Incidence Of Renal Artery Stenosis Research Articles

Abstract 056: Pooled, 6-month Renal Safety And Blood Pressure Reductions Using The Symplicity Spyral Radiofrequency Renal Denervation Catheter

Background: Renal denervation (RDN) targets the sympathetic nervous system to lower blood pressure (BP). Impact on long-term renal function after RDN is less well known. We report 6-month renal safety and BP reductions after RDN from the largest database, using the latest generation, multi-electrode, radiofrequency (RF) Symplicity Spyral™ catheter. Methods: A broad spectrum of patients with hypertension were enrolled in the SPYRAL HTN Global Clinical Program (4 major studies; SPYRAL First-In-Man, SPYRAL HTN-OFF MED, -ON MED and Global SYMPLICITY Registry [GSR]). GSR is an all-comer registry for patients with uncontrolled hypertension, including chronic kidney disease (CKD), whereas patients enrolled in the SPYRAL HTN-OFF and -ON MED trials required to have OSBP ≥150 and <180 mmHg and ODBP ≥90 mmHg. OFF MED patients were required to have a drug washout period prior to treatment and did not take drugs for the first 3 months. ON MED patients were on a stable 1-3 antihypertensive drug regimen for 6 months. All were treated with RF RDN using the Spyral catheter. We pooled reductions in office and 24-h ambulatory BP, safety outcomes include changes in the estimated glomerular filtration rate (eGFR) and renal artery stenosis incidence (>70%, confirmed by angiography). Results: As of December 2022, 1,284 patients have received RF RDN with the Spyral catheter. Patients at baseline were 58±12yrs old, 37.6% female, 29.1% had type 2 diabetes, eGFR was 77.7±23.9mL/min/1.73m2, 20.7% had CKD stage 3 or higher, OSBP was 166±21mmHg and ASBP was 153±16mmHg. 6 months after RDN, OSBP changed by -14.8±22.1 (n=940; p<0.001) and ASBP changed by -8.9±16.0 (n=678; p<0.001). Significant diastolic BP reductions were also observed. eGFR changed by -2.0mL/min/1.73m2. There was no incidence of renal artery stenosis (>70%). Conclusion: In this large, pooled population of patients receiving RF RDN using the Spyral catheter, there were significant and consistent BP reductions through 6 months. There was no incidence of renal artery stenosis, and eGFR change was consistent with the natural progression of the aging hypertensive population. These data highlight the safety and efficacy of RF RDN as an adjunctive therapy to antihypertensive drugs to treat high BP.

Renal Artery Reimplantation Versus Bypass in Elective Open Aneurysm Repair

Complex open abdominal aortic aneurysm (AAA) repair often necessitates revascularization of renal arteries by either renal artery reimplantation or bypass. This study aims to evaluate the perioperative and short term outcomes between these two strategies of renal artery revascularization. We performed a retrospective review of patients who underwent open AAA repair from 2004-2020 at our own institution. Patients who underwent elective suprarenal, juxtarenal, or type 4 thoracoabdominal aneurysm repair were identified using current procedural terminology (CPT) codes as well as a retrospectively maintained database of AAA patients. Patients who had symptomatic aneurysm or significant renal artery stenosis prior to AAA repair were excluded. Patient demographics, intraoperative conditions, renal function, bypass patency and perioperative and postoperative outcome at 30 days and 1 year were compared. 143 patients underwent either renal artery reimplantation (n=86) or bypass (n=57) during this time period. The mean age was 69.7 years and 76.2% of the patients were male. Median preoperative creatinine was 1.2 mg/dL for the renal bypass group vs 1.06 mg/dL for reimplantation (P=0.088). Both groups had similar median preoperative glomerular filtration rate (GFR) of >60 mL/min (P=0.13). Bypass and reimplantation groups had similar perioperative complications including acute kidney injury (51.8% vs 49.4% P=0.78), inpatient dialysis (3.6% vs 1.2% P=0.56), myocardial infarction (1.8% vs 2.4% P=0.99), and death (3.5% vs 4.7% P=0.99), respectively. During the 30 day follow-up period, renal artery stenosis was identified in 9.8% of bypasses and 6.7% of reimplantations (P=0.71). 6.1% of patients in the bypass group had renal failure requiring dialysis (both acute and permanent) compared to 1.3% in reimplantation group (P=0.3). For those who had 1 year follow up, the reimplantation group had higher new incidence of renal artery stenosis compared to bypass group (6 vs. 0 p=0.16). Given that there is no significant difference in outcomes between renal artery reimplantation and bypass within 30 days or at 1 year follow-up, both bypass and re-implantation are acceptable means for renal artery revascularization during elective AAA repair.

