Renal Artery Stenting Research Articles

Design and implementation of digital home blood pressure monitoring based on Bluetooth and WeChat App in the FAIR-Pilot study

Abstract Background Home blood pressure monitoring (HBPM) could be an alternative way to office blood pressure and ambulatory blood pressure monitoring for hypertensive patient management. However, the measurement protocol of HBPM still requires standardization, which may be improved by digital technology. Purpose To investigate the use of digital HBPM management in hypertensive patients and its application in clinical practice. Methods Fractional Flow Reserve to Determine the Appropriateness of Percutaneous Renal Artery Intervention in Atherosclerosis Renal Hypertension Patients (FAIR)-pilot study is a multicenter pilot randomized controlled trial exploring the application of fractional flow reserve (FFR) to guide the renal artery stenting in patients with renovascular hypertension. After randomization and FFR measurement, participants were divided into stenting with FFR≥ 0.8 (Stent group), no stent implantation with FFR≥ 0.8 (No stent group), and stenting with FFR＜ 0.8 (Controlled group). Participants of the FAIR-pilot study enrolled from February 1st, 2023 to February 25th, 2024 were included. A validated Bluetooth blood pressure monitor was given to every participant at the time of enrollment. Participants were taught to undertake standardized HBP and were advised to take morning and night HBPs every day. HBPM data were automatically uploaded to a WeChat App developed by FAIR investigators and could be reviewed by both participants and investigators. Twice-daily blood pressure reports were automatically generated and sent to investigators for participant compliance monitoring and reminding (Figure 1). HBPM data and blood pressure variability were analyzed. Results A total of 93 participants with 58 males (62.4%) and a mean age of 59.97 ± 16.18 years, including 26,802 HBP readings were analyzed. The average numbers of daily HBP measurement were similar between three groups and were all less than twice a day. Systolic HBP decreased from 143.11 ± 14.91 to 133.01 ± 13.01mmHg after the procedure in the Controlled group, which was more than the other two groups (140.51 ± 13.38 to 138.53 ± 17.30 mmHg and 136.20 ± 15.67 to 130.84 ± 11.04 mmHg). During the follow-up after the procedure, the HBP variability (BPV) of overall participants was 13.78 ± 4.87 and 5.46 ± 3.14 for systolic and diastolic BP, respectively. The systolic BPV of No stent group was higher than the other two groups (No stent vs. Stent vs. Controlled: 33.00 ± 9.49 vs. 8.34 ± 2.86 vs. 9.12 ± 2.71, P=0.125), however without statistical significance. Similar was found for morning and night systolic BPVs. (Table 1). Conclusion Digital HBPM management via novel information technology is feasible in the hypertension field and could be a helpful tool in clinical practice.

Combining fractional flow reserve and the index of microcirculatory resistance for prognosis prediction in renal artery stenosis interventions: a feasibility sub-study of FAIR-pilot trial

Abstract Background Interventional therapies for renal artery stenosis (RAS) was debatable in previous randomized trials. Fractional flow reserve (FFR), while useful in coronary interventions, does not assess microcirculatory status, which may be critical in RAS. The index of microcirculatory resistance (IMR) provides additional microvascular information, which has not been used in RAS patients. Purpose To investigate the feasibility of IMR measurement in RAS patients and the association with the outcome. Methods FAIR-pilot study is a multicenter pilot randomized controlled trial exploring the application of FFR to guide the renal artery stenting in patients with renovascular hypertension (NCT05732077). A pressure-temperature sensor guidewire was used to measure the IMR. To derive mean transit time at rest, thermodilution curves were obtained by 3 injections of 4 mL of room temperature saline down the renal artery. Hyperemia was induced using dopamine 50μg/kg bolus to the renal artery. The IMR was calculated as distal arterial pressure (Pd) x mean transit time during hyperemia (TmnH) (Figure 1). Prognostic evaluation was based on improvements in postoperative blood pressure, which was assessed using both ambulatory blood pressure monitor (ABPM) and anti-hypertensive medication number, along with renal function, as determined by the estimated glomerular filtration rate (eGFR). Results The IMR was measured among five patients enrolled in FAIR-pilot study. As shown in Table 1 and 2, stent implantation was conducted on five lesions across patients 1 to 4 based on renal FFR < 0.8, with each experiencing varying degrees of improved blood pressure control subsequently. Patient 5 did not receive a stent and was lost to follow-up. At three-month, the recorded decrease in systolic blood pressure ranged from a maximum of 34 mmHg to a minimum decrease of -6 mmHg among the four patients. The antihypertensive medication number showed a maximum reduction of 2 and no change as the minimum. We observed a correlation between baseline IMR and baseline renal function. No significant change in IMR was noted after interventional procedures. Preliminary findings suggest that IMR measurement is feasible in patients with RAS, while the ∆T (temperature change time) was very small, which potentially increasing the measurement bias. Conclusion The study suggests measuring IMR in patients with RAS is feasible and can offer information into the renal microvasculature. However, the small ∆T encountered during measurement may introduce increased bias, which should be considered when interpreting results.

