Renal perfusion improvement in the perioperative period after unilateral endovascular revascularization in patients with atherosclerotic renal artery stenosis

Front Cardiovasc Med. 2023 Jul 12:10:1193864. doi: 10.3389/fcvm.2023.1193864. eCollection 2023.

Authors

Leyin Xu^#¹, Jiang Shao^#¹, Kang Li¹, Chaonan Wang¹, Zhichao Lai¹, Jiangyu Ma¹, Xiaoxi Yu¹, Fenghe Du¹, Junye Chen¹, Xiaolong Liu¹, Jinghui Yuan¹, Bao Liu^#¹, Chunyang Wang^#²

Affiliations

¹ Department of Vascular Surgery, Peking Union Medical College Hospital (Dongdan Campus), Beijing, China.
² Department of Urology, PLA General Hospital, Beijing, China.

^# Contributed equally.

Abstract

Background: The clinical benefits of endovascular treatment in renal artery stenosis (RAS) remain controversial. This study used an intraoperative renal perfusion imaging technique, called flat-panel detector parenchymal blood volume imaging (FD-PBV), to observe the change in renal perfusion after endovascular treatment in RAS.

Materials and methods: In a prospective, single-center study, we assigned 30 patients with atherosclerotic RAS who underwent endovascular treatment between March 2016 and March 2021. The preoperative and postoperative results of renal perfusion, blood pressure, and renal function, were compared.

Results: Both median kidney volume (p < 0.001) and median preoperative mean density of contrast medium (MDCM) (p = 0.028) increased significantly after endovascular treatment. The ratio of postoperative and preoperative MDCM differed greatly among the patients. For patients with preoperative MDCM <304.0 HU (Subgroup A, 15 cases), MDCM significantly increased after treatment (p = 0.001) and 12 (80.0%) patients had more than 10% increase in renal perfusion. For patients who had relatively high preoperative renal perfusion (MDCM ≥304.0 HU, Subgroup B, 15 cases), preoperative and postoperative MDCM were similar (p = 0.776). On the other hand, the serum creatinine levels significantly decreased in Subgroup A (p = 0.033) and fewer antihypertensive drugs were used after endovascular revascularization (p = 0.041). The preoperative and postoperative creatinine levels and number of antihypertensive drugs were similar in Subgroup B.

Conclusions: During the perioperative period, RAS patients with relatively low preoperative renal perfusion levels had greater improvement in renal perfusion, renal function, and blood pressure control after endovascular treatment. The improvement of renal function needs to be confirmed by long-term follow-up.

Keywords: atherosclerosis; endovascular treatment; flatpanel detector parenchymal blood volume (FD-PBV); renal artery stenosis; renal perfusion.

© 2023 Xu, Shao, Li, Wang, Lai, Ma, Yu, Du, Chen, Liu, Yuan, Liu and Wang.

Grants and funding

The study was supported by the National Natural Science Foundation of China (82070498 and 82100521), National High Level Hospital Clinical Research Funding (2022-PUMCH-A-078, 2022-PUMCH-A-189, and 2022-PUMCH-B-125), CAMS Innovation Fund for Medical Sciences (CIFMS) (2022-I2M-C&T-A-002), Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences (2022-JKCS-09), Fundamental Research Funds for the Central Universities (No. 3332020009), and PUMCH Science Fund of Key Projects for Junior Faculty (No.PUMCH-2016–1.20).