POOLED, 6-MONTH SAFETY AND EFFICACY RESULTS USING THE SYMPLICITY SPYRAL RADIOFREQUENCY RENAL DENERVATION CATHETER

Objective: Over 1,200 patients received renal denervation (RDN) to reduce high blood pressure using the current generation, multi-electrode, radiofrequency Symplicity SpyralTM catheter as part of the SPYRAL HTN Global Clinical Program. The Spyral FIM was a prospective, single-arm study to assess feasibility. The SPYRAL HTN-OFF MED and -ON MED studies were randomized, sham controlled, blinded trials assessing the safety and efficacy of RDN in the absence and presence of antihypertensive medications, respectively. The Global SYMPLICITY Registry is an all-comer, global, single-arm study assessing safety and efficacy of RDN in a real-world setting with patients on various medication regimens. Here, we present the pooled, 6-month efficacy and safety results of RDN using the Spyral catheter. Design and method: At each follow-up, including at 6 months, office systolic and diastolic blood pressures and 24-h ambulatory systolic and diastolic were collected. Adverse safety events and other indicators including estimated glomerular filtration rate (eGFR) and incidence of renal artery stenosis were recorded. GSR was an all-comer registry for patients with uncontrolled hypertension, whereas patients in the SPYRAL HTN-OFF and ON MED trials were required to have an OSBP > = 150 and <180 mmHg and ODBP > = 90 mmHg. Results: As of December 19, 2022, 1,298 patients have received RDN therapy using the Spyral catheter, including eligible control patients from the randomized trials who elected to cross over to receive RDN after unblinding. Mean, 6-month reductions in office and 24-h ambulatory BP from baseline are shown in the Figure. Patients had similar, significant reductions in diastolic blood pressure from baseline through 6 months. Including crossover patients, eGFR decreased by 1.5 mL/min/1.73 m2 through 6 months in RDN patients using the SPYRAL catheter (n = 962; 95% CI: -2.27,-0.74; p < 0.001). There have been no recorded instances of renal artery stenosis >70% through 6 months. Conclusions: Patients receiving RDN had significant and consistent 6-month reductions in BP compared to baseline measures. There have been no incidences of renal artery stenosis, and reductions in eGFR are consistent with natural progression with age. These results highlight the efficacy and safety of RDN using the current generation Spyral catheter.

Incidence of renal artery stenosis and its hemodynamic significance in patients subjected to angiography for suspected coronary artery disease

Background: Renal artery stenosis (RAS) may occur alone (isolated anatomical RAS) or in combination with hypertension (renovascular or essential hypertension), renal insufficiency (ischemic nephropathy), or both. Renal artery stenting can be performed safely with nearly uniform technical success without exposing them to significant incremental risk. Aims and Objectives: The objectives of the study are as follows: (A) To study the incidence of RAS in suspected coronary artery disease patients. (B) To study the hemodynamic significance of RAS in patients diagnosed having RAS. (C) Should patients undergoing coronary angiography be subjected to routine renal angiography during the procedure? Materials and Methods: We prospectively did renal angiography of consecutive 100 patients, who underwent coronary angiography for their suspected coronary artery disease. Data regarding risk factors were recorded for every patient. Results: Out of 12 patients with RAS, 10 had significant stenosis (>50%) out of which seven patients showed hemodynamically significant RAS on captopril renogram. These were the patients having stenosis of 70% or more on renal angiography. Three patients having RAS 50–70% on renal angiography were not having hemodynamically significant lesion on captopril renograms. Conclusion: Renal angiography should be performed in patients undergoing coronary angiography. Femoral artery should be the preferred access site for coronary angiography to approach renal arteries. The patients with RAS should undergo captopril renography to evaluate the hemodynamic significance of the stenosis.