Quality of Life Effects of Renal Artery Stenting Versus Medical Therapy for Atherosclerotic Renal-Artery Stenosis: Results from the Randomized CORAL Trial.

Renal-artery stenosis can be associated with difficult to control hypertension, although renal-artery stenting has not been shown to improve clinical outcomes. Alternative antihypertensive medications could potentially result in quality of life benefits with renal-artery stenting. We performed a pre-specified quality of life sub-study of the CORAL trial-multicenter, randomized, open-label trial of renal-artery stenting versus medical therapy in patients with atherosclerotic renal-artery stenosis. Longitudinal growth curve models were used to compare the Physical Symptoms Distress Index (PSDI), SF-36, and EQ-5D scores over time between treatment groups. We also sought to validate the approach of assessing quality of life in hypertension studies. Among 906 patients (mean age 69.2±9.1years, 49.7% men), symptom frequency and distress due to side effects from antihypertensive medications changed minimally over time, with no significant differences between treatment groups. There were also no clinically significant differences between treatment groups for the SF-36 and its subscales or the EQ-5D. In internal validation of the quality of life measures, the PSDI correlated well with number/type of antihypertensive medications, and generic health status measures correlated with late clinical events. In a large, multicenter, randomized clinical trial, we found no significant benefit of routine renal-artery stenting over medical management for the treatment of atherosclerotic renal-artery stenosis in terms of disease-specific or generic quality of life measures. As these quality of life measures are important to patients and are associated with medication compliance, future studies of antihypertensive treatments should consider including these quality of life measures as secondary outcomes. Trial registration: ClinicalTrials.gov: NCT00081731.

Short-Term Renal Function Outcomes after Renal Artery Stenting in Atherosclerotic Renal Artery Stenosis

Short-Term Renal Function Outcomes after Renal Artery Stenting in Atherosclerotic Renal Artery Stenosis

Exploring hemodynamic mechanisms and re-intervention strategies for partial false lumen thrombosis in Stanford type B aortic dissection after thoracic aortic endovascular repair

ObjectivesFalse lumen (FL) thrombosis status for Stanford type B aortic dissection (TBAD) after thoracic endovascular aortic repair (TEVAR) is critical for evaluating aortic remodeling and long-term prognosis. This study aimed to monitor the morphology evolution of partial FL thrombosis (PFLT) and its hemodynamic conditions through an innovative approach, providing a re-intervention strategy from both morphologic and hemodynamic perspectives. MethodsThree-dimensional geometries are extracted from a five-year follow-up of CTA images for TBAD after TEVAR. The morphology and hemodynamics of PFLT are comprehensively analyzed based on patient-specific reconstructions and computational fluid dynamics (CFD). The impact of various strategies treating risk factors of PFLT, including proximal entry closure, left renal artery stenting, or accessory renal artery embolism on hemodynamics is assessed. ResultsThe introduced morphologic approaches appropriately reflected the evolution of PFLT. Gradual dilation of FL (surface area from 82.63cm2 to 98.84cm2, volume from 45.12 mL to 63.40 mL, increase in distal tear (from 3.72 cm to 4.32 cm), and fluctuation of thrombosis-blood lumen boundary are observed. For further surgical preparation in the absence of unanimously recognized re-intervention indicators, velocity and wall shear stress distributions reveal different simulated re-interventions have distinctly suppressive effects on hemodynamic conditions within the PFLT, providing valuable insights for further surgical preparation. ConclusionsThe present study demonstrates a re-intervention strategy for PFLT in TBAD patients after TEVAR utilizing morphologic and hemodynamic analyses. Acknowledging the deterioration of PFLT may result in adverse long-term outcomes, this strategy might offer an alternative approach for clinical monitoring and management of related patients.

