Renal artery stenosis resident survival guide: Difference between revisions

Jump to navigation Jump to search
 
(40 intermediate revisions by 2 users not shown)
Line 2: Line 2:
{{WikiDoc CMG}}; {{AE}} {{KGH}}
{{WikiDoc CMG}}; {{AE}} {{KGH}}


==Definition==
==Overview==
Renal artery stenosis is defined as a dimished diameter of the lumen of the renal artery.
Renal artery stenosis is defined as a dimished diameter of the lumen of the renal artery.
Renal artery of >70% is considered hemodynamically significant.<ref name="pmid23457117">{{cite journal| author=Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH et al.| title=Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA guideline recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2013 | volume= 127 | issue= 13 | pages= 1425-43 | pmid=23457117 | doi=10.1161/CIR.0b013e31828b82aa | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23457117  }} </ref>
Renal artery of >70% is considered hemodynamically significant.<ref name="pmid23457117">{{cite journal| author=Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH et al.| title=Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA guideline recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2013 | volume= 127 | issue= 13 | pages= 1425-43 | pmid=23457117 | doi=10.1161/CIR.0b013e31828b82aa | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23457117  }} </ref>
Line 18: Line 18:
* [[Radiation]]
* [[Radiation]]


==Managment of RAS==
==Management==
===Clinical Clues to the Diagnosis of RAS===
===Diagnostic Approach===
Shown below is the diagnostic approach to RAS based on the 2013 AHA Guidelines Recommendations for Management of Patients with PAD.<ref name="pmid23457117">{{cite journal| author=Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH et al.| title=Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA guideline recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2013 | volume= 127 | issue= 13 | pages= 1425-43 | pmid=23457117 | doi=10.1161/CIR.0b013e31828b82aa | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23457117  }} </ref>
 
