Renovascular Arterial Hypertension Research Articles

Idebenone protects the kidneys of rats with renovascular arterial hypertension by inhibiting oxidative stress and apoptosis.

Here, the protective effect of antioxidant Idebenone (IDB) on renovascular hypertension was studied. The two-kidney one-clip (2K-1C) model of renal hypertension was established. The rats were divided into 3 groups: sham-operation group, 2K-1C renal hypertensive rats' model group and model treated with IDB group. The mean arterial blood pressure (MBP) of rats was measured and pathological condition of kidney was observed by H&E staining. The change of renal damage biomarkers (Cre, BUN, urine proteins), inflammatory factors (IL-6, IL-1β and TNF-α), oxidative stress ratio and key factors (MDA, SOD and CAT) were assessed by kits. The apoptosis key proteins (BAD, BAX, Caspase9, GSK-3β) were detected via Western blot. The 2K-1C model of renal hypertension was established. IDB reduced the MBP, Cre, BUN, urine proteins and improved the pathological condition of 2K-1C kidney. IDB restrained the inflammation factors (IL-6, IL-1β and TNF-α) and oxidative stress in kidney of renal hypertensive rats' model. Besides, IDB suppressed the expression of apoptosis key factors (BAD, BAX, Caspase9, GSK-3β) in kidney of renal hypertensive rats' model. IDB protects the kidneys of rats with renovascular arterial hypertension by inhibiting inflammation, oxidative stress, and apoptosis. These findings might provide medication guidance for IDB in renovascular arterial hypertension.

Treatment of renal artery fibromuscular dysplasia with drug-eluting balloon angioplasty and intravascular imaging: a case report

Fibromuscular dysplasia (FD) is a segmental, non-inflammatory and non-atherosclerotic disease of vascular smooth muscle of unknown etiology, which leads to stenosis of smalland medium-sized arteries. The choice of surgical treatment tactics for renal artery FD depends on the severity of clinical manifestations and the response to the conservative drug treatment used. Young age, female sex, high blood pressure with failure to achieve target values with therapy, as well as the absence of atherosclerotic involvement of other arterial systems gives reason to suspect renal artery FD. According to modern guidelines, the invasive treatment of hemodynamically significant renal artery stenoses includes transluminal drug-eluting balloon angioplasty. In this disease, renal artery stenting is not recommended. However, stent implantation is required if balloon angioplasty did not give the optimal result or in case of periprocedural complications, such as arterial dissection. Open reconstructive surgery is indicated for complex anatomy of the related artery, macroaneurysms in which stent grafts are ineffective, refractory intimal fibroplastic lesions, increased risk of endovascular treatment, or after unsuccessful endovascular intervention. The article presents a case of a young patient with renal artery FD, renovascular arterial hypertension, who successfully underwent renal artery transluminal drugeluting balloon angioplasty.

ТАКТИКА ЛЕЧЕНИЯ ТЯЖЕЛОЙ РЕФРАКТЕРНОЙ АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИИ У ПОДРОСТКА С ГИПОПЛАЗИЕЙ БРЮШНОЙ АОРТЫ И СТЕНОЗАМИ ПОЧЕЧНЫХ АРТЕРИЙ: КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ

Renovascular arterial hypertension (AH) is one of the most common and prognostically most serious secondary hypertensions in children, however, descriptions of renal artery stenosis as part of middle aortic syndrome are quite rarely described Worldwide, and the etiology of this syndrome remains unclear in more than half of all the cases. Treatment approaches include a combination of complex conservative and surgical endovascular techniques that require constant monitoring of effectiveness. A clinical case observation and treatment tactics for refractory hypertension in an adolescent patient with hypoplasia of the abdominal aorta, stenosis of both renal arteries, a progressive decline in the function and volume of the left kidney (a picture of shrinkage of the left kidney on scintigraphy, an increase in hyperazotemia) and left ventricular (LV) hypertrophy is presented. Due to the ineffectiveness of drug antihypertensive therapy, the patient subsequently underwent aortoaortic bypass surgery of the abdominal aorta with prosthetics and implantation of the left renal artery into the shunt, balloon vasodilation with the installation of stents in the lower pole artery of the left kidney and the right renal artery. Over time, there was an improvement in the velocity parameters of the vessels of both kidneys, a decrease in blood pressure to values close to normal and regression of LV hypertrophy. Conclusion: the treatment tactics for a patient with renovascular hypertension and hypoplasia of the abdominal aorta, including drug methods in combination with two-stage surgical correction - the application of an aortoaortic shunt and endovascular treatment - turned out to be the most effective in terms of controlled hypertension.