Long-Term Results of Physician-Modified Endografts for the Treatment of Elective, Symptomatic, and Ruptured Juxtarenal Abdominal Aortic Aneurysms.

The objective of this study was to report long-term results of an ongoing physician-sponsored, investigational device exemption (IDE) pivotal clinical trial using physician-modified endovascular grafts (PMEGs) for the treatment of patients with juxtarenal aortic aneurysms. Data from a nonrandomized, prospective, consecutively enrolling IDE clinical trial were used. Data collection began on April 1, 2011, and data lock occurred on January 2, 2024, with outcomes analysis through December 31, 2023. Primary safety and effectiveness end points were used to measure treatment success. The safety end point was defined as the proportion of subjects who experienced a major adverse event within 30 days of the procedure. The effectiveness end point was the proportion of subjects who achieved treatment success. Treatment success required the following at 12 months: technical success, defined as successful delivery and deployment of a PMEG with preservation of intended branch vessels; and freedom from: type I and III endoleak, stent graft migration >10mm, aortic aneurysm sack enlargement >5mm, and aortic aneurysm rupture or open conversion. Over the 12-year study period, 228 patients were enrolled; 205 began the implant procedure, and 203 received PMEG. Thirteen patients withdrew prior to PMEG. Two withdrew (<1.0%) after failure to deploy due to tortuous iliac anatomy and are tracked as intent to treat, and a total of 24 withdrew after receiving the PMEG implant. Forty-four patients died during the study period. A total of 14 were deemed lost to follow-up. Fifty-nine completed the 5-year follow-up period, and 62 remain active in follow-up visits.Aneurysm anatomy, operative details, and lengths of stay were recorded and included: aneurysm diameter (mean, 67.5mm; range, 49-124mm), proximal seal zone length (mean, 41.6mm; range, 18.9-92.9mm), graft modification time (mean, 48.7min), procedure time (mean, 137.7min), fluoroscopy time (mean, 33.8min), contrast material use (mean, 93.0mL), estimated blood loss (mean, 118.8mL), length of hospital stay (mean, 3.7d), and intensive care unit length of stay (mean, 1.6d).A total of 575 fenestrations were created for 387 renal arteries, 181 superior mesenteric arteries (SMAs), and 7 celiac arteries. Renal arteries were in 96% of patients and included 410 renal artery stents in 203 patients. The SMA was stented as needed and included one patient with an SMA stent placed before the procedure, 19 during the procedure, and 2 patients who underwent stent placement after the procedure. There were no open conversions or device migrations and 1 partial explant due to late distal graft occlusion. Three ruptures (1.4%) were recorded on days 830, 1346, and 1460. There was 1 presumed graft infection at 750 days (<0.5%) treated with? Thirty-day all-cause mortality was 2.9% (6/204). One type Ia, 1 type Ib, and 7 type III endoleaks were identified during follow-up and treated with successful reintervention at the 1-year period. The overall rate of major adverse events at 30 days was 15% (29/194). Technical success was 93.7%, and overall treatment success was 82.6%. PMEG can be performed with low rates of long-term morbidity and mortality, confirming our early and midterm reports that endovascular repair with PMEG is safe, durable, and effective for managing patients with juxtarenal aortic aneurysms. While historically considered experimental, these results suggest that PMEG is a safe and durable option and should be considered for patients where off-the-shelf devices are not available.

