“ Accounts for less than 5% of hypertension in adults. In the elderly, it is mostly due to atherosclerosis (90%) ; in the young, consider fi...
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Accounts for less than 5% of hypertension in adults. In the elderly, it is mostly due to atherosclerosis (90%); in the young, consider fibromuscular dysplasia. Presents with severe refractory hypertension, renal impairment and raised intracranial pressure. Biochemistry shows raised plasma renin (captopril test).
DOPPLER US
• Raised peak systolic velocity, mild 100-200 cm/second and severe >200 cm/second.
• Damped systolic waveform (‘ parvus-tardus ’).
• Affected side may show an elevated resistive index if measured proximal to the stenosis.
INTERVENTION
• Focal or segmental stenosis, atherosclerotic lesions tend to be at the ostium or proximal 2 cm.
• Angioplasty effective in 80% for proximal lesions, 30% for ostial lesions.
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