{{familytree/start}}
{{familytree/start}}
{{familytree | | | | A01 | |A01='''Determine if one or more of the following is present:'''  <br> <div style="float: left; text-align: left;"> ❑ Onset of hypertension before the age of 30 years <br> ❑ Onset of severe hypertension after the age of 55<br> ❑ Accelerated, resistant, or [[malignant hypertension]]<br> ❑ Development of new [[azotemia]] or worsening renal function after administration of an [[ACE inhibitor]] or [[ARB]] agent<br> ❑ Unexplained [[atrophic kidney]] or size discrepancy between kidneys >1.5 cm<br> ❑ Sudden, unexplained pulmonary edema<br> ❑ Unexplained renal dysfunction, including individuals starting renal replacement therapy<br>❑ Multi-vessel [[CAD]]<br> ❑ Unexplained [[CHF]]<br> ❑ Refractory [[angina]] </div>}}
{{familytree | | | | | A01 | |A01='''Determine if one or more of the following is present:'''  <br> <div style="float: left; text-align: left; height: 17em; width: 37em; padding:1em;"> ❑ Onset of hypertension before the age of 30 years <br> ❑ Onset of severe hypertension after the age of 55<br> ❑ Accelerated, resistant, or [[malignant hypertension]]<br> ❑ Development of new [[azotemia]] or worsening renal function after administration of an [[ACE inhibitor]] or [[ARB]] agent<br> ❑ Unexplained [[atrophic kidney]] or size discrepancy between kidneys >1.5 cm<br> ❑ Sudden, unexplained pulmonary edema<br> ❑ Unexplained renal dysfunction, including individuals starting renal replacement therapy<br>❑ Multi-vessel [[CAD]]<br> ❑ Unexplained [[CHF]]<br> ❑ Refractory [[angina]] </div>}}
{{familytree | | | | |!| | | | | | | | | | | | }}
{{familytree | | | | | |!| | | | | | | | | | | | }}
{{familytree | | | | B01 | | | | | | | B01='''If yes:''' <br>  <div style=height: 1em; width: 10em; padding:1em;">❑ Proceed with non-invasive imaging <ref name="pmid21719621‎">{{cite journal| author=Lao D, Parasher PS, Cho KC, Yeghiazarians Y| title=Atherosclerotic renal artery stenosis--diagnosis and treatment. | journal=Mayo Clin Proc | year= 2011 | volume= 86 | issue= 7 | pages= 649-57 | pmid=21719621‎ | doi=10.4065/mcp.2011.0181 | pmc=PMC3127560 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21719621  }} </ref><br> </div>}}
{{familytree | | | | | B01 | | | | | | | B01=<div style="float: left; text-align: left; height: 2em; width: 37em; padding:1em;">❑ Proceed with non-invasive imaging <ref name="pmid21719621‎">{{cite journal| author=Lao D, Parasher PS, Cho KC, Yeghiazarians Y| title=Atherosclerotic renal artery stenosis--diagnosis and treatment. | journal=Mayo Clin Proc | year= 2011 | volume= 86 | issue= 7 | pages= 649-57 | pmid=21719621‎ | doi=10.4065/mcp.2011.0181 | pmc=PMC3127560 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21719621  }} </ref><br> </div>}}
{{familytree | | | | |!| | | | | | | | | | | | | | | | | }}
{{familytree | | | | | |!| | | | | | | | | | | }}
{{familytree | | | | |!| | | | | | | | | | | }}
{{familytree | | | | | C01 | | | | | | | | | | | C01=<div style="float: left; text-align: left; height: 1em; width: 37em; padding:1em;">'''Is the patient allergic to contrast?'''</div>}}
{{familytree | | | | C01 | | | | | | | | | | | C01=<div style="height: 1em; width: 15em; padding:1em;">'''Is patient allergic to contrast'''</div>}}
{{familytree | | |,|-|-|^|-|-|.| | | | | | | | | | }}
{{familytree | | |,|-|^|-|.| | | | | | | | | | }}
{{familytree | | C02 | | | | C03 | | | | | | | | | C02= '''Yes'''| C03= '''No'''}}
{{familytree | | D01 | | D02 | | | | | | | D01= '''If yes:'''<br> <div style=float: left; text-align: left;">❑ Proceed with US<br></div>| D02= '''If no check for:''' <br><div style=float: left; text-align: left;"> ❑ Implanted devices:<br> - Pacemakers<br> - Defibrillators<br> - Cochlear implants<br> - Spinal cord stimulators <br> ❑ Claustrophobic patient </div>}}
{{familytree | | |!| | | | | |!| | | | | | | | | | }}
{{familytree | | |!| |,|-|^|-|.| | | | | | | |}}
{{familytree | | |!| | | | | D01 | | | | | | | D01= <div style="float: left; text-align: left; height: 12em; width: 20em; padding:1em;">'''Does the patient has any of the following?'''<br> ❑ Implanted devices:<br> - [[Pacemaker]]s<br> - [[Defibrillator]]s<br> - [[Cochlear implants]]<br> - Spinal cord stimulators <br> ❑ [[Claustrophobia]] </div>}}
{{familytree | | |!| E01 | | E02 | | | | | | | | | E01=<div style="height: 3em; width: 10em; padding:1em;">If none of the above proceed with [[MRA]]  
{{familytree | | |!| | | |,|-|^|-|.| | | | | | | |}}
</div>| E02= <div style="height: 3em; width: 13em; padding:1em;">If yes to any of the above, proceed with [[CT]]</div>}}
{{familytree | | |!| | | D03 | | D04 | | | | | | | D03= '''No'''| D04= '''Yes'''}}
{{familytree | | |`|-|-|+|-|-|'| | | | | | | |}}
{{familytree | | |!| | | |!| | | |!| | | | | | | |}}
{{familytree | | | |,|-|^|-|.| | | | | | | | |}}
{{familytree | | E01 | | E02 | | E03 | | | | | | | | | E01=❑ Proceed with [[US]]| E02= ❑ Proceed with [[MRA]] | E03= ❑ Proceed with [[CT]]}}
{{familytree | | | F01 | | F02 | | | | | | F01= '''Inconclusive noninvasive test but with high clinical index of suspicion:''' <br><div style=float: left; text-align: left;"> ❑ Perform catheter angiography</div> | F02= <div style="height: 6em; width: 10em; padding:1em;">'''Confirmed RAS:'''
{{familytree | | |`|-|-|-|+|-|-|-|'| | | | | | |}}
❑Proceed to treatment</div>}}
{{familytree | | | | |,|-|^|-|.| | | | | | | | |}}
{{familytree | | | | F01 | | F02 | | | | | | F01= '''Inconclusive noninvasive test but with high clinical index of suspicion:''' <br>❑ Perform [[angiography|catheter angiography]] | F02= '''Confirmed RAS:''' <br> ❑ Proceed to treatment}}
{{familytree/end}}
{{familytree/end}}