Effects of aurantiamide on a rat model of renovascular arterial hypertension.

Asperglaucide (ASP) is an aurantiamide, an effective constituent of purslane (Portulaca oleracea L.), a safe to eat greenery. Effects of ASP on endothelial function, endothelial nitric oxide synthase (eNOS) expression, vascular fluidity, renal and vascular reactive oxygen, and nitrogen species (ROS/RNS) production was examined in the two-kidney one-clip (2K-1C) rat model of renovascular arterial hypertension. ASP toxicity, dose dependent eNOS gene expression and protein levels were also analyzed in human umbilical vein endothelial cells (HUVEC). The 2K-1C model of hypertension was created via surgery and mean blood pressure (MBP) was measured by tail-cuff method during four weeks of ASP treatment. Erythrocyte deformability was monitored by rotational ektacytometry, while vascular constrictor and dilator responses were determined in organ baths. eNOS gene expression and protein levels were assessed in thoracic aorta and HUVEC. MBP was significantly decreased in hypertensive rats treated with ASP. Endothelium dependent vascular dilator and constrictor responses were also considerably improved following ASP treatment. There was a notable increase in red blood cell deformability in hypertensive rats treated with ASP as compared to hypertensive rats alone. A significant increase was observed in eNOS gene expression and protein levels in both normotensive and hypertensive rats treated with ASP. Treatment of HUVEC with 3µM ASP notably increased eNOS mRNA and protein levels. In conclusion, ASP lowered blood pressure, improved endothelium-mediated relaxation, decreased renovascular ROS/RNS production in hypertensive rats. ASP also increased eNOS protein expression in aorta and HUVEC at nontoxic doses. ASP may have future potential as an anti-hypertensive agent.

Interest of renal scintigraphy with captopril in the diagnosis of renovascular arterial hypertension

Introduction: Renal scintigraphy with captopril test of the kidney is a simple, non-invasive functional imaging technique that can be used to demonstrate the role of stenosis in the development of renovascular hypertension (RVH). It also makes it possible to distinguish renal artery stenosis responsible for RVH from stenosis associated with primary arterial hypertension. Objective: To illustrate the benefits of renal scintigraphy with captopril test in the diagnosis of RVH. Material and method: This was a prospective and descriptive study over a period of 12 months, from 1 March 2016 to 4 March 2017, carried out in the nuclear medicine department of the Institut des Radio Isotopes (IRI) in Niamey. The parameters studied were age, frequency, creatinemia, tracer used, relative perfusion, relative renal function and maximum uptake time. Results: We collected 6 cases presenting with either hypertension refractory to well-administered two- or three- therapy, or severe hypertension at the complication stage, or hypertension associated with hypokalaemia or unexplained renal failure or reversible renal failure induced by a conversion enzyme inhibitor. The mean age was 35 years. The age of diagnosis of hypertension ranged from 20 to 28 years. Four patients underwent echodoppler of the renal arteries: unilateral stenosis in patients A, C and F, and bilateral stenosis in patient D. The captopril test was positive in 3 cases, patients A, B and C. Conclusion: Dynamic renal scintigraphy with captopril testing is a non-invasive, low-radiation diagnostic method for the investigation of renovascular hypertension. It has a triple benefit, including the detection of the most severe arterial stenoses, the prediction of the curability of the stenosis by a revascularisation procedure and, finally, post-treatment follow-up.

