Renal revascularization with polytetrafluoroethylene grafts.
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Aged↗
Biomedical subjects
A C Novick
Publications and source records attributed to A C Novick.
Renal artery stenosis, nephrotic-range proteinuria, and focal and segmental glomerulosclerosis.
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Glomerulonephritis↗
Digital subtraction angiography for noninvasive imaging of the renal artery.
Digital subtraction angiography (DSA) is a relatively new radiologic technique for noninvasive imaging of arterial anatomy. DSA has been shown to be effective in defining the renal arteries in patients with known or suspected renovascular disease. DSA is an excellent means of screening for renovascular disease and of following patients with serial studies after surgical revascularization or percutaneous dilatation of renal arterial stenosis. It is excellent for monitoring patients with known renovascular disease.
Angiography↗
Coronary artery disease in 100 diabetics with end-stage renal failure.
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Adult↗
Diminished operative risk and improved results following revascularization for atherosclerotic renovascular disease.
Refinements in patient selection, preoperative preparation, and the technical performance of vascular reconstruction have improved the results of revascularization in atherosclerotic renovascular disease. These advances have expanded the eligibility criteria for surgical therapy in this group and now also appear to be favorably influencing late patient survival. This article documents this improved outlook and focuses on the policies in management that have been primarily responsible for its development.
Adult↗
Microvascular reconstruction of complex branch renal artery disease.
The task of renal revascularization is considerably more complicated in patients with branch disease because of the necessity to perform multiple vascular anastomoses to renal artery branches that may be difficult to expose and are small in caliber. Technical advances during the past decade, namely, incorporation of microvascular and extracorporeal techniques into the armamentarium of the renovascular surgeon, have improved this outlook. This article focuses on general microvascular principles and specific reconstructive techniques currently applicable to patients with branch renal artery disease.
Aneurysm↗
Revascularization to preserve renal function in patients with atherosclerotic renovascular disease.
There are a significant number of patients with advanced atherosclerotic renovascular disease whose blood pressure is well controlled with medical therapy but in whom such vascular disease poses a grave risk to overall renal function. This article reviews current concepts regarding screening, evaluation, and selection of patients with this disease for revascularization to preserve renal function. The underlying rationale for this approach is an increasing awareness that, in selected patients, atherosclerotic renovascular disease represents a surgically correctable cause of progressive renal failure.
Arteriosclerosis↗
The natural history of atherosclerotic and fibrous renal artery disease.
From 1969 to 1979, 169 patients with two or more renal angiograms for renovascular disease (85 atherosclerotic, 75 fibrous, 9 atherosclerotic and fibrous) were reviewed in an attempt to characterize progression of disease and to determine clinical markers of progression. Progression of renal artery atherosclerosis was observed in 37 patients (44 per cent); progression to complete occlusion was observed in 14 patients (16 per cent). In the 66 patients with medial fibroplasia, progression was observed in 22 patients (33 per cent). Serial serum creatinine measurements in conjunction with measurements of kidney size may be used as markers of progressive atherosclerotic renovascular disease. These clinical markers did not represent progressive disease for individuals with medial fibroplasia.
Adult↗
Predictive value of angiotensin II antagonists in renovascular hypertension.
An angiotensin II antagonist, sarcosine-1, threonine-8 angiotensin II ( [Sar1, Thr8] A II), was infused preoperatively in 14 patients with renal artery stenosis. Postoperative graft patency was documented by renal flow scan in 13 patients. One of these required antihypertensive therapy immediately after surgery, while the other 12 had a significant BP reduction in the first postoperative week (141 +/- 3.7 to 110 +/- 1.6 mm Hg). With longer follow-up, six patients remained normotensive (group 1), while the other six had "residual hypertension" (group 2). There was no significant difference between the two groups as regards age, preoperative BP level, plasma renin activity, blood volume, or response to [Sar1, Thr8] A II. In contrast, clinical signs were most helpful in predicting response to surgery. "Cured" patients had shorter duration of hypertension (less than one year) than patients with residual hypertension, and less impairment of renal excretory function; three patients in group 2 but none in group 1 had a history of malignant hypertension. The decision to operate remains a multifactorial evaluation and cannot be based on results of any single test alone.
Adult↗
Preservation of the ureteral blood supply in rat renal transplantation.
A new technique of preserving ureteral blood supply in heterotopic rat renal transplantation is described. This entails leaving an intact gonadal artery in continuity with the donor aortic stump, which is anastomosed to the recipient aorta. Comparison of this technique with conventional methods wherein the spermatic artery is ligated revealed a marked decrease in the incidence of ureteral complications with the former. Preservation of adequate blood supply to the ureter in experimental rat renal transplantation provides more consistent results and lessens the risk of unnecessary animal loss.
Animals↗
Radiation-induced cystitis following intracavitary irradiation for superficial bladder cancer.
Intracavitary irradiation is effective in the treatment of noninvasive papillary transitional cell carcinoma and carcinoma in situ of the bladder. Mortality has not been associated with this form of therapy. The morbidity associated with intracavitary irradiation consists of mild to severe radiation cystitis and we report 2 such cases. One patient is from a series of 65 patients with noninvasive bladder tumors treated with intracavitary irradiation at this clinic since 1965. The second patient had noninvasive bladder tumors and was treated with intracavitary irradiation elsewhere. In both patients severe radiation cystitis subsequently developed, requiring simple cystectomy and urinary diversion. The potential for this serious side effect must be considered when choosing a form of therapy for patients with noninvasive papillary transitional cell carcinoma and carcinoma in situ of the bladder.
Aged↗
Improved results of cadaver renal transplantation in the diabetic patient.