Treatment of renal artery fibromuscular dysplasia with drug-eluting balloon angioplasty and intravascular imaging: a case report

Fibromuscular dysplasia (FD) is a segmental, non-inflammatory and non-atherosclerotic disease of vascular smooth muscle of unknown etiology, which leads to stenosis of smalland medium-sized arteries. The choice of surgical treatment tactics for renal artery FD depends on the severity of clinical manifestations and the response to the conservative drug treatment used. Young age, female sex, high blood pressure with failure to achieve target values with therapy, as well as the absence of atherosclerotic involvement of other arterial systems gives reason to suspect renal artery FD. According to modern guidelines, the invasive treatment of hemodynamically significant renal artery stenoses includes transluminal drug-eluting balloon angioplasty. In this disease, renal artery stenting is not recommended. However, stent implantation is required if balloon angioplasty did not give the optimal result or in case of periprocedural complications, such as arterial dissection. Open reconstructive surgery is indicated for complex anatomy of the related artery, macroaneurysms in which stent grafts are ineffective, refractory intimal fibroplastic lesions, increased risk of endovascular treatment, or after unsuccessful endovascular intervention. The article presents a case of a young patient with renal artery FD, renovascular arterial hypertension, who successfully underwent renal artery transluminal drugeluting balloon angioplasty.

Interventions for renal artery stenosis: Appraisal of novel physiological insights and procedural techniques to improve clinical outcome.

Randomized clinical trials failed to show additional benefit of renal artery stenting on top of medical therapy. Instead of writing an obituary on renal artery stenting, we try to explain these disappointing results. A transstenotic pressure gradient is needed to reduce renal perfusion and to activate the renin-angiotensin-aldosterone system. In only a minority of patients included in trials, a transstenotic pressure gradient is measured and reported. Like the coronary circulation, integration of physiological lesion assessment will allow to avoid stenting of non-significant lesions and select those patients that are most likely to benefit from renal artery stenting. Renal artery interventions are associated with peri-procedural complications. Contemporary techniques, including radial artery access, no-touch technique to engage the renal ostium and the use of embolic protection devices, will minimize procedural risk. Combining optimal patient selection and meticulous technique might lead to a netto clinical benefit when renal artery stenting is added to optimal medical therapy.

Оценка чувствительности методов диагностики в выявлении гемодинамически значимых односторонних стенозов почечных артерий

Objective. Assessment of renal artery stenosis significance in patients with resistant arterial hypertension using non-invasive diagnostic methods and to compare them with the results of selective angiography and methods of physiological assessment of renal artery stenoses.Materials and methods. Prospectively, 156 patients with drug-resistant arterial hypertension and signs of renal artery stenosis detected by doppler ultrasonography of renal arteries were included in the study. Subsequently, 25 patients were excluded from the study due to multiple variant renal blood supply and bilateral renal artery stenosis. The remaining patients (n=131) underwent selective angiography of renal arteries, and 66 of them additionally underwent CTA of renal arteries with intravenous contrast. If the artery narrowing was 90% or more (n=27) in diameter, the stenosis was considered hemodynamically significant and further stenting of the affected artery was performed, and in case of 60-90% stenosis (n=52) additional assessment of functional significance of the stenosis was performed by measuring translesional pressure gradient, fractional blood flow reserve, instantaneous blood flow reserve (iFR) and Pd/ Pa ratio. Results. Among all patients (n=131), in whom the doppler ultrasonography of renal arteries showed signs of unilateral renal artery stenosis, after angiography combined with additional methods of functional significance assessment, hemodynamically significant renal artery stenosis was confirmed in 41% of cases (n=54). Thus, the sensitivity of doppler ultrasonography of renal arteries in detection of hemodynamically significant stenoses was 74%, prognostic value of positive 78% and negative result 64% (p&lt;0,001). According to CTA (n=66) renal artery stenosis was confirmed in 56 patients. The results of CTA of renal arteries in 88% of cases coincided with the results of selective angiography, and using additional functional methods hemodynamically significant stenosis was confirmed in 32 (48%) patients. The sensitivity of CTA in detection of hemodynamically significant stenoses of renal arteries was 69%, specificity 91%, prognostic value of positive and negative results was 91 and 68% respectively. According to selective angiography, out of 131 patients, 24 patients had no renal artery stenosis, 28 patients had stenosis &lt;60%, 27 patients had renal artery stenosis &gt;90% and 52 patients had stenosis 60-90%. Patients with stenosis &lt;60% were not considered candidates for renal artery stenting.

Doppler Ultrasound of the Renal Vasculature.