Consensus on renovascular hypertension: diagnosis and treatment

The clinical significance of renovascular arterial hypertension is determined by it is high prevalence as well as it is negative impact on prognosis. The most common causes of renovascular arterial hypertension are atherosclerotic stenosis of the renal arteries and fibromuscular dysplasia. Renovascular arterial hypertension is characterized by the development of blood pressure resistant to antihypertensive therapy with an unfavorable prognosis of worsening renal function and cardiovascular complications. Currently, the most available screening method in the diagnosis of renovascular arterial hypertension is duplex scanning of the renal arteries. Non-invasive diagnostic methods also include magnetic resonance and multispiral computed tomography with intravenous contrast. Contrast angiography remains “the golden standard” for diagnosing renovascular arterial hypertension and determining the indications for surgical treatment. Together with the use of diagnostic techniques such as measurement of translesion pressure gradient and fractional blood flow reserve, it allows to assess the functional significance of renal artery stenosis. Treatment of renovascular arterial hypertension is a complex process aimed at normalization of blood pressure, improvement of renal function, as well as mortality and cardiovascular risk reduction. To date, the feasibility of endovascular treatment remains an open question. More often the preference is given to conservative treatment. The indications for renal artery revascularization are less obvious, available clinical guidelines and results of large trials are controversial.

Current trends in the use of the renin-angiotensin system blocking drugs in renovascular arterial hypertension

Renovascular hypertension (RH) is one of the most common secondary forms of arterial hypertension, in most cases caused by atherosclerotic renal artery stenosis (ARAS). The development of a course of hypertension resistant to antihypertensive therapy with an unfavorable prognosis of deterioration of kidney function and cardiovascular complications is characteristic. The review discusses the pathophysiological mechanisms of RH development in ARAS, draws attention to the important role of the renin-angiotensin system (RAS) activation, which determines the nature of the course of the disease, the high frequency of target organ damage. Modern approaches to the drug treatment of this form of hypertension, the validity and benefits of the use of drugs that block the effects of RAS in patients with RH of atherosclerotic genesis, constituting a category of high risk of cardiovascular complications, are The issues of the effectiveness of the use of these drugs in order to reduce the risk of cardiovascular complications and improve the long-term prognosis of the course of this form of hypertension are discussed.

Effects of asperglaucide on endothelium function in 2K1C hypertensive rats

Background and Aims : This study aimed to investigate the effects of Asperglaucide (ASP) on endothelial nitric oxide synthase (eNOS) expression, vascular fluidity and vascular endothelial function in the two-kidney one-clip (2K-1C) model of renovascular arterial hypertension.

Extensive Retroperitoneal Fibrosis Secondary to Spondylodiscitis: A Case Report

Retroperitoneal fibrosis is a rare pathology and often its etiology is unknown. The retroperitoneal fibrosis secondary to infectious diseases are infrequent. A delay in diagnosis can lead to irreversible complications, as renal failure and renovascular arterial hypertension. We describe a case of retroperitoneal fibrosis diagnosed two years after an Escherichia coli spondylodiscitis.

Clinical manifestations, course variants and complications of Takayasu arteritis in Kyrgyz patients

