Flash pulmonary edema in patients with renal artery stenosis - The Pickering Syndrome

• Published in: Blood pressure 2011-02, Vol.20 (1), p.15-19
• Main Authors: Pelta, Anna, Andersen, Ulrik B., Just, Sven, Bækgaard, Niels
• Format: Article
• Language: English
• Subjects: Aged; Angioplasty, Balloon; Atrial Fibrillation - complications; Balloon angioplasty; Female; Humans; Hypertrophy, Left Ventricular - complications; Male; Middle Aged; pulmonary edema; Pulmonary Edema - epidemiology; Pulmonary Edema - etiology; Pulmonary Edema - physiopathology; Pulmonary Edema - therapy; renal artery obstruction; Renal Artery Obstruction - complications; Renal Artery Obstruction - epidemiology; Renal Artery Obstruction - physiopathology; Renal Artery Obstruction - therapy; renal artery stenosis; Retrospective Studies; Secondary Prevention; Syndrome; Ultrasonography, Doppler; Vascular Grafting
• ISSN: 0803-7051; 1651-1999
• DOI: 10.3109/08037051.2010.527445

Abstract Aim. We report the prevalence of flash pulmonary edema in patients consecutively referred for balloon angioplasty of unior bilateral renal artery stenosis (PTRA), and describe the characteristics of this special fraction of the patients. We further report two unusual cases. Methods and material. Review of medical records from 60 patients consecutively referred for unior bilateral PTRA from 2004-2005 in Copenhagen County. Results. Eight out of 60 patients had one or more episodes of flash pulmonary edema before PTRA. Compared with the remaining patients, they had a higher prevalence of bilateral stenosis (50% vs 27%) and coronary artery disease (75% vs 28%). However, only one of eight had severe systolic dysfunction of the left ventricle. After PTRA, two recurrences of flash pulmonary edema were observed. One was caused by severe restenosis and did not recur after aorto-renal bypass surgery. The other one was caused by rapid atrial fibrillation and did not recur after pacemaker and medical treatment. Conclusion. Flash pulmonary edema can be observed in patients with unilateral as well as bilateral stenosis. The prognosis is usually excellent upon treatment of the stenoses. Recurrences are rare unless restenosis occurs, and therefore, regular control, e.g. by Doppler-ultrasound examination is recommended.