The Incidence and Predictors of Renal artery Stenosis in Patients Referred for Coronary Angiography

Background: Renal artery stenosis (RAS) and coronary artery disease (CAD) are two manifestations of a same pathogenesis which is atherosclerosis.. RAS is a leading factor of secondary hypertension, ischemic nephropathy and end stage renal disease (ESRD). Aim of work: This study was aimed to detect the incidence and predictors of renal artery stenosis in patients referred for elective coronary angiography. Patients and Methods: In this study we included 100 patients who underwent coronary and renal angiography.The mean age was 56.6 + 7.9 years, 60 males (60%), 40 females (40%), 60 diabetic (60%), 58 hypertensive (58%), 41 smokers (41%), 62 dyslipidemic (62%), 27 patients with family history of ischemic heart disease (27%), and patient with normal coronaries 12 (12 %). Our study consisted of 2 groups; 87 (87%) patients with normal renal arteries (group 1) and 13 (13%) patients with renal artery stenosis (group 2). Results: The incidence of RAS was 13% and the incidence of significant RAS (>50% stenosis) was 7%. The significant difference between the two groups was in the terms of hypertension (p-value 0.014), female gender (p-value 0.021), multivessel (> 2 vessels) coronary artery disease (p-value 0.046), normal coronaries had a significant negative association with RAS (p-value 0.027) and there was a significant relationship between atherosclerotic involvement of Left anterior descending artery (LAD), Diagonal, and right coronary artery (RCA) with RAS (p-value 0.037, 0.041 and 0.042). Conclusion: It could be concluded that predictors of RAS were hypertension, multivessel coronary artery disease (> 2 vessels) and female gender.

Bovine Carotid Artery Patch Helps Reduce the Incidence of Renal Artery Stenosis in Living Kidney Transplants

Bovine Carotid Artery Patch Helps Reduce the Incidence of Renal Artery Stenosis in Living Kidney Transplants

Incidence of renal artery stenosis after renal denervation in patients with resistant arterial hypertension

Catheter-based ablation of nerves in the adventitia of renal arteries (renal artery denervation [RAD]) using radiofrequency energy can reduce blood pressure (BP) in patients with resistant arterial hypertension (RAH). Occurrence of renal artery stenosis after RAD is still an important concern. We systematically investigated the renal artery anatomy using magnetic resonance imaging (MRI) or computed tomography (CT) angiography in a consecutive series of patients 6 months after RAD. Patients with RAH were treated by RAD after exclusion of secondary causes of hypertension. RAH was defined by a mean systolic office BP >160 mm Hg. Renal artery imaging was performed 6 months after RAD by MRI angiography. In case of any contraindication for MRI, a CT angiography was performed. The primary end point was the incidence of significant renal artery stenosis (‡70% lumen diameter reduction). RAD was performed in 76 patients, and evaluation of renal artery anatomy by MRI (n [ 66; 87%) or CT angiography (n [ 10; 13%) was performed in all patients 6 months after RAD. We found no renal artery stenosis but 2 cases of new nonsignificant stenosis (50% TO 69% lumen diameter reduction). In responders, mean systolic office BP reduction was L30 mm Hg (p <0.001) and mean systolic 24-hour BP reduction was L18 mm Hg (p <0.001). In conclusion, the incidence of significant renal artery stenosis 6 months after RAD seems to be very low. However, late-onset development of nonsignificant renal artery narrowing cannot be excluded in some patients and should be anticipated in the case of RAH relapse or worsening of renal function after successful

Incidence of renal artery stenosis in normal coronaries with co- morbidities

Incidence of renal artery stenosis in normal coronaries with co- morbidities

What is the true incidence of renal artery stenosis after sympathetic denervation?