Objective: to study clinical presentation, course variants and complications of Takayasu arteritis (AT) in Kyrgyz patients.Patients and methods. 75 Kyrgyz patients with a definite diagnosis of AT were included in the study, most of them were women (93.3%). The median age was 33 [23; 40] years, the median duration of the disease was 7 [3.0; 13.0] years. The anatomical type of vascular lesions was determined using the angiographic classification of R. Moriwaki et al., the AT activity – according to the BVAS index, the clinical stage of AT – using the R. Jefferson classification, the severity and prognosis of the disease – according to the K. Ishikawa classification. Highly sensitivity CRP (hsCRP) was assessed in 44 (58.67%) patients, interleukin 6 (IL6) – in 26 (34.7%). Instrumental procedures included duplex Doppler ultrasonography of peripheral arteries and contrast-enhanced computed pan aortography.Results and discussion. The mean age of AT onset was 24.4±9.4 years. The majority of patients had V anatomical type of vascular lesions (61.3%), vascular stage (89.3%), severe stenosis (54.7%) with predominant affection of the brachiocephalic trunk (68%), common carotid arteries (53.7 %) and renal (52%) arteries. Most patients (82.7%) at the time of inclusion in the study had a severe exacerbation of AT according to the BVAS index. An increase in hsCRP level was seen in 66% of cases, IL6 – in 31%. At the onset of AT, 20% of patients had fever, general weakness, weight loss, myalgia and/or arthralgia. 43% of patients had ≥2 complications. The clinical manifestations of AT were mainly characterized by cardiovascular pathology (77.3%) with the formation of relative aortic valve insufficiency (AVI) (93.1%) and kidney damage (57.3%) with the development of renovascular arterial hypertension (91%). At the first visit, more than one third of patients (37.3%) had irreversible damage, accompanied in half of them by AVI degree II or III.Conclusion. Young women predominated among Kyrgyz patients with AT. Most of the patients had anatomical type V AT (61.3%), vascular stage (89.3%), severe stenosis (54.7%), affection of the brachiocephalic trunk (68%), common carotid (57.3%) and renal (52%) arteries. Severe exacerbation of the disease was observed in 82.7% of patients. The presence of ≥2 complications worsened the prognosis of AT. The clinical manifestations of AT were characterized mainly by cardiovascular pathology (77.3%) and kidney damage (57.3%). In more than one third of patients (37.3%) AT was diagnosed late.

Factors affecting the effectiveness of endovascular kidney revascularization in patients with renal arteria stenosis

The paper analyzes the results of surgical treatment of 109 patients with renal artery stenosis and manifestations of ischemic kidney disease (IBD) in the form of renovascular arterial hypertension. Blood pressure normalization was noted in 97 (89%) patients in the early and in 91 (84%) in the late postoperative periods. A sequential regression and multivariate correlation analysis of the factors of a good outcome of the operation was carried out. It was determined that significant prognostic factors are the presence of microalbuminuria and the duration of the history of arterial hypertension before surgery (correlation coefficients (HR) –0.684 and –0.695 at p = 0.0001). With these factors, the difference between the assessment of cumulative survival without clinical deterioration and the Cox proportional hazards regression model was statistically significant.

Changes in the expression of the MADD gene in experimental models of myocardial hypertrophy

Objective. The aim of the work was to evaluate the expression of the MADD gene during the development of myocardial hypertrophy caused by hemodynamic factors in the model of aortic coarctation, as well as in the model of renovascular arterial hypertension (model “2 kidney — 1 clip”). Design and methods. The study involved Wistar rats (n = 60) at the age of 8 weeks. Two experimental models of myocardial hypertrophy were used: the aortic coarctation model (n = 30) and the “2 kidneys — 1 clip” model (n = 21). Animals were divided into groups according to the duration of the experiment (1 and 10 weeks), we also formed a group of intact animals (n = 9). Myocardial hypertrophy was verified by echocardiography. After euthanasia and myocardial extraction, the tissues were homogenized in Extract RNA reagent (Evrogen) in order to obtain RNA. A complementary DNA strand was obtained by reverse transcription using Random (dN) 10-primer (Evrogen) and MMLV RT kit (Evrogen) primers. The relative expression level of the MADD gene in rat myocardium was determined using real-time polymerase chain reaction. The expression level was calculated using the ΔΔCt method; the GAPDH and HPRT genes were used as a reference control. Results. In the aortic coarctation model, MADD gene expression in the 1-week group was significantly higher (p < 0,05) compared with the intact group. In this model, there as a direct correlation of the expression of the MADD gene with NPPA gene, as well as with echocardiography indicators (final systolic size, final diastolic size, and myocardial mass index, p < 0,05), and an inverse relationship between MADD gene expression and the shortening fraction (p < 0,05). The renovascular hypertension model did not show a significant increase in the expression of the MADD gene in myocardium in experimental group compared to intact animals. Conclusions. The expression of the MADD gene increases mainly under the influence of acute hemodynamic overload, and is likely to be important for the immediate response by cardiomyocytes to pressure load. Correlation was found between the expression level of the MADD gene and such echocardiographic parameters as the shortening fraction, end-diastolic and end-systolic sizes of the left ventricle.

