Internal Medicine

P1: SBT

0521779407-04a CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:48

186 Atherosclerotic Occlusive Disease

Renal Artery Stenting/Angioplasty

■Renal artery occlusion or dissection (5%)

■In-stent restenosis (>30% at 2 years)

Visceral/Renal/Lower Extremity Revascularization

■Perioperative complications (per carotid endarterectomy)

■Embolization (5%)

■Restenosis of iliac stents (30%)

■Late graft occlusion with recurrent symptoms (variable incidence)

■Graft infection (2% lifetime risk)

■Carotid Stenosis

■Long Term Stroke rates (per year)

■After endarterectomy 1–2%

■After carotid occlusion (not amenable to endarterectomy)−4%

■High-grade stenosis managed medically−4–6%

Mesenteric Occlusive disease

■Without revascularization, prognosis is grim−80% dead at 2 years

■After revasc, 15% will have recurrent disease and symptoms long

term

Renal Artery Occlusive Disease

■80–95% have relief of HTN, stabilization of creatinine with surgery

■Stenting has 30–40% long-term failure rate; trials show no benefit to

stenting versus medical management

■Surgical bypass has better long-term patency

Lower Extremity Occlusive Disease

■Claudication is not predictive of future limb loss (7% limb loss at

5 years)

■Patients with limb threat (see above) have high rates of limb loss

without revascularization and high long-term mortality

■Renal artery stenting/angioplasty

➣Renal artery occlusion or dissection (<5%)

➣In-stent restenosis (<30% at 2 years)

■Visceral/renal/lower extremity revascularization

➣Perioperative complications (per carotid endarterectomy)

➣Embolization (<5%)

➣Restenosis of iliac stents (30%)

➣Late graft occlusion with recurrent symptoms (variable inci-

dence)

➣Prosthetic graft infection (2% lifetime risk)