Renal denervation (RDN), a recently developed therapy for resistant hypertension, is generally regarded as a safe procedure (Krum et al., 2009; Esler et al., 2010; Bhatt et al., 2014). The Symplicity HTN trials reported that the rate of renal artery stenosis after RDN was low. For example, the Symplicity HTN-1 trial showed that 1 of 45 (2.2%) denervated patients developed a non-obstructive renal artery stenosis in an untreated area at 6 months after RDN (Krum et al., 2009). This low rate of renal artery stenosis after RDN was confirmed by the 6-month report of the Symplicity HTN-2 trial (N = 106) (Esler et al., 2010) and the recently published 6-month report of the Symplicity HTN-3 trial (N = 535) (Bhatt et al., 2014), which was 1.9 and 0.3%, respectively. In these Symplicity HTN trials, renal artery stenosis occurred at a low rate (0.3–2.2%) and was not reported to cause further complications. However, some studies reported that renal artery stenosis occurred at a higher rate. For example, the EnligHTN I study (Worthley et al., 2013) reported that 2 of 46 (4.3%) patients showed progression of a pre-existing renal artery stenosis; a study from 10 European expert centers (Persu et al., 2014) reported that 3 of 109 (2.8%) patients showed progression of a non-significant (<30%) renal artery stenosis; and Versaci et al. (2014a) reported that 2 of 11 (18.2%) patients developed severe renal artery stenosis. It is worthwhile to point out that the sample size of 11 in Versaci et al.'s report is relatively small (Versaci et al., 2014a). In 2012, Vonend et al. reported that a patient developed a 75% stenosis near the ostium of the right renal artery, which caused recurrent hypertension (Vonend et al., 2012). Subsequently, another 3 case reports reported that renal artery stenosis after RDN caused recurrent hypertension (Kaltenbach et al., 2012; Aguila et al., 2014; Pucci et al., 2014). The causal role of RDN in promoting renal artery stenosis is currently speculative. However, given that (1) renal artery stenosis causes recurrent hypertension in denervated patients (Kaltenbach et al., 2012; Vonend et al., 2012; Aguila et al., 2014; Pucci et al., 2014) and (2) treatment of renal artery stenosis is not always safe and sometimes leads to death (Soriano-Perez et al., 2012), it is important to thoroughly investigate the effect of RDN on renal artery stenosis (Mahfoud and Kjeldsen, 2013; Wang, 2014a,b,c,d). To do this, the following three points need to be emphasized in future clinical trials on RDN: Long-term randomized trials are needed. Two major randomized trials on RDN, i.e., the Symplicity HTN-2 and HTN-3 trials (Esler et al., 2012; Kandzari et al., 2012), allowed patients in the randomized control group to receive RDN after completion of the 6-month study. This crossover design makes it difficult to investigate possible long-term side effects of RDN, e.g., promoting renal artery stenosis. Therefore, long-term randomized trials without a short-term crossover design are needed to investigate the effect of RDN on renal artery stenosis. Imaging methods monitoring renal artery stenosis need to be standardized. Symplicity HTN trials did not standardize renal artery imaging methods during follow ups. Ultrasonography, magnetic resonance angiography, and computerized tomographic angiography were used (Krum et al., 2009; Esler et al., 2010). The computerized tomographic angiography, the gold standard method to detect renal artery stenosis (Persu et al., 2012), was not the major imaging method in these trials. It is known that ultrasonography has limited visualization on renal artery stenosis because (1) the imaging is interfered by overlying adipose tissue and bowel gas (Zhang et al., 2009); and (2) the entire length of the renal artery or an accessory renal artery can be overlooked (Lao et al., 2011). Therefore, it is worthwhile to use computerized tomographic angiography as the standardized method during follow ups in future trials to investigate the effect of RDN on renal artery stenosis. It is likely that improved catheters for RDN using lower power radiofrequency over a shorter time will reduce the local tissue injury at the ablation site compared with that caused by the first generation RDN systems (Versaci et al., 2014b). However data regarding the vascular injury induced by these new devices are lacking.