Ultrasound is the first-line imaging modality used in patients with suspected renovascular disease. Common indications include renovascular hypertension and unexplained renal dysfunction. We review the ultrasound imaging findings of various pathologies involving the renal vessels, including the renal arteries (atherosclerotic stenosis, fibromuscular dysplasia, dissection, arteriovenous fistula, and aneurysm) and veins (tumor and bland thrombus as well as vascular compression syndromes). The current role of renal artery stent placement for atherosclerotic stenosis is also discussed.

Early outcomes of fenestrated and/or branched endovascular repair of complex aortic aneurysms (F/B-EVAR); A single-center experience

Background: Open surgical repair of juxta-, para- and thoracoabdominal aortic aneurysms (TAAA) has been the gold-standard for patients fit for surgery. However, endovascular repair of complex aortic aneurysms using devices implementing directional branches or fenestrations for incorporation of reno-visceral target vessels (TV) has gained widespread attention, due to its lower mortality and complication rate and its more attractive profile for high-risk patients. Nonetheless, complex endovascular technologies require meticulous abidance to protocols for successful application. Methods: A retrospective analysis of prospectively collected data from a single, tertiary center was undertaken, including all patients undergoing complex aortic endovascular repair with fenestrated (F-EVAR) of branched devices (B-EVAR) from a 5-year time period (2018-2023). Primary outcomes included 30-day mortality, while secondary outcomes included primary TV patency, acute kidney injury (AKI), spinal cord ischemia (SCI), myocardial infarction (MI) and stroke rates. Results: Of 74 patients (mean age: 69 ± 5.6 years-old, 98% males), 31 (42.6) and 43 (57.6%) were treated by F-EVAR and B-EVAR, respectively. Mean aneurysm diameter was 68 ± 1.8cm, with 15 (20.5%) juxtarenal AAA, 27 (35.6%) pararenal AAA, 16 (21.9%) type IV TAAA, 6 (8.2%) type III TAAA, and 10 (13.7%) type II TAAA treated. Sixteen (21.6%) patients were treated due to failed-EVAR. In total, 272 TV were successfully revascularized. Thirty-day mortality was 8.1%. Primary TV patency rate was 99.2% (270/272). Endoleak rate was 8.1% (6/74). No cases of AKI or MI were observed. One (1.3%) case of hemorrhagic stroke was observed. Three cases (4%) of SCI were observed, including one temporary paraparesis and two permanent paraplegia cases. Reintervention rate was 5.4%, including two cases of renal artery stent thrombosis revascularization procedures. Conclusions: Endovascular repair of complex aortic aneurysms is feasible, with good perioperative outcomes. Adherence to precise protocols covering every technical aspect of patient care is warranted for satisfactory outcomes.

Contrast-enhanced ultrasound evaluation of renal perfusion before angioplasty and its predictive value for hypertension.

Atherosclerotic renal artery stenosis (ARAS) is a common disease in the elderly population. The aim was to develop a contrast-enhanced ultrasound (CEUS)-based model for predicting post-angioplasty improvement in hypertension in patients with severe ARAS. Thirty-five patients with severe ARAS (⩾ 70%) were included in this study, and 42 renal arteries received percutaneous transluminal renal arterial stenting. An optimal integral formula was developed from pre-interventional color-coded duplex sonography (CCDS) and CEUS parameters using least absolute shrinkage and selection operator (LASSO) regression and receiver operating characteristic (ROC) curve analysis. A model for predicting short-term hypertension improvement was established using the integral formula and clinical risk factors. Bootstrapping was used for internal validation. Two integral formulas, LASSO.CCDS and LASSO.CEUS, were established. ROC curves of the two integral formulas showed that LASSO.CEUS was the better formula for predicting hypertension improvement (AUC 0.816, specificity 78.6%). Univariate and multivariate regression analyses showed that duration of hypertension (OR 0.841, P= 0.027), diabetes (OR = 0.019, P= 0.010), and LASSO.CEUS (OR 7.641, P= 0.052) were predictors of short-term hypertension improvement after interventional therapy. Using LASSO.CEUS combined with clinical risk factors, the following prediction model was established: logit (short-term improvement in hypertension) = 1.879-0.173 × hypertension duration - 3.961 × diabetes + 2.034 × LASSO.CEUS (AUC 0.939). The model established using CEUS parameters and clinical risk factors could predict hypertension improvement after interventional therapy, but further research and verification are needed.

