Transluminal Renal Angioplasty Research Articles

Kidney autotransplantation for the treatment of renal artery occlusion after endovascular aortic repair: a case report

BackgroundUnintentional renal artery occlusion after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm remains one of the most unfavorable complications. Renal salvage options include percutaneous transluminal renal artery angioplasty (PTRA) and open hepatosplenorenal bypass. However, the usefulness of kidney autotransplantation (AutoTx) remains unclear.Case presentationA 76-year-old woman with a right solitary kidney attributable to a left renal thromboembolism had previously undergone EVAR with a stent graft for an infrarenal aortic aneurysm, which led to ostial occlusion of the right renal artery. In addition, she had undergone PTRA and stenting. Two days before admission, she developed leg edema and hypertension, leading her to visit the hospital. Her serum creatinine level was 2.4 (baseline, 1.0) mg/dL. Acute kidney injury due to renal artery in-stent restenosis was suspected; re-angioplasty was attempted on day 2 of hospitalization, but was unsuccessful. Her renal function did not improve and anuria persisted; thus, hemodialysis was initiated on the same day. The right kidney size (8.6 cm) was preserved relative to her body size, with only mild cortical atrophy. Doppler ultrasonography and mercaptoacetyltriglycine scintigraphy revealed minimal but significant perfusion of the right kidney. Therefore, we considered that kidney perfusion was sustained and renal function could be reversed. On day 25 of hospitalization, right kidney AutoTx to the right iliac fossa was performed to reestablish adequate renal perfusion and reverse the need for dialysis. Soon after the procedure, the patient started passing urine. Her renal function improved; her serum creatinine level decreased to 1.0 mg/dL on day 33 of hospitalization. Hemodialysis was discontinued after the surgery. Zero-hour kidney biopsy showed only mild tubular injury, with neither tubular necrosis nor glomerular abnormalities.ConclusionsKidney AutoTx can be performed for patients with renal artery in-stent occlusion after unsuccessful PTRA who previously underwent EVAR. Our case showed successful recovery of renal function nearly 1 month after renal artery occlusion, indicating that revascularization should be considered even if it is delayed, as the kidney might be perfused through collateral circulation.

Renal dynamic imaging for the treatment assessment of renal artery angioplasty and stenting in patients with atherosclerotic renal artery stenosis

Objective To investigate the value of renal dynamic imaging with 99Tcm-DTPA on the evaluation and prediction of the outcome after percutaneous transluminal renal artery angioplasty and stenting (PTRAS) in patients with atherosclerotic renal artery stenosis (ARAS).Methods Seventy-six patients with unilateral ARAS underwent PTRAS successfully.All the patients received baseline renal dynamic imaging within 2 weeks before the surgery and follow-up imaging 6 months after PTRAS.GFR ( per 1.73 m2 of body surface area) of kidney with ARAS was measured with the Gates method.ARAS was classified as mild (50％-69％),moderate (70％-89％),and severe ( ≥90％ ) stenosis according to the results of renoarteriography before the surgery.GFR was graded as Ⅰ ( GFR≥30 ml · min -1 ),Ⅱ ( 15 ml · min -1 ≤GFR ＜30 ml · min -1 ) and Ⅲ ( GFR ＜ 15 ml · min-1 ),on the baseline dynamic imaging.Blood pressure was also measured before and after the surgery.The t test,x2 test,Fisher exact test and multiple logistic regression analysis were used for statistical analysis with SPSS 13.0.Results The baseline GFR of kidney with mild and moderate ARAS was significant higher than that with severe stenosis ( (26.79 ± 15.34) vs ( 19.48 ±11.56) ml · min - 1,t =2.262,P =0.027 ).The blood pressure was improved in 32％ (24/75),and not changed in 68％ (51/75) of patients.Improvement of blood pressure was observed in 39.62％ (21/53) of patients with a baseline GFR≥ 15 ml · min-1,and in 13.64％ (3/22) of patients with a baseline GFR ＜15 ml · min - 1 (x2 =4.825,P =0.028 ).Using multivariate analysis,baseline GFR ≥ 15 ml · min - 1 was the only predictor of blood pressure improvement ( OR =0.465,P =0.032 ).GFR in kidney with ARAS was improved in 22.37％ ( 17/76),stable in 68.42％ (52/76),and worse in 9.21％ (7/76) of patients.The 33.33％ (8/24) and 17.65％ (9/51) of patients with and without blood pressure improvement,respectively,achieved GFR improvement.However,the difference was not statistically significant ( Fisher exact test,P =0.081 ).Conclusion Renal dynamic imaging with 99Tcm-DTPA is a useful method for the evaluation and prediction of the therapeutic effect of PTRAS in patients with ARAS. Key words: Renal artery ; Atherosclerosis; Angioplasty; Radionuclide imaging; DTPA

Impact of endovascular treatment of atherosclerotic renal artery stenosis on endothelial function and arterial blood pressure.

