True posterior tibial artery aneurysm in a young patient: surgical or endovascular treatment?

Aneurysms of tibial arteries are extremely rare. Here we report a case of a true posterior tibial artery aneurysm in a young patient without any associated pathology and discuss surgical and endovascular treatment. A young Caucasian male was admitted to our department for painful and pulsatile swelling of the right calf. Colour Doppler ultrasound scan visualised an aneurysmal dilation of the posterior tibial artery. The patient had no trauma to the area and denied other history of vascular disease. Angio-CT and angio-magnetic resonance imaging showed a larger aneurysm compared to ultrasound scan. We performed an embolisation of the aneurysm because of the risk of rupture, as distal collateral circulation ensured foot vascularisation. Endovascular treatment of aneurysms of small arteries seems to be a safe therapeutic and non-invasive choice, particularly in young patients in whom the presence of collaterals guarantees distal vascularisation

Corso teorico/ pratico di Nefro-Cardiologia

Il presente corso teorico/pratico è finalizzato alla gestione del paziente iperteso ovvero un soggetto affetto di ipertensione arteriosa probabilmente portatore oltre che di disfunzione renale, di patologia cardiovascolare. Lo scopo del corso è quello di ottimizzare, attraverso la corretta interpretazione del dato laboratoristico e strumentali, la gestione del danno d’organo renale e vascolare e cardiologico indotto dall’ipertensione arteriosa. Inoltre suggerire anche le indagini diagnostiche più appropriate per approfondire tale patologia, anche alla luce della recente pubblicazione delle linee guida ESH/ESC 2007 alla luce dei più recenti trial; andrà presa in esame la personalizzazione della terapia con particolare riferimento al dosaggio delle diverse terapie, considerata la gravità dello stato ipertensivo di base. Si intende realizzare un progetto ECM sul danno cardiovascolare e renale indotta dall’ ipertensione con l’obiettivo di verificarne l’incidenza, fornendo ai partecipanti(30 medici di medicina generale delle ASL RMA e B) elementi utili a facilitarne l’individuazione precoce ed a migliorarne sia l’approccio sia clinico che terapeutico alla luce delle nuove linee guida ESH/ESC 2007 alla luce dei più recenti trial. Ciò sarà dissertato soprattutto attraverso l’analisi e la discussione pratica in aula ed in ambulatorio di casi clinici

Ischemic nephropathy: proteinuria and renal resistance index could suggest if revascularization is recommended

Background: The aim of endovascular therapy in renal artery stenosis (RAS) is to preserve renal function and have a better hypertension control. The purpose of our study was to determine which biochemical and instrumental parameters could predict a better renal outcome in patients with RAS treated with percutaneous transluminal angioplasty and stenting (RPTAS). Methods: We performed an observational study based on 40 patients with RAS who met the following criteria before revascularization: urinary protein excretion of over 250 mg/24 h, normal renal function, and/or mild-moderate renal insufficiency (I, II, and III levels of classification of chronic kidney disease, K-DOQI). Results: Assessment at 12 months after RPTAS showed in 20 patients (Group A) that proteinuria serum creatinine (Scr) and creatinine clearance (CrCl) significantly worsened from the baseline; whereas in 20 patients (Group B) proteinuria remained unchanged and the renal function improved after the procedure. Conclusions: In our study, the decline of renal function after RPTAS is associated with an elevated renal resistance index (RI) in both kidneys (0.83 +/- 0.2) and preexisting proteinuria

Nephroangiosclerosis and Its Pharmacological Approach

Nephroangiosclerosis (NAS) is a major cause of progressive renal insufficiency. Hypertension is very important in the causation of NAS but other factors such as race, age, metabolic variables, and genetics play a pathogenic and prognostic role. A multifactorial treatment strategy, including antihypertensive, lipid-lowering and anti-platelet agents, could improve cardiovascular and renal outcomes in patients with vascular nephropathy