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 Printable version |
Isolated spontaneous dissection of the renal artery |
Sang Thrombose Vaisseaux. Volume 14, Number 2, 92-8, Février 2002, Mini-revues
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 Résumé
Article gratuit
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Author(s) : Michel Lacombe |
Summary : Isolated spontaneous dissection of the renal artery, without associated aortic dissection, is an uncommon cause of renovascular hypertension. It occurs sometimes as a complication of fibromuscular dysplasia but, in approximately half of cases, its cause is unknown. Its usual clinical presentation is the sudden onset of severe persistent and poorly controlled hypertension. Diagnosis rests mainly on angiography that shows, in typical cases, the aspect of a double lumen artery but, more frequently, atypical images (aneurysm, bulging of the artery, irregular stenosis, false obstruction). Medical treatment alone is indicated when hypertension is moderate and easily controlled by the treament. The indication of surgical treatment is severe and uncontrollable hypertension. Nephrectomy must be reserved for severely damaged kidneys and dissection extending to intrarenal surgically inaccessible branches. Arterial reconstruction is the ideal treatment. Extra-corporeal surgery has increased the feasibility of repair to complex cases and the ease and safety of these repairs. The results of surgical treatment on blood pressure control are very favourable provided that normal vascularization of the kidney(s) is re-established, and that renal parenchyma is healthy. Endovascular treatment has not proven to be feasible or effective in large series of cases. Follow-up of patients must be prolonged because late dissection may occur on the opposite side after unilateral involvement. |
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