Prevalence of Renal Artery Stenosis in Patients Undergoing Routine Coronary Angiography

This retrospective observational study aimed to see the angiographic association of at Renal-Artery Stenosis (RAS) with Coronary Artery Disease(CAD) in Bangladeshi population. It was conducted in the department of cardiology, Khwaja Yunus Ali Medical College and Hospital (KYAMCH), Enayetpur, Sirajgonj, Bangladesh, from January 2007 to January 2009.A total 281 patients with Ischaemic heart disease, on non emergent coronary angiogram who underwent either selective or non selective renal angiography were enrolled in this study. Among 281 patients, male patients was 241(85.76%), female was 40(14.23%) and age group was 30-75 years. Among those patients 228(81%) patients had Coronary artery disease, 53(18.86%) patients had normal coronary artery. Among CAD, 51(18.14%) patients had single vessel disease (SVD),39(13.87%) patients had double vessel disease (DVD),124(44.12%) patients had triple vessel disease(TVD) and 14(4.9%) patients had minimal coronary artery disease. RAS was detected 23(8.18%) patients and RAS with HTN was 18(78%) patients and ARAS without HTN was 5(21.73%) patients. RAS tends to increase with age. In age group 30-45 years, RAS was 17.39% and age group 50-75 it was 82.60%.The incidence of was high in50.09±8.76 years. Incidence of RAS was more common in male patients (73.91% vs. 26.08%).DOI: http://dx.doi.org/10.3329/kyamcj.v2i1.13513 KYAMC Journal Vol.2(1) 2011 pp.109-113

Endovascular treatment of stenosis of the renal artery in transplanted kidney

IntroductionThe incidence of renal artery stenosis in the transplanted kidney (TRAS) varies between 2 and 23%, being the most frequent vascular complication following renal trasplantation. The delay in diagnosis and treatment can lead to functional graft loss. Percutaneous transluminal angioplasty with stent (PTAS) is the treatment of choice to restore kidney perfusion. Materials and methodsRetrospective review of renal transplant casuistic in our institution between September 2005 and August 2009 was included in patients with greater than 70% TRAS and impaired graft function, treated with PTAS. Follow-up at 3, 12 and 36 months was done with creatinine, glomerular filtration rate (GFR) and Doppler ultrasonography (DUS). Technical success was defined as correct stent placement associated with decreased flow, and clinical success as improved renal function during follow-up. ResultsIncidence of TRAS was 7.3% (22/298), 60% PTAS subsidiary. 100% technical success and 84.6% clinical success, 15.4% without changes in renal function. 84% decreases flow rate greater than 70% by DUS, and 26% up to 60%. Wave changes from type III to type II were recorded in 69% and to type I in 33%. ConclusionsThe PTAS is a safe and effective procedure for the treatment of selected TRAS patients, as it preserves vascular permeability in the short and medium term, ensuring the functionality of the graft. DUS is the method of choice for diagnosis and monitoring TRAS.

Tratamiento endovascular de la estenosis de la arteria renal en el riñón trasplantado

IntroductionThe incidence of renal artery stenosis in the transplanted kidney (TRAS) varies between 2 and 23%, being the most frequent vascular complication following renal trasplantation. The delay in diagnosis and treatment can lead to functional graft loss. Percutaneous trasluminal angioplasty with stent (PTAS) is the treatment of choice to restore kidney perfusion. Materials and MethodsRetrospective review of renal transplant casuistic in our institution between September 2005 and August 2009. Were included patients with greater than 70% TRAS and impaired graft function, treated with PTAS. Follow-up at 3, 12 and 36 months was done with creatinine, glomerular filtration rate (GFR) and Doppler ultrasonography (DUS). Technical success was defined as correct stent placement associated with decreased flow, and clinical success as improve renal function during follow-up. ResultsIncidence of TRAS was 7.3% (22/298), 60% PTAS subsidiary. 100% technical success and 84.6% clinical success, 15.4% without changes in renal function. 84% decreases flow rate greater than 70% by DUS, and 26% up to 60%. Wave changes from type III to type II were recorded in 69% and to type I in 33%. ConclusionsThe PTAS is a safe and effective procedure for the treatment of selected TRAS patients, as it preserves vascular permeability in short and medium term, ensuring the functionality of the graft. DUS is the method of choice for diagnosis and monitoring TRAS.