Renovascular disease may cause arterial hypertension and decreases renal function, which both impair endothelial function. Endothelial function, a surrogate marker for cardiovascular risk, can be assessed non-invasively by ultrasound. The aim of this study was to investigate the impact of percutaneous transluminal renal artery angioplasty (PTRA) with stenting on endothelial function and arterial blood pressure in patients with renal artery stenosis (RAS). Flow mediated dilatation of the brachial artery, flow velocities and shear stress were measured with high resolution ultrasound in 24 hypertensive patients with renal artery stenosis prior and one day after revascularization by PTRA with stenting. Endothelial-independent brachial dilatation was measured after application of nitroglycerin. Endothelial-dependent dilatation improved from 2.4±0.9% to 6.1±1.4% (P=0.03), whereas endothelial-independent dilatation did not change after PTRA. Endothelial-dependent reactive hyperemic blood flow increased from 195±40 mL/min to 536±94 mL/min (P=0.0008), whereas endothelial-independent hyperemia did not increase after revascularization. After PTRA, shear stress at rest decreased from 37±11 to 23±3 dyne/cm² (P<0.0001), and reactive hyperemic shear stress increased from 89±29 to 107±12 dyne/cm² (P=0.014). The impact of PTRA on arterial blood pressure resulted in a mean decrease of 21±5 mmHg in systolic pressure (P<0.0001), of 9±2 mmHg in diastolic pressure (P=0.03), and of 14±5 mmHg in peripheral pulse pressure (P=0.0003), respectively. Endovascular treatment of renovascular disease improves endothelial function and decreases in resting shear stress.

Nierenarterienstenose: Intervention oder medikamentöse Behandlung?

Angioplasty in patients with renal artery stenosis aims at reducing blood pressure and at improving kidney function. Its efficacy has however been questioned by recent published data. It was the aim of this retrospective study to compare angioplasty with medical treatment in an unselected patient population. Data on 109 patients were retrospectively analysed. This cohort included all those patients admitted to the Lippe-Detmold Hospital between 1992 and 2008 for renal artery stenosis. The data included blood pressure, creatinine-based calculated glomerular filtration rate (cGFR), any renal dialysis, cardiovascular risk factors, events and survival time after transluminal renal angioplasty or drug treatment, respectively. Patients who had undergone angioplasty were younger (p = 0.04), had less cardiovascular co-morbidity (p < 0.01), but a higher degree of stenosis (p < 0.01). After a median follow-up of 32.5 (angioplasty) and 36.0 months (drug treatment), respectively, a significant decrease of cGFR was recorded in drug treated patients (- 16.2 ml/min, 95 %, CI - 25.7 to - 6.7) but not in the angioplasty group (- 4.5 ml/min, 95 %, CI - 13.5 to 4.5). There were no other significant differences were not observed. Younger patients with a high degree of renal artery stenosis but without generalized atherosclerosis more frequently underwent angioplasty in clinical practice. The smaller post-angioplasty reduction in the loss of renal function in this group needs to be validated in a prospective, randomized study.

Renal artery stent revascularization with embolic protection in patients with ischemic nephropathy

A prospective analysis of renal artery stent revascularization with distal embolic protection in a high-risk patient population with ischemic nephropathy is presented. A total of 63 patients (median age 70.2 years, range 54-86 years) had significant atherosclerotic stenosis of 83 renal arteries documented on pre-procedural imaging. All patients had baseline chronic renal insufficiency with a documented deterioration in renal function in the 6 months before revascularization. The endovascular technique used in all patients involved primary passage of an embolic filter into the distal main renal artery followed by primary stent deployment with a balloon expandable stainless steel stent. The filter baskets were recaptured and contents submitted for pathological analysis. At 6 months post-intervention, 97% of patients demonstrated stabilization or improvement in renal function. Only 3% of patients had an inexorable decline in renal function, unchanged by the intervention. After a mean follow up of 16.0 months (6-27), 94% of patients demonstrated stabilization or improvement in renal function. One patient suffered an acute post-procedural deterioration in renal function. In total, 60% of the filter baskets contained embolic material. This study confirms the technical feasibility of renal artery stent deployment with adjuvant embolic protection. The excellent results for renal preservation at 6 months post-intervention also suggest that a distal embolic protection device may improve the impact of percutaneous renal revascularization on progressive deterioration in renal function. The postulated mechanism is through the prevention of atheromatous embolization and the embolic yield from the distal filters supports this hypothesis. Patients most likely to receive the greatest benefit are those with mild baseline chronic renal insufficiency and a recent decline in renal function.