The results of 54 renal transplants performed on 48 patients with end stage renal disease and insulin-dependent diabetes mellitus are reported. Pre-transplant screening with coronary angiography was done to determine the presence and severity of coronary artery disease and left ventricular dysfunction. There were 12 living related donor (group 1) and 42 cadaver renal transplants. The cadaver transplant recipients were grouped further into those who received additional prophylactic immunosuppression with antilymphoblast globulin (group 2, 18 patients) and those who received standard immunosuppression with azathioprine and prednisone (group 3, 18 patients). The 2-year patient and graft survival rates in groups 1 to 3 were 81 and 67, 88 and 69, and 61 and 32 per cent, respectively. The use of prophylactic antilymphoblast globulin for adjunctive immunosuppression resulted in significantly improved graft survival among cadaver recipients (p less than 0.003). Selection of patients for transplantation on the basis of preliminary screening with coronary angiography was found to have a major impact on patient survival.
Adult↗
Predictive value of angiotensin II blockade with (sarcosine-1, threonine-8) angiotensin II in renovascular hypertension.
Administration of an angiotensin II antagonist, (sarcosine-1, threonine-8) angiotensin II, was used to diagnose renovascular hypertension in 22 patients before renal revascularization or nephrectomy. Positive and negative responses to infusion occurred in 12 and 10 patients, respectively. Postoperatively, hypertension was cured in 13 patients, improved in 6 and unchanged in 3. The over-all accuracy of the infusion test in predicting the outcome of surgical therapy was 59 per cent, the false positive rate was 8.3 per cent and the false negative rate was 80 per cent. A similar high incidence of false negative results has been observed with differential renal vein plasma renin assays. The most accurate prediction of the blood pressure response to surgical therapy is obtained by considering multiple factors rather than a single test.
Adolescent↗
Simultaneous structural and functional imaging of the transplant kidney using digital subtraction angiography.
We herein describe our preliminary experience with digital subtraction angiography in the noninvasive evaluation of renal transplant structure and function. A single digital subtraction angiography study was obtained in 38 patients with transplant kidneys and various levels of renal function. The main renal artery was demonstrated well in all studies. Stored digital information was used to generate appearance and clearance rates of contrast medium to produce a functional renal image. There was good correlation between the functional image pattern on digital subtraction angiography and the known degree of renal functional impairment. No adverse effects resulted from the small dose of intravenous contrast material used for angiography. This initial study suggests that digital subtraction angiography is a rapid, safe and noninvasive method for visualization of the transplant kidney, and can afford clinically relevant structural and functional information.
Adult↗
Concomitant carotid, mesenteric and renal artery stenosis due to primary intimal fibroplasia.
We report 2 cases of primary intimal fibroplasia involving the carotid, mesenteric and renal arteries. These patients presented with hypertension and neurological symptoms. Clinical and histologic features of neurofibromatosis or Takayasu's arteritis were absent. In both cases successful staged carotid and renovascular reconstruction was performed. Primary intimal fibroplasia may be a more generalized process than has been considered previously.
Adult↗
Revascularization for preservation of renal function in patients with atherosclerotic renovascular disease.
Fifty-one patients with atherosclerotic renovascular disease have undergone elective revascularization primarily to preserve renal function. In all patients the blood pressure was well controlled preoperatively with medical therapy and was not an indication for revascularization. The preoperative serum creatinine value was 2.0 mg./dl. or more in 35 patients and less than 2.0 mg./dl. in 16. Vascular reconstruction was technically successful in all patients, with postoperative followup ranging from 4 to 76 months. The current level of over-all renal function is improved in 34 patients (67 per cent), unchanged in 14 (27 per cent) and deteriorated in 3 (6 per cent). In selected patients with atherosclerotic renal artery disease revascularization can achieve preservation or improvement of renal function.
Aged↗
Extended cadaver renal preservation with combined simple cold storage and hypothermic pulsatile perfusion.
Although simple cold storage and hypothermic pulsatile perfusion are each accepted methods of cadaver kidney preservation the efficacy of combining these techniques for extended renal preservation is unclear. In 18 patients cadaver allografts were used that had been preserved with combined simple cold storage (range 6 to 20 hours) and hypothermic pulsatile perfusion (range 9 to 38 hours). The total interval of preservation for these kidneys ranged from 25 to 48 hours. Excellent post-transplant graft function was achieved in all cases, with a mean serum creatinine nadir of 1.4 mg./dl. In 14 patients (78 per cent) grafts continued to function at intervals of 3 to 38 months after transplantation. Of the remaining 4 patients 3 lost the grafts to rejection, while 1 died 7 months after transplantation with a well functioning graft. These data suggest that the combination of simple cold storage and hypothermic pulsatile perfusion provides a safe and effective method for extended renal preservation.
Adolescent↗
A controlled randomized double-blind study of antilymphoblast globulin in cadaver renal transplantation.
Herein are presented the results of a controlled prospective randomized double-blind evaluation of antilymphoblast globulin as an immunosuppressive adjunct to azathioprine and prednisone in cadaver renal transplantation. There were 31 patients and 36 patients randomly assigned to therapeutic and control groups, respectively. ALG-treated patients experienced no major side-effects, a delayed onset of rejection following transplantation (P less than .005), a reduced total number of rejection episodes (P less than .05), fewer days in the hospital (P less than .05), a reduced cost of transplantation (P less than .02), improved graft survival (P less than .05), and patient survival equivalent to that of the control group. These data indicate that ALG is safe, cost-effective, and of immunologic benefit in cadaver renal transplantation.
Adult↗