The most common location for the development of atherosclerotic disease is:
Obstructive lesions of the renal artery can produce hypertension, resulting in a condition known as renovascular hypertension, which is the most common form of hypertension amenable to therapeutic intervention, and affects 5 to 10% of all hypertensive patients in the United States. Patients with renovascular hypertension are at an increased risk for irreversible end-organ dysfunction, including permanent kidney damage, if inadequate pharmacologic therapies are used to control the blood pressure. The majority of patients with renal artery obstructive disease have vascular lesions of either atherosclerotic disease or fibrodysplasia involving the renal arteries. The proximal portion of the renal artery represents the most common location for the development of atherosclerotic disease. It is well established that renal artery intervention, either by surgical or endovascular revascularization, provides an effective treatment for controlling renovascular hypertension as well as preserving renal function. The decision for intervention is complex and needs to consider a variety of anatomic, physiologic, and clinical features, unique for the individual patient.
Angiograph indications for renal artery revascularization include all of the following EXCEPT:
Indications for renal artery revascularization:
Aortoiliac disease represented by diffuse aortoiliac disease above the iliac artery is classified as:
Aortoiliac disease can be classified into three types.
The treatment of choice for type B iliac lesions is:
The most commonly used classification system of iliac lesions has been set forth by the TransAtlantic Inter-Society Consensus (TASC) group with recommended treatment options. This lesion classification categorizes the extent of atherosclerosis and has suggested a therapeutic approach based on this classification (Table and Fig. below). According to this consensus document, endovascular therapy is the treatment of choice for type A lesions, and surgery is the treatment of choice for type D lesions. Endovascular treatment is the preferred treatment for type B lesions, and surgery is the preferred treatment for good-risk patients with type C lesions. In comparison to the 2000 TASC document, the commission has not only made allowances for treatment of more extensive lesions, but also takes into account the continuing evolution of endovascular technology and the skills of individual interventionalists when stating the patient's comorbidities, fully informed patient preference, and the local operator's long-term success rates must be considered when making treatment decisions for type B and type C lesions.
TASC classification of aortoiliac occlusive lesions:
AAA = abdominal aortic aneurysm; CFA = common femoral artery; CIA = common iliac artery; EIA = external iliac artery.
Schematic depiction of TASC classification of aortoiliac occlusive lesions.
Carotid bifurcation occlusive disease resulting in stroke is usually caused by:
Stroke due to carotid bifurcation occlusive disease is usually caused by atheroemboli (Fig. below). The carotid bifurcation is an area of low flow velocity and low shear stress. As the blood circulates through the carotid bifurcation, there is separation of flow into the low-resistance internal carotid artery and the high-resistance external carotid artery.
Stroke due to carotid bifurcation occlusive disease is usually caused by atheroemboli arising from the internal carotid artery which provides the majority of blood flow to the cerebral hemisphere. With increasing degree of stenosis in the carotid artery, flow becomes more turbulent, and the risk of atheroembolization escalates.
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