Background
Renal artery stenosis comprises both atherosclerotic renovascular disease and fibromuscular
dysplasia, and may be associated with refractory hypertension, acute ‘flash’ pulmonary
oedema and renal failure. The long-term clinical effects of renal artery stenting
remain unclear.
Aim
To assess the procedural and long-term safety and efficacy of renal artery stenting
and its effect on blood pressure, antihypertensive medication usage and serum creatinine.
Methods
All patients referred for renal artery stenting at our institution between September
1997 and December 2003 were entered into a prospectively collected database. Systolic
and diastolic blood pressure, number of antihypertensive medications, serum creatinine
and estimated glomerular filtration rate (eGFR) were recorded. Patients were followed-up
at least six months post-procedure.
Results
Eighty-nine patients underwent renal arteriography, with 110 stents deployed in 102
lesions. The procedural success rate was 99% with no procedural mortality. There were
two cases of peri-procedural haemorrhage and one of sepsis. One patient developed
renal and peripheral atheroemboli.
Follow-up
Mean follow-up was 28 months (range 6 months–7 years). Eight patients were lost to
follow-up. There were nine deaths with a mean time to death of 20.7 months (range
12 months–3 years). There was a highly statistically significant fall in systolic
blood pressure (BP) from 161.7 ± 29.5 mmHg pre-procedure to 138.7 ± 17.9 mmHg at long-term follow-up post-procedure (p < 0.0001). The clinical restenosis rate was 6.2%. Renal function and eGFR remained stable
and there was a borderline significant decrease in the number of antihypertensive
medications used (p = 0.05).
Conclusion
Renal artery stenting is safe and appears effective for the treatment of clinically
significant renal artery stenosis.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Heart, Lung and CirculationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- New insights into the epidemiologic and clinical manifestations of atherosclerotic renovascular disease.Am J Kid Dis. 2000; 35: 573-587
- The profile of cardiac patients with renal artery stenosis.JACC. 2004; 43: 1606-1613
- Clinical characteristics of atherosclerotic renovascular disease.Am J Kid Dis. 1994; 24: 636-641
- Atherosclerotic renal artery stenosis: from diagnosis to treatment.Postgrad Med J. 1999; 75: 527-536
- Experimental renal artery stenosis. Diagnostic significance of arterial haemodynamics.J Cardiovasc Surg. 1962; 3: 259-262
- Natural history of atherosclerotic renal artery stenosis: a prospective study with duplex ultrasonography.J Vasc Surg. 1994; 19 (discussion 257–8): 250-257
- Predictors of cure of hypertension in fibromuscular renovascular disease.Am J Kid Dis. 1996; 28: 334-338
- Atherosclerotic renovascular disease and progressive renal failure.Ann Intern Med. 1993; 118: 712-719
- Effect of renal artery stenting on progression of renovascular renal failure.Lancet. 1997; 349: 1133-1136
- Blood pressure outcome of angioplasty in atherosclerotic renal artery stenosis: a randomized trial. The EMMA-study group.Hypertension. 1998; 31: 823-829
- Palmaz stent in atherosclerotic stenoses involving the ostia of renal arteries: preliminary report of a multicenter study.Radiology. 1991; 181: 507-514
- Percutaneous transluminal angioplasty in patients with renal failure.Q J Med. 1992; 85: 883-888
- Percutaneous angioplasty for atherosclerotic renal artery disease: effect on renal function in azotemic patients.Cardiovasc Intervent Radiol. 1994; 17: 143-146
- Use of splenic and hepatic artery for renal revascularzation in patients with atherosclerotic renal artery disease.Ann Vasc Surg. 1997; 11: 85-89
- Management of renovascular disease: a review of renal artery stenting in ten studies.Q J Med. 1999; 92: 159-167
- Long-term effects of arterial stenting on kidney function for patients with ostial atherosclerotic renal artery stenosis and renal insufficiency.J Am Soc Neph. 2001; 12: 1475-1481
- A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group.Ann Intern Med. 1999; 130: 461-470
- Chronic kidney disease and automatic reporting of estimated glomerular filtration rate: a position statement.MJA. 2005; 183: 138-141
Article info
Publication history
Accepted:
December 30,
2006
Received in revised form:
October 9,
2006
Received:
May 4,
2006
Identification
Copyright
© 2007 Australasian Society of Cardiac and Thoracic Surgeons and the Cardiac Society of Australia and New Zealand. Published by Elsevier Inc. All rights reserved.
