Author(s): Olin JW, Melia M, Young JR, Graor RA, Risius B
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Abstract PURPOSE: To determine the prevalence of atherosclerotic renal artery stenosis in patients who have atherosclerosis elsewhere but lack the usual clinical clues to suggest renal artery stenosis. PATIENTS AND METHODS: The arteriograms and charts of 395 consecutive patients were prospectively reviewed by a member of the Vascular Medicine Department and a member of the Radiology Department. These patients underwent arteriography as part of the routine evaluation for abdominal aortic aneurysm (109 patients), aorto-occlusive disease (21 patients), lower-extremity occlusive disease (189 patients), and suspected renal artery stenosis (76 patients). Patients in the first three groups did not have the usual clues that suggest renal artery stenosis. RESULTS: There was greater than 50\% renal artery stenosis in 41 patients (38\%) with abdominal aortic aneurysm, seven patients (33\%) with aorto-occlusive disease, 74 patients (39\%) with lower-extremity occlusive disease, and 53 patients (70\%) with suspected renal artery stenosis. The prevalence of renal artery stenosis was similar in diabetic and nondiabetic patients with abdominal aortic aneurysm, aorto-occlusive disease, or suspected renal artery stenosis, but higher in diabetics with lower-extremity occlusive disease (50\%) compared to nondiabetics with lower-extremity occlusive disease (33\%) (p = 0.022). High-grade bilateral disease was present in approximately 13\% of patients with abdominal aortic aneurysm or lower-extremity occlusive disease, and totally occluded renal arteries occurred in 5\% of the patients in these groups. There was an association between increasing degree of renal artery stenosis and the presence of hypertension and worsening of renal function. CONCLUSION: Patients with atherosclerosis elsewhere, especially abdominal aortic aneurysm, aorto-occlusive disease, or lower-extremity occlusive disease, have a high prevalence of significant renal artery stenosis even in the absence of the usual clues to suspect renal artery stenosis. Diabetic patients have a similar prevalence as nondiabetic patients. This information may have important therapeutic implications in patients being considered for vascular surgery.
This article was published in Am J Med
and referenced in Journal of Clinical & Experimental Cardiology