RT Book, Section
A1 Weinberg, Ido
A1 Jaff, Michael R.
A2 Dean, Steven M.
A2 Satiani, Bhagwan
A2 Abraham, William T.
SR Print(0)
ID 1105290876
T1 ATHEROSCLEROTIC RENAL ARTERY STENOSIS
T2 Color Atlas and Synopsis of Vascular Diseases
YR 2015
FD 2015
PB McGraw-Hill Medical
PP New York, NY
SN 9780071749541
LK accesssurgery.mhmedical.com/content.aspx?aid=1105290876
RD 2024/04/20
AB A  67-year-old  man  treated  for  hypertension  (HTN)  for  the  past  25  years  is  now  having  difficulty  with  his  blood  pressure  control.  His  medical  history  is  notable  for  long-standing  hypercholesterolemia  and  former  tobacco  abuse  (25  pack-years)  until  1  month  ago  when  he  was  hospitalized  for  chest  pain.  At  that  time  his  blood  pressure  was  195/110  mm  Hg.  He  has  noted  that  blood  pressure  control  has  been  gradually  worsening  over  the  past  several  years.  Most  recently,  his  blood  pressure  measurements  have  not  been  below  160/95  mm  Hg.  He  has  eliminated  salt  from  his  diet,  has  been  watching  his  weight,  and  has  been  compliant  with  his  three  antihypertensive  medications,  all  of  which  have  been  prescribed  at  maximal  doses  (hydrochlorothiazide  25  mg/d,  lisinopril  40  mg/d,  and  amlodipine  10  mg/d).  On  physical  examination  he  has  a  midline  systolic  bruit  just  above  the  umbilicus  radiating  to  his  right  flank.  Figures  43-1,43-2,  and  43-3  demonstrate  the  typical  appearance  of  atherosclerotic  renal  artery  stenosis  (ARAS)  by  duplex  ultrasonography,  computed  tomography  (CT),  and  contrast  angiography.