To determine diagnostic efficiency of vascular color Doppler ultrasound for renal artery stenosis

Background: Early diagnosis of RAS is an important clinical objective since interventional therapy may improve or cure hypertension and preserve renal function. The present study was conducted to determine diagnostic efficiency of vascular color Doppler ultrasound for renal artery stenoses. Materials & Methods: The present study was conducted on 43 suspected of having renovascular arterial hypertension patients of both genders. All patients were subjected to vascular color doppler ultrasound according to the direct technique with the patients in the supine position with low-frequency curve transducers (2 to 3.5 MHz) to allow greater penetration (10-12 cm) of the ultrasound beam.Results: Out of 43 patients, males were 22 and females were 21. Color Doppler of renal arteries, 14 were normal, 12 showed moderate stenosis, 8 had hemodynamically significant stenosis, 7 were obstructed and 2 were inconclusive. The difference was significant (P< 0.05). Sensitivity of color Doppler found to be 92.4%, specificity 91.5%, positive predictive value (PPD) 86.2% and negative predictive value (NPV) 88.1%.Conclusion: Early diagnosis of renal artery stenosis may be helpful in preventing renal hypertension. Color Doppler provides useful information in renal artery stenosis.

Aortic bypass and bilateral renal autotransplantation for mid-aortic syndrome

Middle aortic syndrome (MAS) is a rare condition characterized by stenosis of the proximal abdominal aorta and the origin of the renal and digestive arteries. When medical therapy and interventional radiology fail to control threatening reno-vascular arterial hypertension (AHT), surgery is required and may need several interventions, which are usually delayed until late childhood. We report on a 3-year-old girl with severe AHT (180/130 mmHg) caused by MAS. There was no evidence of generalized vascular disease or complications of AHT. AHT failed to respond to medical therapy (five drugs), endovascular dilatation, and stenting was considered unfeasible due to the complex multiple strictures. Surgery consisted of: explantation of the two kidneys; aortic bypass between the lower thoracic and lower abdominal aorta using a prosthetic graft; reimplantation of the kidneys onto the normal iliac arteries. The post-operative course was uneventful. Owing to recurrent stenosis of the re-implanted renal arteries, endoluminal dilatations were performed 4 and 5 months after surgery. Two years after surgery, the child is alive and well, off anti-hypertensive therapy, with normal blood pressure. Mild aortic syndrome can be treated with a one-stage surgical repair with aorto-aortic bypass and bilateral auto-transplantation, even in young children.

Energy Deficit as a Possible Factor for the Induction of Caspase-Dependent Apoptosis in Left Ventricular Myocardial Cells during Genetically Determined and Secondary Arterial Hypertension

Activities of caspase-3 and caspase-8 in the left ventricular myocardium of Chinchilla rabbits with renovascular arterial hypertension and spontaneously hypertensive rats were measured after 10-day administration of a macroergic compound phosphocreatine. Treatment with phosphocreatine prevented activation of caspase-3, but had no effect on caspase-8 during secondary and genetically determined arterial hypertension. Our results indicate that the intrinsic mechanism of the induction of the caspase cascade in myocardial cells dominates over the extrinsic pathway during both types of arterial hypertension. Energy deficit is one of the inducing factors of these processes.