The Incidence of Renal Artery Stenosis in Patients with Significant Stenosis of Lower Extremity Arteries

The purpose of this study is to evaluate the unity of renal artery stenosis and peripheral vascular disease and to find the fre quency of incidental renal artery stenosis in the patients with peripheral vascular disease. In this study,it was included 1502 patients that were sent from cardiovascular surgery department to radiology department to do lower extremity digital substraction angiography and found on at least one segment 50% stenosis and more. The arteries of lower extremity were evaluated by dividing into three segments as aortoiliac, femoropopliteal and infrapopliteal. Segments were classified as unisegment and mul tisegment. Multisegments were named aortoiliac+femoropopliteal, aortoiliac+infrapopliteal, femoropopliteal+infrapopliteal and aortoiliac+femoropopliteal+ infrapopliteal. Patients with 50% stenosis and more of renal artery are decided. The unity of renal artery stenosis and the segmental disease of peripheral artery were compared by using Chi-Square test. It was found evident renal artery stenosis in 228 (15.2%) of 1502 patients with peripheral vascular disease. The frequency of renal artery stenosis was found lesser at unisegment disease than multisegment disease (p=0.03). The renal artery stenosis was found 11.9% unisegment and %16.4 at multisegment disease. The frequency of renal artery stenosis was appeared less at infrapopliteal (6%) disease compared to the others (p=0.027). It was not found any difference between groups when the segmental groups of peripheral vascular disease was compared with right, left and bilateral renal artery stenosis (p=0.086, p=0.219). It was found higher rate of renal artery stenosis at women (23.6%, p=0.01). The frequency of renal artery stenosis is %15,2 in the patients with peripheral vascular disease. Renal artery stenosis is less at infrapopliteal segment disease. Renal artery stenosis in women is more than men at multisegment disease compared to unisegment disease.

The incidence of renal artery stenosis in the patients referred for coronary artery bypass grafting

Multivessel coronary disease or peripheral arterial disease is the clinical clue to diagnosis of renal artery stenosis (RAS). RAS is considered equivalent to coronary artery disease in terms of cardiovascular risk. In this study, we evaluated the incidence of RAS in the patients who were proposed to undergo coronary artery bypass grafting (CABG). Diagnostic evaluations of coronary arteriography and renal artery angiography were performed during the same procedure; the patients who were proposed for CABG in terms of CAD anatomy and clinical manifestation were enrolled. RAS was evaluated and a diameter stenosis of ≥50% was considered as significant RAS; significant RAS patients were divided into five groups. The five groups of RAS were as follows: (1) unilateral RAS ≥50–70%, (2) unilateral RAS ≥70%, (3) bilateral RAS ≥50–70%, (4) one-renal-artery stenosis ≥50–70%, contralateral RAS ≥70%, and (5) bilateral renal artery stenosis ≥70%. A total of 151 patients were enrolled, and RAS (≥50% stenosis in either or both renal arteries) was identified in 47.02% (71/151) patients. Unilateral RAS ≥50–70% was identified in 16.6% (25/151) patients, unilateral RAS ≥70% in 4.6% (7/151) patients, bilateral RAS ≥50–70% in 7.9% (12/151) patients, one-renal-artery stenosis ≥50–70% and contralateral RAS ≥70% in 7.9% (12/151) patients, and bilateral RAS ≥70% was in 9.9%(15/151) patients. The incidence of RAS was 29.03% (18/62) in patients aged ≤60 years, 60% (36/60) in patients aged >60 and ≤70 years, and 58.62% (17/29) in patients aged >70 years. The incidence of RAS was significantly higher in patients aged >60 - ≤70, and >70 years than patients aged ≤60 years (P = 0.001 and P = 0.007, respectively). There was a trend that the incidence of RAS in patients with hypertension [HTN, 50.40% (64/127)] was higher than those without HTN (29.17%, 7/24), with P = 0.056. The incidence of RAS was 47.02% in patients who were proposed for CABG; bilateral RAS of ≥70% was 9.9%. Older age and HTN were associated with RAS in patients who were referred for CABG. This study indicates that the incidence of RAS was high in the patients referred for CABG, and the renal function should be taken care of.

