Renal Sympathetic Denervation: MDCT Evaluation of the Renal Arteries

Abstract

Percutaneous transluminal renal sympathetic denervation is a new treatment of refractory systemic hypertension. The purpose of this study was to assess the clinical utility of MDCT to evaluate the anatomic configuration of the renal arteries in the context of renal sympathetic denervation. Two readers retrospectively evaluated the MDCT renal artery scans of 90 patients (mean age, 70 ± 13 years; range, 32-98 years). Analysis included the number of renal arteries on each side, ostial shape and size, angle off the aorta, branching pattern, degree of tortuosity, and distance to adjacent vascular structures. Sixty-five patients had one, 23 had two, and two had three renal arteries on one side. One hundred forty-six arteries were funnel-shaped (72 left and 74 right; mean ostial diameter, 0.9 ± 0.2 cm tapering to 0.6 ± 0.1 cm). The mean tortuosity index was 1.1 (range, 1 [no tortuosity] to 3.1). Compared with the left renal artery, the right renal artery was longer (4.0 ± 0.9 cm vs 5.0 ± 1.2 cm, p ≤ 0.001), originated at a more acute angle on axial (67° vs 98°, p < 0.05) and coronal images (57° ± 16° vs 65° ± 14°, p < 0.05), was significantly closer to the superior mesenteric artery (1.0 ± 0.7 cm vs 1.6 ± 1.2 cm, p < 0.001), and came in closer contact with venous structures (0.0 ± 0.1 vs 0.2 ± 0.9, p < 0.05). Our findings suggest MDCT of the renal arteries is an informative investigation in patients undergoing renal sympathetic denervation, providing data on the number and size of renal branches, ostial shape, and proximity to adjacent venous structures.