Retrospective morphometric study of the suitability of renal arteries for renal denervation according to the Symplicity HTN2 trial criteria

Abstract

ObjectiveThe aim of this study was to describe the renal arteries of humans in vivo, as precisely as possible, and to formulate an expected value for the exclusion of renal denervation due to the anatomical situation based on the criteria of the Symplicity HTN trials.Design and settingIn a retrospective cohort study, the renal arteries of 126 patients (57 women, 69 men, mean age 60±17.2 years (CI 57.7 to 63.6)) were segmented semiautomatically from high-contrast CT angiographies.ResultsAmong the 300 renal arteries, there were three arteries with fibromuscular dysplasia and one with ostial renal artery stenosis. The first left renal artery was shorter than the right (34±11.4 mm (CI 32 to 36) vs 45.9±15 mm (CI 43.2 to 48.6); p<0.0001), but had a slightly larger diameter (5.2±1.4 mm (CI 4.9 to 5.4) vs 4.9±1.2 mm (CI 4.6 to 5.1); p>0.05). The first left renal arteries were 1.1±0.4 mm (CI 0.9 to 1.3), and the first right renal arteries were 0.3±0.6 mm (CI 0.1 to 0.5) thinner in women than in men (p<0.05). Ostial funnels were up to 14 mm long. The cross-sections were elliptical, more pronounced on the right side (p<0.05). In 23 cases (18.3%), the main artery was shorter than 2 cm; in 43 cases (34.1%), the diameter was not >4 mm. Some 46% of the patients, or 58.7% when variants and diseases were taken into consideration, were theoretically not suitable for denervation.ConclusionsBased on these precise measurements, the anatomical situation as a reason for ruling out denervation appears to be significantly more common than previously suspected. Since this can be the cause of the failure of treatment in some cases, further development of catheters or direct percutaneous approaches may improve success rates.

Renal artery anatomy assessed by quantitative analysis of selective renal angiography in 1,000 patients with hypertension

“…The liver forces the right kidney to be lower, more medially displaced and smaller than the left. The renal arteries arise from the lateral aspect of the aorta below the level of the superior mesenteric artery and because the right artery passes posterior to the inferior vena cava it is longer than the left, and indeed our findings confirm these observations [14,22]. We add however also what these studies did not show [22], that the left main renal artery is of larger diameter.…”

“…The renal arteries arise from the lateral aspect of the aorta below the level of the superior mesenteric artery and because the right artery passes posterior to the inferior vena cava it is longer than the left, and indeed our findings confirm these observations [14,22]. We add however also what these studies did not show [22], that the left main renal artery is of larger diameter. Our data also suggest that accessory renal arteries are associated with longer main renal arteries, in contrast to previous studies that described solitary renal arteries as longer [14].…”

Analysis of renal artery morphometery in adults: A study conducted by using Multidetector computed Tomography Angiography

“…It is essential for the radiologists and surgeons to have background knowledge of normal range of renal artery measurements and variation in measurementsin a specific population as this can affect complex and expertise required procedure. 23 , 24 In our study a significant difference was observed between mean diameter of right and left main renal arteries. Mean diameter of right renal artery was found to be smaller than mean diameter of left renal artery.…”

A comprehensive study of the abdominal ganglia part 2: Aorticorenal ganglia

“…Studies have shown great variability in the renal vasculature. In one clinical trial this resulted in nearly 50% of patients to be unsuitable for direct renal denervation therapy (Schönherr et al, 2016; Song et al, 2020). The varied results from the clinical trials, has led researchers to investigate the anatomy of the surrounding area as well as the potential of blocking the aorticorenal ganglion instead (Hori et al, 2021; Reetu et al, 2018).…”