Abstract
Catheter-based renal denervation (RDN) was introduced to treat resistant hypertension. However, the reduction in blood pressure after the RDN was modest. Catheter-based RDN was performed only at main renal arteries, except for accessory and branch arteries due to the diameter being too small for the catheter to approach. Here, we retrospectively analyzed the anatomy of diverse renal arteries via 64-channel multi-detector computed tomography angiograms of 314 consecutive donors who underwent living donor nephrectomy from January 2012 to July 2017. Occurrence rates of one or more accessory renal arteries in donors were 25.3% and 19.4% on the left and right sides, respectively. Early branching rates before 25 mm from the aorta to the right and left renal arteries were 13.7% and 10.5%, respectively. Overall, 63.1% and 78.3% of donors had no accessory artery bilaterally and no branched renal artery, respectively. As a result, 47.1% had only main renal arteries without an accessory artery and early-branching artery. Approximately half of the donors had multiple small renal arteries bilaterally, for which catheter-based denervation may not be suitable. Thus, preoperative computed tomography angiography requires careful attention to patient selection, and there is a need for improved methods for denervation at various renal arteries.
Highlights
Catheter-based renal denervation (RDN) was introduced to treat resistant hypertension
Resistant hypertension refers to hypertension with a blood pressure ≥ 140/90 mm Hg when treated with appropriate doses of three different types of hypertensive medications, one of which should be a diuretic[1,2]
This study systematically evaluated consecutive patients who underwent donor nephrectomy and preoperative 64-channel multi-detector computed tomography (MDCT) angiography, which is more sensitive and accurate than conventional angiography
Summary
Catheter-based renal denervation (RDN) was introduced to treat resistant hypertension. Catheter-based RDN was performed only at main renal arteries, except for accessory and branch arteries due to the diameter being too small for the catheter to approach. Half of the donors had multiple small renal arteries bilaterally, for which catheter-based denervation may not be suitable. Among previous methods for treating resistant hypertension, catheter-based sympathetic renal denervation (RDN) was the most s tudied[4]. Because sympathetic nerve fibers around the renal artery, which is responsible for blood pressure control, are distributed beyond the penetration depth of energy from the lumen of the artery, the previous catheter-based ablation method did not allow for complete denervation, and the possibility of intima injury increases when surgeons increase the energy to obtain deeper p enetration[6,7]. Many patients who had small renal arteries (< 3 mm diameter) could not be properly excluded from the previous clinical trials
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