Reduction of Blood Pressure Following After Renal Artery Adventitia Stripping During Total Nephroureterectomy: Potential Effect of Renal Sympathetic Denervation

Abstract

Case seriesPatients: Male, 85 • Male, 89Final Diagnosis: Essential hypertensionSymptoms: High blood pressureMedication: Anti-hypertensive agentsClinical Procedure: OperationSpecialty: Cardiology and HypertensionObjective:Unusual or unexpected effect of treatmentBackground:Catheter-based renal sympathetic denervation has been reported to be effective for treatment resistance hypertension in Australia and Europe. However, in the blinded SYMPLICITY HTN-3 trial, renal denervation did not achieve a significant decrease in blood pressure (BP) in comparison to sham controls. There have been various discussions on the factors that influenced this result.Case Reports:Two men on antihypertensive therapy underwent unilateral radical nephroureterectomy for cancer of the renal pelvis. When the renal artery adventitia was stripped and cauterized just before renal artery ligation, the measured BP of the 2 men increased after stripping adventitia and decreased gradually after cauterization of the renal artery. This was presumably due to removal of renal artery sympathetic nerves, similar to the mechanism of catheter-based renal sympathetic denervation, although anesthesia, fluid infusion, and/or mesenteric traction may have had an influence.Conclusions:A similar strategy involving thoracolumbar sympathectomy was reported about 50 years ago. The clinically significant blood pressure reduction in these patients suggests renal denervation is effective.

Effect of extensive artery isolation during robotic-assisted partial nephrectomy on blood pressure of patients with poorly controlled hypertension: a preliminary study

“…Laparoscopic RDN with no ablation also shows promise in the treatment of carefully selected patients with resistant hypertension. Keisuke reported two cases of unilateral radical nephroureterectomy for renal pelvic cancer, during which the peri-arterial tissues containing RSNs were stripped to expose the vessel and ligated after cauterization; the patients showed reduced BP after surgery [ 26 ]. In our study, the renal artery was skeletonized, and adventitia around the renal artery containing RSNs was stripped off, disconnected and cauterized.…”

Regions of the human renal artery: histomorphometric analysis

“…Angioplasty to repair renal artery stenosis [2][3][4] renal de-nervation to control sympathetic arterial activity, including catheter-based renal denervation [5][6][7] and renal artery adventitia stripping [8] are all techniques currently considered for the control of refractory hypertension. These techniques act on the main renal artery as the target.…”