Renal Revascularization to Preserve and Restore Renal Function

Libertino, John A.; Bosco, Peter J.; Ying, Christopher Y.; Breslin, Donald J.; Woods, Bartholomew O’B.; Tsapatsaris, Nicholas P.; Swinton, Neil W.

doi:10.1016/s0022-5347(17)37603-6

Cited by 88 publications

(30 citation statements)

References 9 publications

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“…However, the high surgical perioperative complication rates and the increased periprocedural mortalities ranging from 2.1% to 6.1% 14,15,[33][34][35] sharply contrast with those of stent revascularization. Furthermore, surgical mortality was adversely affected (9-fold increase) by clinically evident diffuse atherosclerosis.…”

Section: Discussionmentioning

confidence: 99%

Four-Year Follow-up of Palmaz-Schatz Stent Revascularization as Treatment for Atherosclerotic Renal Artery Stenosis

et al. 1998

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Background-Stent revascularization is perceived as superior to balloon angioplasty and surgical revascularization, but the paucity of stent publications precludes even historical comparison with surgical data. Methods and Results-Palmaz-Schatz stent revascularization of renal artery stenosis was successfully performed on 163 consecutive patients for poorly controlled hypertension or preservation of renal function. Of these, 145 were eligible for Ն6-month clinical follow-up of the effect of the procedure on renal function, blood pressure control, number of antihypertensive medications, and survival. At 4 years, systolic and diastolic blood pressures significantly decreased (from 166Ϯ26 to 148Ϯ22 mm Hg and from 86Ϯ14 to 80Ϯ11 mm Hg, respectively; PϽ0.05), and blood pressure control was more facile in approximately half of the patients. Creatinine decreased or remained stable in approximately two thirds of the patients. The cumulative probability of survival was 74Ϯ4% at 3 years, with few deaths related to end-stage renal disease. Survival was good in patients with normal (92Ϯ4%) baseline renal function, fair (74Ϯ7%) in those with mildly impaired renal function, and poor (52Ϯ7%) in patients with elevated baseline creatinine levels (Ն2.0 mg/dL). The combination of impaired renal function and bilateral disease adversely affected survival. Conclusions-Renal artery stent revascularization in the presence of normal or mildly impaired renal function had a beneficial effect on blood pressure control and a nondeleterious effect on renal function. Survival was adversely affected by renal dysfunction despite adequate revascularization. Early diagnosis and adequate revascularization before the onset of renal dysfunction could beneficially affect blood pressure control, preserve or prevent deterioration of renal function, and improve patient survival. (Circulation. 1998;98:642-647.)

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Section: Discussionmentioning

confidence: 99%

Four-Year Follow-up of Palmaz-Schatz Stent Revascularization as Treatment for Atherosclerotic Renal Artery Stenosis

et al. 1998

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“…Complications associated with surgery include significant bleeding requiring surgery (1-4%), early graft thrombosis (0-4%), cholesterol embolization (1-4%), MI (2-9%), stroke (0-4%), and death (2.5-8%). [92][93][94][95][96][97][98][99][100] Early graft failure, CAD, uncontrolled HTN, and concomitant abdominal aorticaneurysm repair have all been associated with increased perioperative mortality. Early graft failure (2-10%) is highly associated with perioperative death and is most often related to technical problems.…”

Section: Renal Artery Revascularizationmentioning

confidence: 99%

“…These include access site hematoma (<3%), clinically apparent distal embolization/occlusion (2.2%), cholesterol embolization (1.1%), and injury requiring renal surgery/nephrectomy (2.5%). 96,[104][105][106] PTRA has proven most useful in cases on non-ostial RAS and FMD. PTRA of 'typical' FMD ( Figure 2) for patients with HTN is associated with technical success rates of 82-100% with recurrence in approximately 10%.…”

Section: Renal Artery Revascularizationmentioning

confidence: 99%

The role of percutaneous revascularization for renal artery stenosis

Dubel

Murphy

2008

Vasc Med

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Renal artery stenosis (RAS) is usually caused by atherosclerosis or fibromuscular dysplasia. RAS leads to activation of the renin-angiotensin-aldosterone system and may result in hypertension, ischemic nephropathy, left ventricular hypertrophy and congestive heart failure. Management options include medical therapy and revascularization procedures. Recent studies have shown angiotensin receptor blockers (ARB) and angiotensin converting enzyme inhibitors (ACE-I) to be highly effective in treating the hypertension associated with RAS and in reducing cardiovascular events; however, they do not correct the underlying RAS and loss of renal mass may continue. Renal artery angioplasty was first performed by Gruntzig in 1978. The routine use of stents has increased technical success rates compared with angioplasty, and surgery is now only rarely performed. Although numerous case series claimed benefit in terms of blood pressure control, no adequately powered randomized, controlled, prospective study of renal artery interventions has reported their effect on cardiovascular morbidity or mortality. The CORAL trial, an ongoing study of renal artery stent placement and optimal medical therapy (OMT) funded by the National Institutes of Health, is the first study to attempt to do so. Until the CORAL trial results are in, physicians will continue to be faced with difficult choices when determining the optimal management for RAS patients and deciding which, if any, patients should be offered revascularization.

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“…1 Likewise, the benefits of renal revascularization procedures are well documented. 2,3 These techniques individually have been well elucidated. 4 However, we believe this is the first detailed report of a simultaneous ipsilateral partial nephrectomy and renal artery bypass procedure.…”

Section: Introductionmentioning

confidence: 99%

Renal Artery Stenosis and Ipsilateral Renal Cell Carcinoma: Description of an In Situ Partial Nephrectomy and Splenorenal Arterial Bypass

Slavis

Ganesan

Swift

et al. 2004

The Scientific World JOURNAL

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A case of a renal artery stenosis and ipsilateral renal cell carcinoma with long term results is reported. A 65-year-old man with renovascular hypertension, renal insufficiency, and nephrotic range proteinuria presented with an incidental renal cell carcinoma. Concomitant in situ left partial nephrectomy and splenorenal arterial bypass was achieved. The patient is doing well without evidence of malignancy, stable renal function, markedly improved proteinuria and stable blood pressure more than three years later. The techniques of this procedure are detailed and underscore the possibility of successful removal of a renal cell carcinoma with preservation of renal function despite renal artery stenosis.

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Renal Revascularization to Preserve and Restore Renal Function

Cited by 88 publications

References 9 publications

Four-Year Follow-up of Palmaz-Schatz Stent Revascularization as Treatment for Atherosclerotic Renal Artery Stenosis

Four-Year Follow-up of Palmaz-Schatz Stent Revascularization as Treatment for Atherosclerotic Renal Artery Stenosis

The role of percutaneous revascularization for renal artery stenosis

Renal Artery Stenosis and Ipsilateral Renal Cell Carcinoma: Description of an In Situ Partial Nephrectomy and Splenorenal Arterial Bypass

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