title: Management of isolated non-traumatic renal artery dissection: report of four cases.
abstract: BACKGROUND
  Isolated non-traumatic renal artery dissection (RAD) is a rare disorder with uncertain natural history. The management may be surgical reconstruction, endovascular repair, or conservative medical treatment, yet no official consensus had been established.
  
  
  OBJECTIVE
  To report the management of four cases of isolated non-traumatic RAD, emphasizing the beneficial role of conservative medical treatment.
  
  
  METHODS
  From the year 2000 till 2011, four male patients with mean age of 42.5 years (range 34-48 years) presented with isolated non-traumatic RAD and were initially treated with medical therapy. Transcatheter in situ thrombolysis was performed in a case with thrombotic occlusion.
  
  
  RESULTS
  Isolated non-traumatic RAD in four patients involving at least seven branches progressed to thrombotic occlusion in two branches, luminal narrowing in five, dual lumens in two, and aneurysmal dilatation in three. Medical treatment was efficacious in three patients, who showed persistent preserved renal function, controlled blood pressure, and favorable arterial remodeling. After failure of medical therapy, the fourth patient was referred to surgery. Thrombolysis was successful to dissolute an occluding thrombotic dissection.
  
  
  CONCLUSIONS
  Conservative therapy is safe and effective when the renal artery is patent and blood pressure is controlled: we propose it as the first line of treatment, reserving interventional management for refractory cases.
authors.affiliation: Department of Radiology, Clermont Ferrand University Hospital, Université D'Auvergne, France. amr410@gmail.com
authors.forename: Amr
authors.initials: A
authors.lastname: Abdel-Kerim
authors.forename: Lucie
authors.initials: L
authors.lastname: Cassagnes
authors.forename: Agaicha
authors.initials: A
authors.lastname: Alfidja
authors.forename: Cristian
authors.initials: C
authors.lastname: Gageanu
authors.forename: Gregory
authors.initials: G
authors.lastname: Favrolt
authors.forename: Eric
authors.initials: E
authors.lastname: Dumousset
authors.forename: Anne
authors.initials: A
authors.lastname: Ravel
authors.forename: Louis
authors.initials: L
authors.lastname: Boyer
authors.forename: Pascal
authors.initials: P
authors.lastname: Chabrot
mesh_terms: D000328:Adult; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D015901:Angiography, Digital Subtraction; D000925:Anticoagulants / Q000627:therapeutic use; D003131:Combined Modality Therapy; D017984:Enoxaparin / Q000627:therapeutic use; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D012077:Renal Artery; D012189:Retrospective Studies; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator