Monday, December 6, 2010

Up coming stenting of renal artery

This is a procedure that I look forward to with no little apprehension. Its indication, on present evidence is that my right renal artery is becoming choked off, with atheroma, (or post atherosclerotic fibrosis), at its origin from the aorta. If there is no sort of intervention, then it is very likely that it will infarct my right kidney. i;e the kidney will die of lack of arterial blood supply.

The risks of doing it include a significant mortality rate of at least 2-3 percent, plus the risk of showers of little bits of atheroma breaking off and damaging the more distant blood supply of the kidney, necessitating dialysis. Research papers are all over the place on this issue. Some say categorically "There is no clear indication for stenting! (including one author from the Mayo Clinic), over aggressive medical treatment with statins and hypotensive drugs" Others say"Maybe there are some exceptions when the stenosis is greater that 75 per cent." Most papers say that their samples were not large enough to give a definitive answer as to whether there is an advantage to stenting or not.  So, I guess I will wait for the U/S studies to be repeated at Mayo's and see what they tell us, and then talk turkey with the Vascular guy and the radiologist. One paper I read today said that hypertension does not occur until the stenosis is greater than 75 percent. since I already have significant hypertension, needing two drugs to control it, then, I guess, it must be greater than 75 %. So, I will take myself up there, to a place and doctors I trust,  and make the best decision I can, and go with it.

Since I am getting a little frazzled over all this, I will see the Clinical Psychologist also this week, to see if he can help me see the wood through the trees. It would so help to have Di to talk to. But in the end, she would not be able to do anything but say. "This is a decision you will have to make yourself, and live with the consequences of the decision." And that is the way it should be. So, I leave you , tonight, in deep doubt, and not a little confusion. Peace and love to all. Geoff

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