E0465 The incidence of renal artery stenosis in the patients with CHD treating with various therapeutic regimens

IntroductionRenal artery stenosis (RAS) is one aspect of a multiterritory atherosclerotic disease. This study was to evaluate the incidence of RAS in the patients with CHD treating with various therapeutic...

An 82-Year-Old Woman With Worsening Hypertension

Renal artery stenosis (RAS) is a common disorder in adults with atherosclerosis and is associated with hypertension, impaired renal function, congestive heart failure, and angina pectoris. The incidence of RAS is increasing because of the aging of the US population and increasing prevalence of atherosclerosis. The case of Mrs S, an 82-year-old woman with long-standing hypertension and unilateral RAS detected by magnetic resonance angiography, illustrates the challenges surrounding indications for revascularization. The discussion reviews the clinical presentation and natural history of RAS and strategies for diagnosis. The role of medical therapy, surgery, and endovascular therapy are reviewed, particularly in the context of guidelines and systematic reviews to help clinicians and patients facing this challenging decision.

Is Incidental Renal Arteriography Justified in a Population of Patients with Symptomatic Peripheral Arterial Disease?

Renal artery stenosis is a consequence of generalized atherosclerosis and many specialists perform routine selective renal angiography to detect and treat renal artery stenosis. The incidence of clinically important renal artery stenosis is not well defined in patients with symptomatic peripheral arterial disease. The purpose of this study was to better delineate the incidence of and the risk factors associated with renal artery stenosis, renovascular hypertension, and ischemic nephropathy incidentally discovered during angiography for symptomatic peripheral arterial disease. Two hundred consecutive patients undergoing angiographic evaluation of symptomatic lower extremity peripheral arterial disease were studied retrospectively. Angiograms were reviewed for the presence of renal artery stenosis (defined as >or= 25% diameter reduction in either renal artery) and findings were then correlated to the clinical diagnosis of renovascular hypertension (> 50% renal artery stenosis and >or= 3-drug resistive hypertension) and ischemic nephropathy (defined as > 50% bilateral renal artery stenosis, 3-drug hypertension, and creatinine >or= 1.5). Angiographic findings were also correlated with risk factors to determine if a relationship correlated to the presence of and degree of renal artery stenosis. Data were analyzed using the Student's t test, Chi-square model, and multiple logistic regression analysis. The overall incidence of any degree of renal artery stenosis in this study population was 26% (52 patients). Only 24 (12%) patients had an incidental finding of >or= 50% stenosis in either renal artery. Six (3%) of these patients were found to have associated renovascular hypertension. Additionally, 9 (4.5%) patients had coexistent renal insufficiency and significant renal artery stenosis; five with end-stage renal disease on chronic hemodialysis. Only one patient with end-stage renal disease had poorly controlled 3-drug hypertension. Thus definitive ischemic nephropathy was present in only one (0.5%) patient. Statistically significant risk factors associated with the presence of renal artery stenosis include hypertension (P < .001), coronary disease (P = .024), female gender (P = .010), diabetes (P = .039), aorto-iliac disease (P = .031), multiple levels of peripheral arterial disease (P < .001), and age over 60 ( P < .001). While the incidence of renal artery stenosis in patients being evaluated for symptomatic peripheral arterial disease is similar to that reported in the cardiology literature, the incidence of renovascular hypertension and ischemic nephropathy is exceedingly low (3% and 0.5%, respectively)-findings similar to data reported in the general hypertensive population. These data suggest that incidental selective renal angiography is not justified in patients with symptomatic peripheral arterial disease.