Irbesartan improves autonomic tone in a mouse model of renovascular arterial hypertension

ObjectiveActivation of renin‐angiotensin‐aldsterone and sympathetic nervous system are consequences of renovascular arterial hypertension. Here, in a model of renovascular hypertension, the role of Angiotensin‐II blockade on autonomic tone was assessed.MethodsC57bl6n mice with implanted iliac‐artery catheters received a renal‐artery clip (2‐kidneys‐1 clip, 2K1C). Sham‐surgery mice served as normal controls. Blood pressure of unrestrained, conscious animals was recorded using telemetry. Animals were randomized to Irbesartan (10 mg/kg/d per orally) or vehicle for 7 days. Cumulative intensity of the low‐frequency (LF) band of systolic blood pressure variability (SBPV) (0.15 – 0.6 Hz) was considered as sympathetic tone, the high‐frequency band (2.5–5 Hz) of heart rate variability as parasympathetic tone. Spontaneous blood‐pressure changes were used for baroreflex‐sensitivity calculation using Hemolab software. One‐way ANOVA, Newman‐ Keul test were used to assess differences. P&lt;0.05 was deemed significant.ResultsTherapeutic‐dose Irbesartan did not lower blood pressure in the 2K1C model of arterial hypertension (Figure). However, both baroreflex and parasympathetic tone were significantly augmented by Irbesartan. Lastly, the difference of sympathetic tone between 2K1C and normal group partially vanished. Selective blockade of sympathetic tone by Metoprolol and, likewise, parasympathetic tone by Atropine confirmed the changes induced by Irbesartan on either component of autonomic nervous system (data not shown). As a mechanism, baroreflex control of heart rate was shown to be improved by Irbesartan.ConclusionAngiotensin‐receptor blocker partially normalizes both baroreflex function and parasympathetic tone in a renovascular model of arterial hypertension.

Effects of chronic antioxidant treatment on AT‐1 receptor, NAD(P)H oxidase subunits and main antioxidant enzymes gene expression in the kidneys of 2K‐1C rats

Previous studies showed that chronic treatment with an antioxidant: vitamin C (vC) improves hypertension and sympathetic vasomotor hyperactivity in an Ang II‐dependent model of renovascular arterial hypertension. To test the hypothesis that oxidative stress is associated with NAD(P)H oxidase activation by Ang II, gene expressions of AT‐1 receptor (AT1R), NAD(P)H oxidase subunits (p47phox and gp91phox) and main antioxidant enzymes were evaluated in the renal cortex of 2 kidney‐1 clip model (2K1C, 6 weeks after clipping) rats before and after vC (150mg/kg/day). Gene expression of AT1R was elevated (51%) in the clipped kidney (CK) and reduced (47%) in the nonclipped kidney (NK) of 2K1C group. vC reduced AT1R expression only in the CK (31%). Elevated gene expression of p47phox and gp91phox was observed only in the CK of 2K‐1C group (184% and 132%, respectively) and vC produced no changes in these expressions. Gene expression of catalase was reduced in the CK (70%) and NK (83%) of 2K1C rats. vC increased gene expression of glutathione peroxidase (GPx) in the CK (185%) and NK (212%) of 2K1C. The present study suggests that renal oxidative stress may be related to elevated AT1R and NAD(P)H oxidase subunits gene expression in the CK of 2K1C rats and vitC treatment may produce beneficial effects by AT1R downregulation in the CK and increase in GPx gene expression in the kidneys of 2K1C rats.Supported by FAPESP (07/56925‐1)

Chronic Antioxidant Treatment Improves Arterial Renovascular Hypertension and Oxidative Stress Markers in the Kidney in Wistar Rats

