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Renal Artery Stenosis

  • Thomas A. SosEmail author
Chapter
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Abstract

As a result of the recent highly publicized but poorly designed randomized trials, renal artery angioplasty and stenting have become underutilized as the treatment of choice even in carefully selected patients with hemodynamically significant renal artery stenosis due to atheroma and/or fibromuscular dysplasia. Such patients are frequently and nihilistically medically managed until they are sometimes unsalvageable by revascularization. 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 as above 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 sequela 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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Authors and Affiliations

  1. 1.Peripheral Arterial Disease, Weill Cornell Interventional, New York Presbyterian Hospital-Weill CornellNew YorkUSA

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