Letterbox finger

D Menzies
1988 BMJ (Clinical Research Edition)  
to baseline values within seven days; creatinine clearance was slightly but not significantly reduced (from 81 (9) to 77 (12) ml/min) two days after embolisation but seven days after embolisation was 92 (9) ml/min. Serum creatinine concentration and creatinine clearance were unchanged from baseline values throughout the follow up. Comment The aim in managing renovascular hypertension is relief of the lesion causing hypertension. Recent reports have suggested that percutaneous renal embolisation
more » ... is useful in treating severe hypertension in patients receiving haemodialysis and after transplantation.' 2 We performed percutaneous renal embolisation in eight patients with renovascular hypertension and then monitored their blood pressure and renal function for a mean of 26 months (maximum 59 months). In all patients percutaneous transluminal dilatation and surgical bypass of the renal artery could not be performed because of arterial lesions. Total or partial surgical nephrectomy was too risky because of severe chronic hypertension, severe damage of target organs, and, in some patients, widespread atherosclerosis. Hypertension was not under control in any of the patients despite sustained treatment. The percutaneous renal embolisation was successful in all patients: systolic and diastolic pressures rapidly fell to normal. Severe hypertension returned in only one of the patients, five months after the embolisation. Our study shows that percutaneous renal embolisation is a safe and successful treatment of severe renovascular hypertension in cases that are unsuitable for percutaneous angioplasty or surgical bypass. The result is usually long lasting, but blood pressure should be measured for many months as hypertension may recur. 1 Nanni GS, Hawkins IF, Orak JK. Control of hypertension by ethanol renal ablation. Radiology 1983;148:51-4. 2 Fletcher EWL, Thompson JF, Chalmers DHK, et al. Embolisation of host kidney for the control of hypertension after renal transplantation. BrJ Radiol 1984;57:279-84. 3 Reuter SR, Pomeroy PR, Chuang VP, Cho KS. Embolic control of hypertension caused by segmental renal artery stenosis. AJR 1976;127:389-92. 4 LiPuma JP, Dresner I, Alfidi RJ, Yoon YS. Embolization of an occluded segmental renal artery via collateral circulation in a child. AJtR 1981;136:603-4. 5 Dal Canton A, Russo D, laccarino V, et al. Scleroembolization for treatment of hypertension caused by intrarenal fibrodyspasia.
doi:10.1136/bmj.296.6630.1161 fatcat:ttyyudnyc5hb3cbxoh4stxi4le