The renal arteries are end arteries dividing into segmental branches with no collateral anastomoses — renal infarction from arterial occlusion produces a wedge-shaped cortical infarct corresponding exactly to the segmental territory. Renal artery stenosis from fibromuscular dysplasia (young women) or atherosclerosis (elderly) produces renovascular hypertension and renal impairment. Renal artery aneurysms require repair when greater than 2 cm.
| Origin | Abdominal aorta at the L1-L2 level (just below the superior mesenteric artery) |
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Renovascular hypertension from renal artery stenosis produces severe hypertension refractory to three or more agents, flash pulmonary oedema from bilateral RAS, and deterioration of renal function with ACE inhibitor use (the ACE inhibitor test). Renal artery angioplasty and stenting (PTRA) is indicated for fibromuscular dysplasia (95% cure or improvement) and selected atherosclerotic RAS.
RAS producing renovascular hypertension managed with PTRA for FMD and selected atherosclerotic cases with preserved renal function.
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