Current management of renal artery stenosis

Panminerva Med. 2016 Mar;58(1):94-101. Epub 2016 Jan 5.

Abstract

Severe renal artery stenosis may cause renovascular hypertension; in case of bilateral narrowing or in a stenotic solitary kidney, renal insufficiency (e.g. ischemic kidney disease) or pulmonary flash edema may ensue. Renal artery stenosis can be treated by revasularization, using either percutaneous angioplasty (with or without stenting) or less common open surgical procedures, both with excellent primary patency rates. However, several randomized trials of renal artery angioplasty or stenting in patients with arteriosclerotic disease have failed to demonstrate a longer-term benefit with regard to blood pressure control and renal function over medical management. It has not yet been demonstrated that renal revascularization leads to a prolongation of event-free survival. Furthermore, endovascular procedures are associated with substantial risks. If revascularization is envisaged careful patient selection, e.g. patients with refractory hypertension or progressive renal failure, is important to maximize the potential benefit.

Publication types

  • Review

MeSH terms

  • Angioplasty* / adverse effects
  • Angioplasty* / instrumentation
  • Humans
  • Renal Artery Obstruction / complications
  • Renal Artery Obstruction / diagnostic imaging
  • Renal Artery Obstruction / physiopathology
  • Renal Artery Obstruction / therapy*
  • Renal Artery* / diagnostic imaging
  • Renal Artery* / physiopathology
  • Risk Factors
  • Stents
  • Treatment Outcome
  • Vascular Patency
  • Vascular Surgical Procedures* / adverse effects