Outcomes after stenting of renal artery stenosis in patients with high-risk clinical features

BackgroundIn patients with renal artery stenosis, revascularization was seen as a mean to improve outcomes, but large studies failed to show significant benefit in general population. However, data on benefits of renal artery stenting in patients with high-risk features, such as rapidly declining renal function and cardiac destabilization syndromes, are limited, as they were excluded from trials. In this descriptive study, we aimed to evaluate short- and long-term outcomes in high-risk patients with renal artery stenosis, treated by angioplasty and stenting. We have retrospectively interrogated our local databases for renal artery percutaneous interventions; patients at high-risk (rapidly declining renal function; stable chronic renal failure and bilateral renal artery disease; severe hypertensive crisis) were selected for the current analysis.ResultsOf 30 patients undergoing renal artery stenting, 18 patients were deemed "high-risk." On short term, good in-hospital control of hypertension and cardiac stabilization were obtained in all patients. Renal function improved significantly only in patients admitted with rapidly declining renal function, with significant creatinine level fall from median 3.98 mg/dL to 2.02 mg/dL, p = 0.023. However, for the whole group, creatinine change was non-significant (− 0.12 mg/dL, p = NS). On the long term, five patients (27.8%) ended-up on chronic hemodialysis and six patients died (33.3%) after a median of 20 months. No death occurred during the first year after the procedure.ConclusionsPercutaneous procedures are feasible and safe in patients with high-risk renal artery stenosis, especially in those with rapidly declining renal function, probably saving some of them from the immediate need for renal replacement therapy, but long-term results are negatively influenced by the precarious general and cardio-vascular status of these patients and by the pre-existing significant renal parenchymal disease, non-related to the renal artery stenosis.

Risks and benefits of renal artery stenting in fibromuscular dysplasia: Lessons from the ARCADIA-POL study.

Although renal stenting is the standard revascularization method for atherosclerotic renal artery stenosis (RAS) (FMD-RAS), stenting in fibromuscular dysplasia (FMD) RAS is usually limited to periprocedural complications of angioplasty and primary arterial dissection. The main aim of the study was to retrospectively analyze the immediate and long-term results of renal stenting versus angioplasty in patients with FMD. Of 343 patients in the ARCADIA-POL registry, 58 patients underwent percutaneous treatment due to FMD-RAS (in 70 arteries). Percutaneous transluminal renal angioplasty (PTRA) was performed as an initial treatment in 61 arteries (PTRA-group), whereas primary stenting was undertaken in nine arteries (stent-group). Stent-related complications were defined as: in-stent restenosis > 50% (ISR); stent fracture; under-expansion; or migration. In the PTRA-group, the initial restenosis rate was 50.8%. A second procedure was then performed in 22 arteries: re-PTRA (12 arteries) or stenting (10 arteries). The incidence of recurrent restenosis after re-PTRA was 41.7%. Complications occurred in seven of 10 (70%) arteries secondarily treated by stenting: two with under-expansion and five with ISR. In the stent-group, stent under-expansion occurred in one case (11.1%) and ISR in three of nine stents (33.3%). In combined analysis of stented arteries, either primarily or secondarily, stent-related complications occurred in 11/19 stenting procedures (57.9%): three due to under-expansion and eight due to ISRs. Finally, despite several revascularization attempts, four of 19 (21%) stented arteries were totally occluded and one was significantly stenosed at follow-up imaging. Our study indicates that renal stenting in FMD-RAS may carry a high risk of late complications, including stent occlusion. Further observational data from large-scale registries are required.

