Endovascular interventions in symptomatic atherosclerotic renal artery disease

    Authors

    Abstract

    Renal artery stenosis (RAS) refers to any vascular lesion causing narrowing of the renal artery. Two most common causes are fibromuscular dysplasia (FMD) and atherosclerotic artery disease with atherosclerosis being the most common disease that affect the renal arteries. Patients with atherosclerotic renal artery disease are commonly older and have multiple cardiovascular risk factors. (1) The diagnostic algorithm for RAS includes Doppler ultrasonography, computed tomography angiography and magnetic resonance angiography. According to current guidelines, routine revascularization is not recommended, except for cases in which hypertension is caused by FMD and episodes of heart failure or pulmonary oedema caused by RAS (2). We present a series of 13 patients treated with PTA for RAS (**Figure 1**) in our hospital in 2 consecutive years. Median age was 70 years, 62% of patients were female with multiple risk factors for atherosclerotic vascular disease – 38% had family history of coronary artery disease, 46% had coronary artery disease, 46% had type 2 diabetes mellitus, 100% had arterial hypertension, 77% had dyslipidemia, 15% were current smokers and 31% had polivascular artery disease. Eight patients had intervention on left renal artery and five patients had intervention of right renal artery while one patient had intervention on both renal arteries. Indication for renal artery stenting was resistant hypertension and recurrent episodes of heart failure or pulmonary oedema. FIGURE 1. Left renal artery stenting.

    Keywords

    arterial hypertension, renal artery stenosis, renal artery stenting

    DOI

    https://doi.org/10.15836/ccar2023.82

    Literature

    1. Weber BR, Dieter RS. Renal artery stenosis: epidemiology and treatment. Int J Nephrol Renovasc Dis. 2014 May 13;7:169–81. https://doi.org/10.2147/IJNRD.S40175
    2. Aboyans V, Ricco JB, Bartelink MEL, Björck M, Brodmann M, Cohnert T, et al. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries. Endorsed by: the European Stroke Organization (ESO)The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J. 2018 March 1;39(9):763–816. https://doi.org/10.1093/eurheartj/ehx095
    Cardiologia Croatica
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    Endovascular interventions in symptomatic atherosclerotic renal artery disease

    Extended Abstract
    Issue3-4
    Published
    Pages82
    PDF via DOIhttps://doi.org/10.15836/ccar2023.82
    arterial hypertension
    renal artery stenosis
    renal artery stenting

    Authors

    Tomislav Krpan*ORCIDUniversity Hospital Center Sestre milosrdnice, Zagreb, Croatia
    Tonći BatinićORCIDUniversity Hospital Center Sestre milosrdnice, Zagreb, Croatia
    Nikola KosORCIDUniversity Hospital Center Sestre milosrdnice, Zagreb, Croatia
    Karlo GolubićORCIDUniversity Hospital Center Sestre milosrdnice, Zagreb, Croatia
    Mislav VrsalovićORCIDUniversity Hospital Center Sestre milosrdnice, Zagreb, Croatia

    *Correspondence email: tomislav.krpan@kbcsm.hr

    Abstract

    Renal artery stenosis (RAS) refers to any vascular lesion causing narrowing of the renal artery. Two most common causes are fibromuscular dysplasia (FMD) and atherosclerotic artery disease with atherosclerosis being the most common disease that affect the renal arteries. Patients with atherosclerotic renal artery disease are commonly older and have multiple cardiovascular risk factors. (1) The diagnostic algorithm for RAS includes Doppler ultrasonography, computed tomography angiography and magnetic resonance angiography. According to current guidelines, routine revascularization is not recommended, except for cases in which hypertension is caused by FMD and episodes of heart failure or pulmonary oedema caused by RAS (2). We present a series of 13 patients treated with PTA for RAS (**Figure 1**) in our hospital in 2 consecutive years. Median age was 70 years, 62% of patients were female with multiple risk factors for atherosclerotic vascular disease – 38% had family history of coronary artery disease, 46% had coronary artery disease, 46% had type 2 diabetes mellitus, 100% had arterial hypertension, 77% had dyslipidemia, 15% were current smokers and 31% had polivascular artery disease. Eight patients had intervention on left renal artery and five patients had intervention of right renal artery while one patient had intervention on both renal arteries. Indication for renal artery stenting was resistant hypertension and recurrent episodes of heart failure or pulmonary oedema. FIGURE 1. Left renal artery stenting.

    Literature

    1. 1.
      Weber BR, Dieter RS. Renal artery stenosis: epidemiology and treatment. Int J Nephrol Renovasc Dis. 2014 May 13;7:169–81.DOI
    2. 2.
      Aboyans V, Ricco JB, Bartelink MEL, Björck M, Brodmann M, Cohnert T, et al. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries. Endorsed by: the European Stroke Organization (ESO)The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J. 2018 March 1;39(9):763–816.DOI