Algorithm based on the 2013 AHA Guidelines Recommendations for Management of Patients with PAD.<ref name="pmid23457117">{{cite journal| author=Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH et al.| title=Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA guideline recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2013 | volume= 127 | issue= 13 | pages= 1425-43 | pmid=23457117 | doi=10.1161/CIR.0b013e31828b82aa | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23457117  }} </ref>
<br>
 
=== Therapeutic Approach===
Shown below is the diagnostic approach to RAS based on the 2013 AHA Guidelines Recommendations for Management of Patients with PAD.<ref name="pmid23457117">{{cite journal| author=Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH et al.| title=Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA guideline recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2013 | volume= 127 | issue= 13 | pages= 1425-43 | pmid=23457117 | doi=10.1161/CIR.0b013e31828b82aa | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23457117  }} </ref>


==Treatment==
{{familytree/start}}
{{familytree/start}}
{{familytree | | | | | | | | A01 | |A01='''Initiate a regimen that combines:''' <br> <div style="float: left; text-align: left;"> ❑ Antihypertensives
{{familytree | | | A01 | |A01='''Initiate a regimen that combines:'''<ref name="pmid22279335">{{cite journal| author=Annigeri RA| title=Medical therapy is best for atherosclerotic renal artery stenosis: Arguments for. | journal=Indian J Nephrol | year= 2012 | volume= 22 | issue= 1 | pages= 1-4 | pmid=22279335 | doi=10.4103/0971-4065.91177 | pmc=PMC3263056 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22279335  }} </ref> <br> <div style="float: left; text-align: left; height: 21em; width: 30em; padding:1em;"> ❑ Tight blood pressure control to <130/80 mmHg (120/75 mmHg if proteinuria is present) with:
*[[ACEI]]  
[[ACEI]], or<br>
*[[ARB]]  
[[ARB]], or<br>
*[[CCB]]  
[[CCB]], or<br>
*[[beta blockers]] <br> <div style="float: left; text-align: left;"> ❑ Statins <br> ❑ Optimal glycemic control <br> ❑ Smoking cessation counseling [[angina]] </div>}}
[[Beta blockers]] <br> ❑ Control of hyperlipidemia (LDL cholesterol <70 mg/dl) with [[statins]] <br> ❑ Glycemic control (hemoglobin A1c <7%) <br> [[Antiplatelet]] agents <br> ❑ Life style modifications:<br>
{{familytree | | | | | | | | |!| | | | | | }}
Smoking cessation counseling
{{familytree | | | | | | | | F01| | | | | | | F01= '''Determine if the following conditions are met:''' <br> <div style="float: left; text-align:left;"> ❑ Hypertension controlled on <3 drugs <br> ❑ Stable mild/moderate renal insufficiency <br> ❑ Advanced renal atrophy (<7.5 cm) <br> ❑ Doppler ultrasonographic renal resistance index >80 (<7.5 cm) <br> ❑ History or clinical evidence of cholesterol embolisation </div>}}
♦ Normalization of body weight </div>}}
{{familytree | | | | | | |,|-|^|-|.| | | | | | }}
{{familytree | | | |!| | | | | | }}
{{familytree | | | | | | G01 | | G02 | | | | | G01= '''If yes:''' <br> ❑ Conservative treatment/watchful waiting | G02= '''If no:'''<br> ❑ Check if any of the following are present}}
{{familytree | | | B01 | | | | | | | B01= '''Proceed to evaluate clinical indications for revascularization'''}}
{{familytree | | | | | | | | | | |!| | | | | | }}
{{familytree | | | |!| | | | | | | | }}
{{familytree | | | | | | | | | | H01 | | | H01= <div style="float: left; text-align:left;"> ❑ Hemodynamically significant RAS (see table above) with recurrent, unexplained [[CHF]] or sudden, unexplained [[pulmonary edema]] <br> ❑ RAS with: <br>
{{familytree | | | C01 | | | | | C01= '''Does the patient has any of the following?'''<br> <div style="float: left; text-align: left; height: 19em; width: 30em; padding:1em;"> ❑ RAS with: <br>
- Accelerated, resistant, or [[malignant hypertension]] <br>
- Accelerated, resistant, or [[malignant hypertension]] <br>
- Hypertension with unilateral small kidney <br>
- [[Hypertension]] with an unexplained unilateral small kidney <br>
