Metallic Stents in the Renal and Peripheral Arteries

Abstract

Clinical ConsiderationsIn experienced hands, renal artery stenting has a high technical success rate, 1 and long-term patency is good. 2,3 Why, then, are physicians still reluctant to refer patients with symptoms of renal artery stenosis for this procedure? The answer probably lies in the discrepancy between technical and clinical success rates.The three clear clinical indications for renal revascularization are hypertension, renal insufficiency, and flash pulmonary edema. HYPERTENSIONHypertension was the first clinical condition for which renal artery stenosis was shown to be a possible cause. 4 In young adults, fibromuscular dysplasia of one or both renal arteries is a potentially curable condition. Renal artery angioplasty is recommended and has a high technical and clinical long-term success rate. 5 For these young patients, most operators feel that renal artery stenting is neither necessary nor desirable.For hypertension in older persons, the position is much less clear. In this age group, the underlying disease is usually atherosclerosis, and when the ostium of 215 ABSTRACT This article summarizes the role of metallic stents in the renal and peripheral arteries. The indications for the use of such stents and the technique, results, and complications of placement are outlined.Objectives: On completion of this article, the reader should understand the uses of metallic stents in the renal arteries, as well as the complications and results. Accreditation: Tufts University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Tufts University School of Medicine takes full responsibility for the content, quality, and scientific integrity of this continuing education activity. Credit: Tufts University School of Medicine designates this education activity for a maximum of 1.0 hour credit toward the AMA Physicians Recognition Award in category one. Each physician should claim only those hours that he/she actually spent in the educational activity.