Abstract 14326: Temporal Trends in Renal Artery Stenting Among Older Patients in the United States

Introduction: There is mixed evidence to support renal artery (RA) stenting for improvement in blood pressure control or reduction in cardiovascular and renal events, yet it remains a treatment option in specific clinical scenarios. Contemporary procedural rates and outcomes have been incompletely evaluated. Objective This study aims to describe temporal trends in RA stenting and outcomes among older US patients. Methods: Fee-for-service Medicare beneficiaries age over 65 years, with &gt;1 year of enrollment in Medicare, who underwent RA stenting between January 1, 2016 and December 31, 2020 were included. Outcomes included: (i) a composite of hospitalization for hypertensive urgency, stroke, or myocardial infarction (MI), (ii) new initiation of dialysis, and (iii) need for repeat RA stenting. The cumulative incidence function was used to estimate the incidence of outcomes, accounting for the competing risk of death. Results: A total of 31,359 were included: 55.7% female, average age 75.7 ±6.4 years, 88.9% white and 6.6% black. Among the study sample, 75.9% had chronic kidney disease (CKD), 98.2% had hypertension, and 80.9% had ischemic heart disease. Between 2016-2020, the incidence of RA stenting decreased annually from 27.3 to 15.9 per 100,000 Medicare beneficiaries. The 1-year post-procedure incidence of MI was 4.0%, stroke 2.6%, hypertensive urgency 4.6%, dialysis initiation 2.1% and repeat RA stenting 4.6%. Adverse events occurred more frequently among older patients, Black patients, those whom the indication for RA stenting was cardiovascular disease or CKD, and patients enrolled in both Medicare and Medicaid. ( Fig. 1 ) Conclusion: RA stenting rates in the US are declining, yet it is still frequently used in clinical practice. Post-procedure cardiovascular and renal events are infrequent, but their incidence varies by patient population. Further investigation is warranted to evaluate the risks and benefits of this procedure in specific patient populations.

Recurrent flash pulmonary edema in unilateral renal artery stenosis with contralateral kidney shrinkage: A case report.

Flash pulmonary edema is a critical medical condition characterized by sudden and severe fluid accumulation in the lungs, which poses an immediate and life-threatening emergency. This can arise from a variety of underlying causes. This manuscript presents a case of recurrent pulmonary edema that was successfully managed through the insertion of a renal artery stent. A 78-year-old woman visited the emergency room with recurrent acute dyspnea. Computed tomography renal angiography revealed renal artery stenosis of a single-functioning kidney. Flash pulmonary edema caused by renal artery stenosis of a functioning single kidney. Percutaneous transluminal angioplasty and stenting were performed for the renal artery stenosis. The patient's kidney function rapidly improved, and she has been free of flash pulmonary edema for 2 years. Flash pulmonary edema can have various causes and can immediately be a life-threatening emergency. However, it can be treated with percutaneous revascularization if it is caused by renal artery stenosis. This case report reinforces the importance of accurate and immediate diagnosis when dealing with flash pulmonary edema. This case emphasizes the potential therapeutic benefit of renal artery stenting in the management of flash pulmonary edema caused by renal artery stenosis in patients with a single-functioning kidney.

Off-label use of the Gore Excluder iliac branch endoprosthesis in association with the Rotarex S catheter to achieve total endovascular recanalization of an occluded aortobifemoral bypass

We describe a successful case of hybrid revascularization of a totally occluded aortobifemoral bypass with retrograde use of the Rotarex S catheter (BD) and complete relining with a Gore Excluder iliac branch endoprosthesis (W.L. Gore & Associates). The repair procedure was performed with femoral surgical access and percutaneous brachial access. Despite left renal artery endoclamping, after the final angiography, deployment of a covered stent in the left renal artery was needed because of residual thrombotic material at the vessel ostium. The procedure was completed with reconstruction using a common femoral artery Dacron graft and bilateral complete iliac surgical branch relining using self-expanding covered stents, with recovery of distal pulses.

Long-term harm associated with renal artery stents in a temporally distant time after the renal function is gone

Although large randomized trials have not shown significant benefit of renal artery stent placement, stents continue to be placed in patients with Renal Artery Stenosis (RAS). These intravascular foreign bodies can cause cytokine expression that might result in long-term harm. We evaluated the possibility that they could have adverse effects that were both temporally and spatially distant from their insertion.

