Atherosclerotic renal artery stenosis and renal artery stenting: an evolving therapeutic option

2011 ◽  
Vol 9 (10) ◽  
pp. 1347-1360 ◽  
Author(s):  
Ronan Margey ◽  
Brian G Hynes ◽  
Darragh Moran ◽  
Thomas J Kiernan ◽  
Michael R Jaff
Keyword(s):  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Therapeutic Option ◽  
Artery Stenosis ◽  
Atherosclerotic Renal Artery Stenosis ◽  
Renal Artery Stenting

scholarly journals Spleno-renal anastomotic bypass revascularization for worsening renal failure and uncontrolled hypertension in bilateral calcific atherosclerotic renal artery stenosis

2019 ◽  
Vol 8 (4) ◽  
pp. 253-256
Author(s):  
Macaulay Amechi Chukwukadibia Onuigbo ◽  
Marie Engesser ◽  
Sree Susarla
Keyword(s):  
Renal Failure ◽  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Therapeutic Option ◽  
Artery Stenosis ◽  
Uncontrolled Hypertension ◽  
Recent Experience ◽  
Atherosclerotic Renal Artery Stenosis ◽  
Revascularization Therapy ◽  
Atherosclerotic Renovascular Disease

Following the recent publications of the STAR-study, the ASTRAL trial, the HERCULES trial and the CORAL trial on renal revascularization versus medical therapy in the management of atherosclerotic renovascular disease, there has been a near paradigm shift implying the nonutility of revascularization as a useful and necessary therapeutic option. Our recent experience with a patient who underwent an anastomotic bypass revascularization for worsening renal failure and uncontrolled hypertension in bilateral calcific atherosclerotic renal artery stenosis in Burlington, VT rekindled this debate. We posit that in appropriately selected patients, patients with acutely worsening renal failure, uncontrolled hypertension and/or symptomatic pulmonary edema, there is indeed a place for revascularization therapy, especially in the light of improved and safer surgical and anesthesiology techniques. It must be correctly acknowledged that the above well popularized randomized trials recruited mostly patients with otherwise stable chronic kidney disease at the time of enrollment. Similarly, only 12% of the patients in both arms of the ASTRAL trial demonstrated rapidly worsening renal failure prior to enrollment

Renal artery stenting may not be appropriate for patients with atherosclerotic renal artery stenosis

Vascular ◽  
2015 ◽  
Vol 24 (1) ◽  
pp. 9-18 ◽  
Author(s):  
Anahita Dua ◽  
Sachin Desai ◽  
Gilbert R Upchurch ◽  
Sapan S Desai
Keyword(s):  
Decision Analysis ◽  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Kidney Diseases ◽  
Indirect Costs ◽  
Artery Stenosis ◽  
Atherosclerotic Renal Artery Stenosis ◽  
Free Survival ◽  
Statistical Life ◽  
Renal Artery Stenting

Introduction This study compared aortorenal bypass to renal artery stenting to determine the most efficacious and financially sound method for treating patients with atherosclerotic renal artery stenosis (RAS). Methods A decision analysis using direct and indirect costs, and value of statistical life (VSL) was completed. Direct costs were obtained using the Nationwide Inpatient Sample (NIS), indirect costs from the National Institute of Diabetes and Digestive and Kidney Diseases, and VSL from the Department of Transportation. A variance-based sensitivity analysis was completed to assess the accuracy of the decision analysis. Results Aortorenal bypass has a 95% five-year patency, a 98% 30-day survival, a 26% rate of overall complications, and a 70% five-year dialysis-free survival. Renal artery stenting has a 56% five-year patency, a 99% 30-day survival, a 40% rate of complications, and a 65% five-year dialysis-free survival. Renal artery stenting has an overall cost of $305,370 and aortorenal bypass has an overall cost of $103,453 per patient. After accounting for VSL, renal artery stenting has a negative value of −$182,270 and aortorenal bypass has a value of $415,881. Conclusions Lower five-year patency and higher rate of complications from renal artery stenting that ultimately lead to significantly lower five-year dialysis-free survival.

Issues related to renal artery angioplasty and stenting

Vascular ◽  
2017 ◽  
Vol 25 (6) ◽  
pp. 618-628 ◽  
Author(s):  
Albeir Y Mousa ◽  
Mark C Bates ◽  
Mike Broce ◽  
Joseph Bozzay ◽  
Ramez Morcos ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Patient Selection ◽  
Randomized Clinical Trials ◽  
Secondary Hypertension ◽  
Artery Stenosis ◽  
Atherosclerotic Renal Artery Stenosis ◽  
Specific Patient ◽  
Renal Artery Stenting

Renal artery stenosis may play a significant role in the pathogenesis of secondary hypertension, renal dysfunction, and flash pulmonary edema. Currently correction of renal arterial inflow stenosis is reserved for resistant hypertension patients who have failed maximal medical therapy, have worsening renal function and/or unexplained proximal congestive failure. With the recent advances in minimally invasive percutaneous stent placement techniques, open surgical revascularization has been largely replaced by renal artery stenting. The potential benefit of revascularization seemed intuitive; however, the initial enthusiasm and rise in the number of percutaneous interventions have been tempered by many subsequent negative randomized clinical trials that failed to prove the proposed benefits of the percutaneous intervention. The negative randomized trial results have fallen under scrutiny due to trial design concerns and inconsistent outcomes of these studies compared to pivotal trials undertaken under US Food and Drug Administration scrutiny. Treatment of atherosclerotic renal artery occlusive disease has become one of the most debatable topics in the field of vascular disease. The results from recent randomized clinical trials of renal artery stenting have basically limited the utilization of the procedure in many centers, but not every clinical scenario was covered in those trials. There are potential areas for improvement focusing mainly on procedural details and patient selection with respect to catheter based treatment of atherosclerotic renal artery stenosis. We believe, limiting patient selection, enrollment criteria and outcomes measured functioned to reduce the benefit of renal artery stenosis stenting by not enrolling patients likely to benefit. Future studies incorporating potential procedural improvements and that include patients more likely to benefit from renal stenting than were included in ASTRAL and CORAL are needed to more carefully examine specific patient subgroups so that “the baby is not thrown out with the bath water.” We also discuss several other concerns related to renal artery stenting which include diagnostic, procedure, indication, and reimbursement issues.

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