- Hypertension with medication intolerance <br> ❑ RAS and [[CRI]] with bilateral RAS or RAS to solitary functioning kidney <br> ❑ RAS and [[unstable angina]] <br> ❑ Asymptomatic bilateral or solitary viableʰ kidney with a hemodynamically significant RAS <br> ❑ Asymptomatic unilateral hemodynamically significant RAS in a viable kidney (>7cm) <br> ❑ RAS and [[CRI]] with unilateral RAS (2 kidneys present) </div>}}  
- [[Hypertension]] with medication intolerance <br> ❑ Progressive [[CKD]] with bilateral RAS or RAS to a solitary functioning kidney <br> ❑ Hemodynamically significant RAS with recurrent, unexplained[[CHF]] or sudden, unexplained [[pulmonary edema]] <br> ❑ [[Unstable angina]] <br> ❑ Asymptomatic bilateral or solitary viable kidney <br> ❑ [[Chronic renal failure]] with unilateral RAS </div>}}
{{familytree | | | | | | | | | | |!| | | | | | }}
{{familytree | | | |!| | | | | | }}
{{familytree | | | | | | | | | | I01 | | | I01= ❑ '''If answered yes to any:'''}}
{{familytree | |,|-|^|-|.| | | | }}
{{familytree | | | | | | | | | | |!| | | | | }}
{{familytree | D01 | | D02 | | D01='''If any of the above AND:'''<br><div style="float: left; text-align: left; height: 8em; width: 20em; padding:1em;"> ❑ [[Atherosclerosis|Ostial atherosclerotic RAS]], '''OR'''<br>  ❑ [[Fibromuscular dysplasia]] </div> | D02= '''If any of the above AND:''' <br><div style="float: left; text-align: left; height: 8em; width: 20em; padding:1em;"> ❑ Complex [[fibromuscular dysplasia]] disease that extends into segmental arteries, '''OR''' <br> ❑ [[Aneurysm|Macroaneurysms]], '''OR''' <br> ❑ [[Atherosclerosis|Atherosclerotic]] RAS with multiple small renal arteries or early primary branching of the main [[renal artery]]</div> }}
{{familytree | | | | | | | |,|-|-|^|-|-|.| | }}
{{familytree | |!| | | |!| | | | | }}
{{familytree | | | | | | | J01 | | | | J02 | | J01= '''Renal Angioplasty/Stent'''| J02= ❑ '''Renal artery surgery'''}}
{{familytree | E01 | | E02 | E01=Endovascular treatment | E02=Renal artery surgery }}  
{{familytree | | | | | | |!| | | | | | | | | | }}
{{familytree | | | |,|-|-|^|-|-|.| | }}
{{familytree | | | K01 | | | | K02 | K01=<div style="height: 1em; width: 25em; padding:1em;">Atherosclerotic RAS'''  
</div>| K02= <div style="height: 1em; width: 25em; padding:1em;">Fibromuscular dysplasia RAS'''
</div>}}
{{familytree | | | |!| | | | | |!| | }}
{{familytree | | | L01 | | | | L02 | | L01= Renal stent placement is indicated for ostial atherosclerotic RAS lesions that meet the clinical criteria for intervention |L02= Balloon angioplasty with bailout stent placement if necessary is recommended for fibromuscular dysplasia lesions}}
{{familytree/end}}
{{familytree/end}}
Algorithm based on the 2013 AHA Guidelines Recommendations for Management of Patients with PAD.<ref name="pmid23457117">{{cite journal| author=Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH et al.| title=Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA guideline recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2013 | volume= 127 | issue= 13 | pages= 1425-43 | pmid=23457117 | doi=10.1161/CIR.0b013e31828b82aa | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23457117  }} </ref>  <ref name="pmid12117859">{{cite journal| author=Haller C|title=Arteriosclerotic renal artery stenosis: conservative versus interventional management. | journal=Heart | year= 2002 | volume= 88 | issue= 2 | pages= 193-7 |pmid=12117859 | doi= | pmc=PMC1767237 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12117859  }}</ref>


==References==
==References==

Latest revision as of 00:25, 13 March 2014

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Karol Gema Hernandez, M.D. [2]

Overview

Renal artery stenosis is defined as a dimished diameter of the lumen of the renal artery. Renal artery of >70% is considered hemodynamically significant.[1]

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. Renal artery stenosis does not have life threatening causes.

