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Renal Artery Stenosis

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PanVascular Medicine

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Abstract

Despite the recently highly publicized but poorly designed randomized trials, renal artery angioplasty and stenting remain an important treatment of choice in carefully selected patients with hemodynamically significant renal artery stenosis due to atheroma and/or fibromuscular dysplasia. Indications for renal artery catheter-based interventions include hemodynamically significant renal artery stenosis particularly when associated with renal dysfunction, poorly controlled hypertension, or recurrent pulmonary edema. Careful selection of patients and expert conduct of intervention are key issues to the clinical proof of benefit of this important treatment option for organ preservation, alleviation of renal failure and long-term control of secondary hypertension.

There is no evidence, however, that “prophylactic” stenting of mild to moderate, hemodynamically nonsignificant, and clinically asymptomatic renal artery stenosis (especially, if not fully clinically evaluated prior to intervention) has any benefit compared to aggressive medical therapy and lifestyle changes to prevent progression and the clinical sequels of renal failure, hypertension, and decreased longevity.

Statins and risk reduction are the new paradigm for the treatment of all atheroma including post-interventional treatment, unless the atheroma is clinically symptomatic and hemodynamically significant.

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Abbreviations

GFR:

Glomerular filtration rate

FFR:

Renal fractional flow reserve

RI:

Resistive index

ReI:

Renal insufficiency

IN:

Ischemic nepropathy

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  1. Peripheral Arterial Disease, Weill Cornell Interventional, New York Presbyterian Hospital-Weill Cornell, 525 East 68th Street, Payson 521, 10065, New York, NY, USA

    Thomas A. Sos

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  1. Thomas A. Sos
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  1. Akademisches Lehrkrankenhaus MLU, Bitterfeld-Wolfen, Germany

    Peter Lanzer

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Sos, T.A. (2014). Renal Artery Stenosis. In: Lanzer, P. (eds) PanVascular Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-37393-0_124-1

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