Endovascular approach for nutcracker syndrome using an arterial stent: The first Latin-American experience

ObjectiveThe exact prevalence of nutcracker syndrome (NCS) is unknown, due to the very low incidence of this disease plus the absence of definitive diagnostic criteria. Some authors have reported a higher prevalence of this condition in women, however published and available information is limited. Due to symptoms and consequences that can cause, it is important to suspect it and diagnose it. The aim of this study was to report the outcomes of the first Latin-American experience in the treatment of NCS using an endovascular approach with a left renal vein (LRV) balloon and arterial stent angioplasty. MethodsThe study design was a retrospective cohort analysis of 11 patients who underwent endovascular approach with LRV balloon and arterial stent angioplasty for the treatment of NCS between January 2019 and April 2022 in Bogota, Colombia. ResultsDuring January 2019 to April 2022, 553 patients were treated for congestive pelvic syndrome. Only 11 patients have clinical criteria (hematuria, varicose pelvic veins, and left flank pain), imaging diagnostic criteria (abdominal veins Doppler ultrasound or abdominal computed tomography with superior mesentery artery – abdominal aorta angle <39°) and an average of LRV – inferior vena cava pressure measurement comparison difference of 6mmHg for NCS. The 100% were female patients. All the patients were under 65 years and underwent endovascular approach (EVA) with LRV balloon and arterial stent angioplasty. The 100% of patients presented resolution of the collateral vein circulation in the final control phlebo-cavography. The average age was 46.5 years old. Ten patients had an anterior type of NCS and only 1 had a posterior type of NCS. None of the patients had NCS due to secondary causes such as pancreatic head tumors. ConclusionsThis study shows that the endovascular approach with LRV balloon and arterial stent angioplasty is a safe and cost-effective treatment for NCS with low incidence of complications and no need of postoperative reintervention in short and middle term follow-up.

Changes in renal-mesenteric duplex ultrasound velocities after fenestrated and branched endovascular aortic aneurysm repair

ObjectiveStenting of renal and mesenteric vessels may result in changes in velocity measurements due to arterial compliance, potentially giving rise to confusion about the presence of stenosis during follow-up. The aim of our study was to compare preoperative and postoperative changes in peak systolic velocity (PSV, cm/s) after placement of the celiac axis (CA), superior mesenteric artery (SMA) and renal artery (RAs) bridging stent grafts during fenestrated-branched endovascular aortic repair (FB-EVAR) for treatment of complex abdominal aortic aneurysms (AAA) and thoracoabdominal aortic aneurysms. MethodsPatients were enrolled in a prospective, nonrandomized single-center study to evaluate FB-EVAR for treatment of complex AAA and thoracoabdominal aortic aneurysms between 2013 and 2020. Duplex ultrasound examination of renal-mesenteric vessels were obtained prospectively preoperatively and at 6 to 8 weeks after the procedure. Duplex ultrasound examination was performed by a single vascular laboratory team using a predefined protocol including PSV measurements obtained with <60° angles. All renal-mesenteric vessels incorporated by bridging stent grafts using fenestrations or directional branches were analyzed. Target vessels with significant stenosis in the preoperative exam were excluded from the analysis. The end point was variations in PSV poststent placement at the origin, proximal, and mid segments of the target vessels for fenestrations and branches. ResultsThere were 419 patients (292 male; mean age, 74 ± 8 years) treated by FB-EVAR with 1411 renal-mesenteric targeted vessels, including 260 CAs, 409 SMAs, and 742 RAs. No significant variances in the mean PSVs of all segments of the CA, SMA, and RAs at 6 to 8 weeks after surgery were found as compared with the preoperative values (CA, 135 cm/s vs 141 cm/s [P = .06]; SMA, 128 cm/s vs 125 cm/s [P = .62]; RAs, 90 cm/s vs 83 cm/s [P = .65]). Compared with baseline preoperative values, the PSV of the targeted vessels showed no significant differences in the origin and proximal segment of all vessels. However, the PSV increased significantly in the mid segment of all target vessels after stent placement. ConclusionsStent placement in nonstenotic renal and mesenteric vessels during FB-EVAR is not associated with a significant increase in PSVs at the origin and proximal segments of the target vessels. Although there is a modest but significant increase in velocity measurements in the mid segment of the stented vessel, this difference is not clinically significant. Furthermore, PSVs in stented renal and mesenteric arteries were well below the threshold for significant stenosis in native vessels. These values provide a baseline or benchmark for expected PSVs after renal-mesenteric stenting during FB-EVAR.