The efficacy of renal angioplasty in patients with renal artery stenosis and flash oedema or congestive heart failure: a systematic review

Abstract

AimsRecent randomized controlled trials have reported that angioplasty does not have a beneficial effect compared with pharmacological treatment on blood pressure and renal function in patients with atherosclerotic renal artery stenosis (RAS). We aimed to explore systematically the evidence that angioplasty is effective in subgroups of patients with RAS and either flash pulmonary oedema or congestive heart failure (CHF) and renal insufficiency. Methods and resultsWe searched online databases (PubMed and ClinicalTrials.gov) and references of included articles. We included 25 articles describing 79 patients with RAS and flash oedema and seven articles describing 94 patients with RAS, CHF, and renal insufficiency. According to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system, the quality of the evidence was, at best, low. Seventy-six per cent of patients with flash oedema did not have any recurrence after angioplasty. Recurrence of symptoms was associated with either restenosis of the renal artery or cardiac arrhythmias in all patients. In the patients with CHF and renal insufficiency, the severity of heart failure symptoms, expressed as New York Heart Association (NYHA) functional class, improved after angioplasty in all included articles. ConclusionThe evidence included in this systematic review justifies a weak recommendation in favour of angioplasty in patients with atherosclerotic RAS and either flash pulmonary oedema or CHF and renal insufficiency.--

2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS)

“…Pacjenci z obrzękami płuc o nagłym początku (flash pulmonary edema) lub zastoinową niewydolnością serca, zwykle z zachowaną czynnością skurczową lewej komory, mogą być kandydatami do leczenia wewnątrznaczyniowego [208,[237][238][239], choć subanaliza w badaniu CORAL nie była konkluzywna [229].…”

Renal Artery Stenosis—When To Screen, What To Stent?

“…In one series of patients with proven RAS, 41 % of patients with bilateral disease had a history of pulmonary oedema, and following stenting, 77 % of these patients had no further episodes of pulmonary oedema [71]. A recent systematic review included data from 173 patients and concluded that the quality of evidence was low and justified only a weak recommendation for PTRAA with or without stenting in patients with atherosclerotic RAS and either flash pulmonary oedema or chronic heart failure and renal insufficiency [72]. …”

Renovascular hypertension

“…A separate report by ven den Berg, et.al. summarized reports of renal revascularization for RVD associated with congestive heart failure (5). The authors included 25 articles identifying 79 patients with RVD and “flash” pulmonary edema and an additional seven with 94 patients identified with RVD, congestive heart failure (CHF) and renal insufficiency.…”

“…Since this topic was last reviewed in this journal (1) and elsewhere (2), no major new trial data have been presented. There have been several recent “systematic” and other reviews of the published data (3) (4,5). …”