Valsartan Cardio-Renal Protection in Patients Undergoing Coronary Angiography Complicated With Chronic Renal Insufficiency (VAL-CARP) Trial Rationale and Design

Despite an increase in the frequency of coronary angiography (CAG) in Japan, the exact incidence of contrast-induced nephropathy (CIN) remains unknown in the Japanese population, especially in patients with chronic renal insufficiency. In addition, the nature of pharmacological interventions that would benefit the patients before or after procedures such as coronary bypass graft (CABG) and percutaneous coronary intervention (PCI) has not been fully investigated. In the trial 500 patients with renal insufficiency (defined as a glomerular filtration rate (GFR) of between 89 and 30 ml . min(-1) . (1.73 m(-2)) following CAG will be randomly assigned to receive either valsartan, an angiotensin receptor blocker or angiotensin converting enzyme (ACE) inhibitor plus valsartan.1 The primary end-point is a change in the GFR of patients, which will be followed up for 3 years, including following CABG surgery or PCI. The incidence of cardiac events as well as the adverse effects of pharmacological intervention will be evaluated. In addition, the incidence of renal artery stenosis at the time of CAG will be reported also; however, the patients with renal artery stenosis will be excluded from the present study. The present study will provide data on: 1) the exact incidence and course of renal function of CIN after CAG; and 2) the comparative therapeutic benefit of pharmacological intervention with valsartan alone or with valsartan and an ACE inhibitor in combination in patients with coexisting coronary artery diseases and chronic renal insufficiency, regardless of whether they receive CABG or PCI. In addition to these studies, an estimate of the incidence of renal artery stenosis in these patients will be demonstrated.

Analysis of Recent Papers in Hypertension Jan Basile, MD, Senior Editor

Analysis of Recent Papers in Hypertension Jan Basile, MD, Senior Editor

A Single Chinese Center Investigation of Renal Artery Stenosis in 141 Consecutive Cases with Coronary Angiography

Background: There is an increasing prevalence of ischemic nephropathy in the aging population of the world. However, the exact incidence of ischemic nephropathy in the Chinese population is still uncertain. The present study investigated the incidence of renal artery stenosis (RAS) in patients with suspected coronary artery disease (CAD) using renal angiography. Methods: Renal angiography was performed immediately after coronary artery angiography in 141 patients with suspected CAD, including 59 males and 82 females whose mean ages were 59 ± 10 years. Comorbidities included hypertension (n = 69), diabetes mellitus (n = 21), hyperlipidemia (n = 19), hypokalemia (n = 7) and preoperative renal insufficiency (Cr >132 µmol/l; n = 14). The patients were divided into CAD (luminal narrowing of ≧50%) and non-CAD (luminal narrowing of <50%) subgroups, and RAS (luminal narrowing of ≧50%) and non-RAS subgroups. In the RAS group, there were 11 patients (5 males, 6 females) in whom percutaneous transluminal renal angioplasty was performed in conjunction with stent implantation due to refractory hypertension. Results: The incidence of RAS was 18.4% (26/141) in all cases and 30.8% (16/52) in patients with CAD identified by coronary artery angiography. Ten cases with RAS were found among the 89 cases with normal coronary arteries (11.2%). The incidence of RAS in patients with CAD was higher than that in patients without CAD (30.8 vs. 11.2%, p< 0.05). In 52 cases with CAD, the incidence of RAS with three vessel lesions was significantly higher than that with one or two vessel lesions. Hypertension, CAD, renal insufficiency, hyperlipidemia and hypokalemia were associated with a higher risk of RAS. Conclusions: This study suggests that RAS is very common in the elderly Chinese population, specifically for those with three vessel lesions in CAD. For early detection of potential ischemic nephropathy, renal angiography is necessary in patients who receive coronary artery angiography.