Controversies in the management of the renal artery stenosis (original) (raw)
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A Review of the Current Treatment of Renal Artery Stenosis
European Journal of Vascular and Endovascular Surgery, 2005
Purpose. Atherosclerotic renal artery stenosis (ARAS) is associated with morbidity and mortality consequent to progressive ischemic renal failure and the cardiovascular consequences of hypertension. There is considerable uncertainty concerning the optimal management of patients with this condition. This review considers the aetiological factors and the physiologic consequences of ARAS and compares the results of clinical studies of medical and endovascular therapies on blood pressure control and preservation of renal function. Results. Although, in patients with fibromuscular disease the results of percutaneous transluminal angioplasty (PTA) are clearly superior to medical therapy and surgery, in asymptomatic patients with ARAS the antihypertensive benefits and preservation of renal function of endovascular, surgical and medical therapies appear similar. In selected symptomatic patients interventions may, however, be life-saving. Surgery is generally reserved for arterial occlusions with preserved renal parenchyma and function.
#6682 Renal Artery Stenosis: A Single Centre Study
Nephrology Dialysis Transplantation
Background and Aims Renal artery stenosis (RAS) is present from 1% to 5% in people affected by arterial hypertension and it is often associated with peripheral artery disease and coronary artery disease; as the matter of fact, it is commonly found in people undergoing cardiac catheterization (18-20%) or angiography for aorto-iliac and lower extremities diseases. The major cause of renal artery stenosis is an atherosclerotic lesion localized in the proximal segment or to the ostium. Clinical presentations are renovascular hypertension and ischemic nephropathy. The aim of the study is to define either endovascular treatment gives a significant benefit on renal function and blood pressure control, when associated to medical therapy. Method This is a retrospective study focused on patients who underwent renal artery angioplasty and stenting in the last ten years, from November 2011 to April 2021 in the Nephrology Department, at Sant'Andrea Hospital, La Spezia (Italy). The primary ou...
SCAI expert consensus statement for renal artery stenting appropriate use
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, 2014
The pathophysiology of atherosclerotic renal artery stenosis (RAS) includes activation of the renin-angiotensin-aldosterone axis with resultant renovascular hypertension. Renal artery stenting has emerged as the primary revascularization strategy in most patients with hemodynamically significant atherosclerotic RAS. Despite the frequency with which hemodynamically significant RAS is observed and high rates of technical success of renal artery stenting, there remains considerable debate among experts regarding the role of medical therapy versus revascularization for renovascular hypertension. Modern, prospective, multicenter registries continue to demonstrate improvement in systolic and diastolic blood pressure with excellent safety profiles in patients with RAS. Modern randomized, controlled clinical trials of optimal medical therapy versus renal stenting particularly designed to demonstrate preservation in renal function after renal artery stenting have demonstrated limited benefit...
Annals of internal medicine, 2016
Atherosclerotic renal artery stenosis (ARAS) is associated with high blood pressure (BP), decreased kidney function, renal replacement therapy (RRT), and death. To compare benefits and harms of percutaneous transluminal renal angioplasty with stent placement (PTRAS) versus medical therapy alone in adults with ARAS. MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials from 1993 to 16 March 2016; gray literature; and prior systematic reviews. Randomized, controlled trials (RCTs); nonrandomized, comparative studies (NRCSs); single-group studies; and selected case reports that reported all-cause and cardiovascular mortality, RRT, kidney function, BP, and adverse events. Six researchers extracted data on design, interventions, outcomes, and study quality into a Web-based database. Eighty-three studies met eligibility criteria. In 5 of 7 RCTs, PTRAS and medical therapy led to similar BP control in patients with ARAS, and no RCTs showed statistically significant differences ...
Management of renal artery stenosis: What does the experimental evidence tell us?
World journal of cardiology, 2014
Optimal management of patients with renal artery stenosis (RAS) is a subject of considerable controversy. There is incontrovertible evidence that renal artery stenosis has profound effects on the heart and cardiovascular system in addition to the kidney. Recent evidence indicates that restoration of blood flow alone does not improve renal or cardiovascular outcomes in patients with renal artery stenosis. A number of human and experimental studies have documented the clinical, hemodynamic, and histopathologic features in renal artery stenosis. New approaches to the treatment of renovascular hypertension due to RAS depend on better understanding of basic mechanisms underlying the development of chronic renal disease in these patients. Several groups have employed the two kidney one clip model of renovascular hypertension to define basic signaling mechanisms responsible for the development of chronic renal disease. Recent studies have underscored the importance of inflammation in the d...
Medical Information on Renal Arterial Stenting
Renal artery stenosis (RAS) is a common pathological condition associated with uncontrolled or refractory hypertension, flash pulmonary edema, and worsening renal function. The high prevalence of RAS in patients with coronary and lower extremity vascular disease has been well established. In a recent study on the practice of "drive-by renal shooting", prevalence of significant RAS was found to be high in patients with suspected coronary atherosclerosis referred for coronary angiography. Another study revealed dramatic increase in volume of renal arterial stenting in the Medicare population. Hence, concerns of over-diagnosis and over-treatment of RAS were raised. However, numerous recent studies demonstrated high success rate of renal artery stent revascularization and its clinical benefits. Aggressive screening and early treatment of RAS are therefore warranted in patients with drug-refractory hypertension and/or worsening renal insufficiency. However, some open issues remain. The paper proposes selection criteria for "drive-by renal shooting" and suggests valid criteria for treating RAS.
Renal artery stenting: one year outcome on BP control and antihypertensive medication
The Journal of the Association of Physicians of India, 2014
There is lot of controversy regarding the efficacy of renal artery stenting in atherosclerotic renal artery stenosis. The aim of this retrospective study is to evaluate blood pressure control and requirement of antihypertensive drugs after renal artery stenting. Eighty patients who have undergone renal artery stenting for atherosclerotic renal artery stenosis with hypertension were evaluated and followed up for one year. Those with procedural complications were excluded. The systolic and diastolic BP control, number of medications, their dosage and serum creatinine levels were assessed at 3 months and at one year. At the end of one year 3 patients had total cure (all 3 had bilateral renal artery stenting). In 30 patients, there was reduction in number of drugs and in 11 patients there was reduction in dosage of antihypertensive drugs. In 16 patients there was a need to change the class of drugs. In 16 patients same drugs and dosage were continued. In 4 patients, the dose was increas...