Sympathetic vasomotor hyperactivity and baroreflex dysfunction are involved in the development and maintenance of renovascular arterial hypertension. We hypothesized that angiotensin (Ang) II-dependent oxidative stress contributes to the pathophysiology of the two-kidney, one-clip (2K-1C) model. The mean arterial pressure (MAP), baroreflex, and renal sympathetic nerve activity (rSNA) were evaluated after chronic administration of an antioxidant, vitamin C (vitC 150 mg/kg/day) in male Wistar 2K-1C rats. Additionally, the mRNA levels of Ang II subtype 1 receptor (AT(1)R), NAD(P)H oxidase subunits (p47phox and gp91phox), and major antioxidant enzymes were evaluated in the renal cortex. After vitC treatment, the MAP (170 +/- 4 vs. 133 +/- 6 mm Hg; P < 0.05) and rSNA (161 +/- 5 vs. 118 +/- 12 spikes/s; P < 0.05) were significantly reduced only in the 2K-1C group. VitC improved the baroreflex control of heart rate (HR) and rSNA. The expression of AT(1)R, p47phox, and gp91phox was elevated (51, 184, and 132%, respectively) in the clipped kidney of 2K-1C group. VitC downregulated AT(1)R in the clipped kidney (31%). Catalase (CAT) expression was reduced in clipped (70%) and nonclipped (83%) kidneys of 2K-1C rats. VitC treatment augmented the expression of glutathione peroxidase (GPx) in both clipped (185%) and nonclipped (212%) kidneys of the 2K-1C group. The present study suggests a role for oxidative stress in the cardiovascular and sympathetic alterations in renovascular hypertension, associated with changes in the expression of AT(1)R, NAD(P)H oxidase subunits, and antioxidant enzymes in the kidney.

Tuberculosis of the Renal Artery: A Rare Cause of Renovascular Arterial Hypertension

Tuberculosis is an endemic disease in Morocco. Main blood vessels are rarely affected; the few mentioned cases are aneurysmal. We report a 17-year-old patient presenting with renovascular arterial hypertension, revealed thanks to the discovery of an occlusion of the right renal artery in Duplex scan. During the intervention, the observation of pararenal and mesenteric tuberculous polyadenopathy let us suggest the same kind of lesion at the level of the occluded renal artery. Once antituberculosis treatment had been carried out, the right renal artery was revascularized with a right iliorenal bypass using reversed internal saphenous vein. The postoperative course was uneventful, with an 18-month follow-up. Arterial pressure was normal without antihypertensive treatment, and the bypass was patent. As far as we know, this is the first case of renovascular arterial hypertension resulting from tuberculosis treated with an iliorenal bypass.

The coral reef aorta - a single centre experience in 70 patients

Coral reef aorta (CRA) is described as rock-hard calcifications in the visceral part of the aorta. These heavily calcified plaques grow into the lumen and can cause significant stenoses, which may lead to malperfusion of the lower limbs, visceral ischemia or hypertension due to renal ischemia. From January 1984 to February 2007, 70 patients (24 men, 46 women, mean age 59.5 years, range 14 to 81 years) underwent treatment in the Department of Vascular Surgery and Renal Transplantation, University Hospital, Heinrich-Heine-University (Düsseldorf, Germany) for CRA. The present study is based on a review of patients' records and the prospective follow-up in the outpatient clinic. The most frequent finding was renovascular arterial hypertension (44.3%) causing headache, vertigo and visual symptoms. Intermittent claudication due to peripheral arterial occlusive disease was found in 28 patients (40.0%). Seventeen patients (24.3%) presented with chronic visceral ischemia causing diarrhea, weight loss and abdominal pain. Sixty-nine of the 70 patients (98.6%) underwent surgery; in 57 patients, aortic reconstruction was achieved with thromboendarterectomy, performed on an isolated suprarenal segment in six cases (8.7%), an infrarenal segment in 15 cases (21.7%), and the supra- and infrarenal aorta in 43 cases (62.3%). Eight patients (11.6%) died during or soon after surgery. Postoperative complications requiring corrective surgery occurred in 11 patients (15.9%). Almost one-third of the patients (n=19, 27.5%) returned for follow-up after a mean of 52.6 months (range six to 215 months). Of the 19 patients, there was significant clinical and diagnostic improvement in 16 patients (84.2%) and three patients (15.8%) were unchanged. Impairment was not observed. Despite the existing and improving surgical techniques for the treatment of CRA, its pathophysiological basis and genesis is not yet understood.