Figure 33

Natural history of atherosclerotic renovascular disease. Retrospective studies, based on serial renal angiograms, suggest that atherosclerotic renal artery disease (ASO-RAD) is a progressive disorder. This figure summarizes retrospective series on the natural history of ASO-RAD. A large series from the Cleveland Clinic in nonoperated patients indicated progression of renal artery obstruction in 44%; progression to total occlusion occurred in 16% of these patients. Reduction in ipsilateral renal size is associated with angiographic evidence of progression in contrast to patients with nonprogressive (angiographically) ASO-RAD.

Zierler and coworkers have prospectively studied the progression of ASO-RAD by sequential duplex ultrasonography. The cumulative incidence of progession of lesions with less than 60% reduction in lumen diameter progressing to more than 60% reduction in lumen diameter was 30% at 1 year, 44% at 2 years, and 48% at 3 years. Progression to total occlusion occurred only in arteries with a baseline reduction in lumen diameter of more than 60%. The cumulative incidence of progression to total occlusion in patients with baseline stenosis of 60% or greater was 4% at 1 year, 4% at 2 years, and 7% at 3 years. Blood pressure control and serum creatinine were not predictors of progression. The risk of renal parenchymal atrophy over time in kidneys with ASO-RAD has also been described. (Table adapted from Rimmer and Gennari [2]; with permission.)

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