Common Causes

Management

Diagnostic Approach

Shown below is the diagnostic approach to RAS based on the 2013 AHA Guidelines Recommendations for Management of Patients with PAD.[1]

 
 
 
 
Determine if one or more of the following is present:
❑ Onset of hypertension before the age of 30 years
❑ Onset of severe hypertension after the age of 55
❑ Accelerated, resistant, or malignant hypertension
❑ Development of new azotemia or worsening renal function after administration of an ACE inhibitor or ARB agent
❑ Unexplained atrophic kidney or size discrepancy between kidneys >1.5 cm
❑ Sudden, unexplained pulmonary edema
❑ Unexplained renal dysfunction, including individuals starting renal replacement therapy
❑ Multi-vessel CAD
❑ Unexplained CHF
❑ Refractory angina
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
❑ Proceed with non-invasive imaging [2]
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Is the patient allergic to contrast?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Does the patient has any of the following?
❑ Implanted devices:
- Pacemakers
- Defibrillators
- Cochlear implants
- Spinal cord stimulators
Claustrophobia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No
 
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
❑ Proceed with US
 
❑ Proceed with MRA
 
❑ Proceed with CT
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Inconclusive noninvasive test but with high clinical index of suspicion:
❑ Perform catheter angiography
 
Confirmed RAS:
❑ Proceed to treatment
 
 
 
 
 


Therapeutic Approach

Shown below is the diagnostic approach to RAS based on the 2013 AHA Guidelines Recommendations for Management of Patients with PAD.[1]

 
 
Initiate a regimen that combines:[3]
❑ Tight blood pressure control to <130/80 mmHg (120/75 mmHg if proteinuria is present) with:

ACEI, or
ARB, or
CCB, or
Beta blockers
❑ Control of hyperlipidemia (LDL cholesterol <70 mg/dl) with statins
❑ Glycemic control (hemoglobin A1c <7%)
Antiplatelet agents
❑ Life style modifications:
♦ Smoking cessation counseling

♦ Normalization of body weight
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Proceed to evaluate clinical indications for revascularization
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Does the patient has any of the following?
❑ RAS with:

- Accelerated, resistant, or malignant hypertension
- Hypertension with an unexplained unilateral small kidney

- Hypertension with medication intolerance
❑ Progressive CKD with bilateral RAS or RAS to a solitary functioning kidney
❑ Hemodynamically significant RAS with recurrent, unexplainedCHF or sudden, unexplained pulmonary edema
Unstable angina
❑ Asymptomatic bilateral or solitary viable kidney
Chronic renal failure with unilateral RAS
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
If any of the above AND:
 
If any of the above AND:
❑ Complex fibromuscular dysplasia disease that extends into segmental arteries, OR
Macroaneurysms, OR
Atherosclerotic RAS with multiple small renal arteries or early primary branching of the main renal artery
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Endovascular treatment
 
Renal artery surgery

References

  1. 1.0 1.1 1.2 Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH; et al. (2013). "Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA guideline recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". Circulation. 127 (13): 1425–43. doi:10.1161/CIR.0b013e31828b82aa. PMID 23457117.
  2. Lao D, Parasher PS, Cho KC, Yeghiazarians Y (2011). "Atherosclerotic renal artery stenosis--diagnosis and treatment". Mayo Clin Proc. 86 (7): 649–57. doi:10.4065/mcp.2011.0181. PMC 3127560. PMID 21719621‎ Check |pmid= value (help).
  3. Annigeri RA (2012). "Medical therapy is best for atherosclerotic renal artery stenosis: Arguments for". Indian J Nephrol. 22 (1): 1–4. doi:10.4103/0971-4065.91177. PMC 3263056. PMID 22279335.


Template:WikiDoc Sources