Analysis of causes contributing to inefficiency of roentgenoendovascular destruction of adrenal glands in hypertensive patients

• Published in: Angiologii͡a︡ i sosudistai͡a︡ khirurgii͡a Vol. 15; no. 3; p. 49
• Main Authors: Karimov, Sh I, Tusrsunov, B Z, Sunnatov, R Dzh, Temirov, S N
• Format: Journal Article
• Language: Russian
• Published: Russia (Federation) 2009
• Subjects: Adrenal Glands - blood supply; Adrenal Glands - diagnostic imaging; Adrenal Insufficiency - complications; Adrenal Insufficiency - diagnostic imaging; Adrenal Insufficiency - surgery; Adult; Angiography - methods; Angioscopy - methods; Blood Pressure - physiology; Catheter Ablation - methods; Female; Follow-Up Studies; Humans; Hypertension - diagnostic imaging; Hypertension - etiology; Hypertension - physiopathology; Male; Middle Aged; Retrospective Studies; Treatment Outcome; Young Adult
• ISSN: 1027-6661

The study was aimed at bettering therapeutic outcomes for patients suffering from adrenal-aetiology arterial hypertension, with the objective deemed attainable at the expense of revealing and removing the underlying causes potentially contributing to unfavourable results obtained after roentgenoendovascular ablation of the adrenal glands. We retrospectively examined the medical records of 49 patients having undergone hospital treatment within the time frame from 1992 to 2007 for recurrent arterial hypertension poorly controlled by previously endured roentgenoendovascular (REV) interventions. The identified causes contributing heavily to poor clinical outcomes obtained after the REV-ablation procedures appeared to have been as follows: renal parenchymatous diseases in 20 patients having a long history of arterial hypertension with evidence ofnephroangiosclerosis; insufficient devitalisation of the adrenal glands in a further 19 patients; a pheochromocytoma of the right adrenal gland in only one instance; and newly onset renovascular hypertension in the remaining nine subjects. It was determined that poor therapeutic outcomes had primarily been caused by overestimating the indications for performing REV ablation of the adrenal glands, being seemingly wanton as a corrective measure to have been taken in the presence of inflammatory diseases of the renal parenchyma and secondary hyperplasia of the adrenal gland, with the second-in-order contributory cause appearing to be insufficient devitalisation of the adrenal glands afflicted by hyperplasia and/or aldosteroma. The development of renal artery stenosis in the remote period after REV interventions may also be responsible for a relapse of arterial hypertension, which is quite often the case.