and recovelY of renal function. Why, then, is there any ąuestion as to its widespread application? Most clinicians recognize that revascularization is a "double-edged sword". AIrhough most procedures can be achieved with excellent technical success, the risks of atheroemboli, arterial dissection and clinical failure are genuine. Sometimes they produce catasrrophic conseąuences leading ro end-srage renal failure. As a resuJt, it is more important than ever to balance the potential benefits with the potential risks for each patient. The purpose of this discussion is to highlight reasons for ambiguity in this area. Changing Population Demographics The lasr several decades have been characrerized by longer Iifespan. This is likely the resulr of several factors, including major declines in mortality related to stroke and cardiovascular disease. Population groups above age 65 are now among the most rapidly growing segments in the United States (1). One conseąuence of lower mortality from coronary and cerebrovascular events is the delayed appearance of vascular disease affecting other bed~, such as the aorta and kidneys (2). As a result, clinical manifestations of renal altelY stenosis are appearing in older individuals, often combinecl with other comorbid diseases. These features change the clinical presentation and affect the risk/benefit considerations inherent in deciding whether to consider renal revascularization. Series with renal artelY intelvention now routinely include average age values above 70 years, whereas a decade ago the mea n age was between 61 and 63 years and series from the 1970s reported a mean age in the 50s (3,4). Changing Medical Therapy Since the early 1980s, new classes of antihypertensive agents have become available and widely used. These