The effect of percutaneous dilatation of renal arterial stenosis on captopril renography in hypertension

Background. The clinical effects of percutaneous transluminal renal artery angioplasty (PTRA) in patients with renal vascular stenosis and hypertension is controversial. Methods. We consecutively recruited all 23 patients referred for evaluation of renovascular hypertension that eventually underwent unilateral PTRA, to be investigated with captopril MAG3 renography (CR), both before and after the endovascular procedure. Data were evaluated on an intention‐to‐treat basis. Results. We found that the relative MAG3 clearance of the stenotic kidney increased (from 29.9±14% to 35.1±14%, p = 0.01) and that the creatinine levels fell following the intervention (from 110±19 to 99±17 µmol/l, p = 0.0003). Blood pressure levels were also lowered (from 173±32/93±17 to 158±31/86±15 mmHg, p<0.006) while the mean number of anti‐hypertensive drugs was unchanged following PTRA (2.9±1.4 before and 2.8±1.3 drugs after the intervention, respectively, p = 0.6). Conclusion. This prospective trial showed statistically significant improvements of individual kidney function as measured by CR and blood pressure in subjects with suspected renovascular hypertension treated with PTRA. Although the endovascular procedure was found to be safe, the magnitude of the absolute improvements was rather modest.

877-3 Effect of percutaneous transluminal renal artery angioplasty with stenting on renal function in patients with atherosclerotic renal artery stenosis

877-3 Effect of percutaneous transluminal renal artery angioplasty with stenting on renal function in patients with atherosclerotic renal artery stenosis

Transluminal percutaneous renal angioplasty in the treatment of renovascular hypertension. Clinical results

Transluminal percutaneous renal angioplasty in the treatment of renovascular hypertension. Clinical results

Infected Renal Artery Pseudoaneurysm and Mycotic Aortic Aneurysm After Percutaneous Transluminal Renal Artery Angioplasty and Stent Placement in a Patient With a Solitary Kidney

Infected Renal Artery Pseudoaneurysm and Mycotic Aortic Aneurysm After Percutaneous Transluminal Renal Artery Angioplasty and Stent Placement in a Patient With a Solitary Kidney

Percutaneous transluminal bilateral renal artery angioplasty in patients with bilateral renal artery stenosis

Percutaneous transluminal bilateral renal artery angioplasty in patients with bilateral renal artery stenosis

OUTCOMES OF RENAL ARTERY ANGIOPLASTY.

Percutaneous transluminal renal artery angioplasty (PTRA) is an alternative to surgery for patients with renal artery stenosis. This report describes the Mayo Clinic's experience with PTRA in 320 patients between 1980 and 1993. The most common indications for PTRA were stenosis from atherosclerosis (190 patients) or fibromuscular …

Hypertension Due to Renal Artery Stenosis in Pregnancy — the use of Angioplasty

The use of transluminal percutaneous renal angioplasty for severe hypertension in the second trimester of pregnancy has not previously been reported. We describe its use in a 19-year-old female. The procedure resulted in a significant improvement in blood pressure control and allowed the pregnancy to proceed to term, resulting in the delivery of a normal female baby on the 90th percentile for weight. No morbidity to mother or fetus was observed as a result of diagnostic or therapeutic procedures. We conclude that pregnancy should not preclude making the diagnosis of renovascular hypertension as angioplasty may be a useful therapeutic option.

Restoration of kidney function after prolonged renal artery occlusion

An 11-month-old child developed renal artery occlusion (RAO) and anuric renal failure following an unsuccessful transluminal renal artery angioplasty of a solitary kidney. Despite the prolonged period of anuria, kidney viability was suspected based upon preservation of kidney length and the absence of glomerulosclerosis. At 19 months of age, revascularization of the kidney was performed. During the 7 months following revascularization, renal function gradually improved so that dialysis was no longer necessary. This improvement occurred in spite of significant tubular atrophy. Kidney viability may have been preserved, despite prolonged ischemia, as a result of the decreased renal oxygen consumption that existed during subfiltration glomerular perfusion pressures. The low normal blood erythropoietin level may have reflected the lack of renal hypoxia. The ability of the kidney to adapt to chronic ischemia underscores the importance of considering vascular reconstruction in all patients with RAO despite a long period of non-function.