Sympathectomy for Hypertension

Newcombe, C. P.; Shucksmith, H. S.; Suffern, W. S.

doi:10.1136/bmj.1.5115.142

Cited by 39 publications

(7 citation statements)

References 5 publications

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“…Furthermore, there is growing evidence that abnormal renal function in hypertension is due to the increased activity of renal sympathetic nerves [7]. Thus, an open surgical procedure to remove renal sympathetic nerves for treating hypertension called Sympathectomy was employed in 1930 [8][9][10]. Although this technique provided effective treatment, its use was discontinued because of its highly invasive nature and associated complications, such as perioperative morbidity, mortality and long-term complications [11,12].…”

Section: Introductionmentioning

confidence: 99%

Design and simulation of novel laparoscopic renal denervation system: a feasibility study

Baik

Lee

et al. 2018

International Journal of Hyperthermia

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Section: Introductionmentioning

confidence: 99%

Design and simulation of novel laparoscopic renal denervation system: a feasibility study

Baik

Lee

et al. 2018

International Journal of Hyperthermia

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“…Symplicity HTN-1 was the first clinical trial examining percutaneous transcatheter RDN in the treatment of ResH. 4 The study consisted of a cohort of 50 patients who underwent RDN; a sustainable BP lowering effect was observed during consecutive follow-up visits at 1, 3, 6, 9, and 12 months. The cohort was then increased to 153 patients and the follow-up period was extended to 3 years.…”

Section: Discussionmentioning

confidence: 99%

“…3 In the case of true ResH, a failure of pharmacotherapy leads to more invasive methods of treatment, which are based conceptually on the role of the autonomic nervous system in the pathogenesis of HA. Initially, invasive techniques involved surgical sympathectomy of abdominal organs, 4 which is usually successful in anti-hypertensive effects but often results in unbearable gastrointestinal distress. Thus, a consensus was reached that renal artery denervation (RDN), a more selective procedure, may be an option for patients with ResH.…”

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confidence: 99%

Resistant hypertension: Renal denervation or pharmacovigilance? Insights from a renal denervation screening program

et al. 2019

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Background. With emerging new therapeutic concepts including renal denervation (RDN), there is a renewed interest in resistant hypertension (ResH). Among patients suspected of having ResH, a definitive diagnosis needs to be established.Objectives. This study presents observations from a standardized single-center screening program for RDN candidates, including medical therapy modification and reassessment.Material and methods. All patients referred to our center for RDN underwent a standardized screening protocol. Candidates were recruited from among patients receiving no less than 3 antihypertensive drugs, including diuretics with office blood pressure (BP) >140/90 mm Hg. The assessment included 2 measurements of BP and ambulatory BP monitoring (ABPM). If needed, pharmacotherapy was intensified and the diagnosis of ResH was reconfirmed after 6 weeks. If ResH was persistent, patients were hospitalized with repeated ABPM on day 4. Further, renal CT-angio was performed and a multidisciplinary team discussed the patients' suitability for RDN. Results.A total of 87 patients with a ResH diagnosis were referred for RDN. Mean office BP was 159/92 (±7.0/6.5) mm Hg and mean ABPM was 154/90 (±9.0/4.8) mm Hg. The initial medication included angiotensin convertase inhibitors (ACE-I, 78%), angiotensin receptor blockers (12%), β-blockers (85%), calcium channel blockers (36%), and diuretics (93%). During the 18 months of the RDN program, 5 patients underwent RDN and 2 further had ineligible renal anatomy. A new diagnosis of secondary hypertension was made in 21 patients. However, in 59 patients, BP control was achieved after optimization of medical therapy, with a mean ABPM of 124/74 mm Hg. The final treatment included ACE-I (100%), β-blockers (92%), indapamide (94%), amlodipine (72%), and spironolactone (61%). Medication in most of these patients (88%) included single-pill triple combination (52.5%) or double combination (35.6%). Conclusions.Patients with elevated BP screened for RDN require a rigorous diagnostic workup. Up to 2/3 of patients can be managed with strict pharmacotherapy compliance and pharmaceutical intensification, including single-pill combinations and improved drug compliance. Hasty use of RDN may be a result of poor drug optimization and/or compliance. It does remain a viable treatment option in thoroughly vetted ResH patients.

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“…The concept of renal denervation for treatment of hypertension is not new. In the 1950s, surgical renal denervation was advocated for management of hypertension [ 15 ], and sympathectomy [ 16 ] was conducted. Of course, this was too invasive for routine antihypertensive treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Of course, this was too invasive for routine antihypertensive treatment. Moreover, those studies [ 15 , 16 ] (as with recent clinical trials) did not involve careful evaluation of the BP response such as by ambulatory monitoring or assessment of the effect of sham surgery, so it is unclear whether sympathetic denervation resulted in a significant decrease of BP.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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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.

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Sympathectomy for Hypertension

Cited by 39 publications

References 5 publications

Design and simulation of novel laparoscopic renal denervation system: a feasibility study

Design and simulation of novel laparoscopic renal denervation system: a feasibility study

Resistant hypertension: Renal denervation or pharmacovigilance? Insights from a renal denervation screening program

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

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