Renal Denervation for Refractory Hypertension - Technical Aspects, Complications and Radiation Exposure

Abstract

For an experienced interventionalist, RDN has a short learning curve with a low risk profile. The radiation dose does not exceed that of other renal artery interventions, but is explicitly higher in obese patients, who account for a large portion of patients with refractory hypertension.

Renal denervation in heart failure with preserved ejection fraction (RDT‐PEF): a randomized controlled trial

“…However, the procedure is not without risk, with two patients requiring balloon angioplasty to treat intense vessel spasm/oedema, a complication which is usually treated with intra‐arterial nitrate alone. Our decision to intervene on these patients was based upon the severity of the vessel reaction (>95% reduction in luminal diameter) and persistence (>20 min); the requirement of balloon angioplasty to treat severe renal artery oedema/spasm following RDT has been reported previously . Two other patients had a decline in eGFR >30%; further clinical follow‐up data were available to us and these patients' eGFR recovered to pre‐randomization levels after completing treatment for fluid overload.…”

Renal Denervation: A Novel Therapy at the Crossroads of Imaging, Intervention, and Innovation

“…Typically, at least conscious sedation is required as the short ablation cycles usually produce severe pain, exactly matching the time of ablation, which may be either visceral or somatic in sensation. 26 Technical specifics of the procure vary from vendor to vendor, but as currently performed, catheter-based RFA renal denervation commences with unilateral transfemoral arterial access with subsequent canulation of the renal artery with a dedicated catheter connected to a lowenergy radiofrequency generator. Slow intra-arterial administration of 0.2 mg nifedipine for spasm prophylaxis (alternatively, use 100-200 µg nitroglycerine) and 2000 IU heparin for thrombosis prophylaxis may be given according to operator preference.…”

“…This occurred once in 53 patients in a recently published series. 26 Dissection is a feared complication requiring access to, and operator experience with, suitable angioplasty balloons and stents. There was a single renal artery dissection in the 153 patients of the Symplicity HTN-I pilot trial but none in the 106 patients in the Symplicity HTN-II trial.…”

Sympathetic Renal Denervation for the Treatment of Hypertension: A Review of Current Progress, Limitations, Techniques, and the Future

“…This makes sense, keeping in mind that patients with renal failure have an increased amount of sympathetic activity compared to hypertensive patients who have normal kidney function [14,15]. Similarly, in the initial studies, presence of accessory renal arteries was considered as a contraindication, but several new studies are including such patients, given that the arteries are> 4mm in diameter and >20 mm in length [13,16,17].…”

“…In HTN-2 trial, one case each of pseudoaneurysm, post-therapeutic hypotension, temporary paraesthesia and flank pain was reported. In other studies, the reported complications include severe arterial spasm, imminent respiratory and cardiocirculatory depression in a patient with OSA and bradycardia, among others [16,18]. Not to forget, the radiation exposure in this procedure may be significant, especially as the eligible population may have many obese patients who require higher amounts of radiation.…”