The management of renal artery atherosclerosis for renal salvage: Does stenting help?

Kashyap, Vikram S.; Sepulveda, Ricardo N.; Bena, James; Nally, Joseph V.; Poggio, Emilio D.; Greenberg, Roy K.; Yadav, Jay S.; Ouriel, Kenneth

doi:10.1016/j.jvs.2006.08.068

Cited by 46 publications

(40 citation statements)

References 26 publications

(22 reference statements)

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“…All cases of atherosclerotic renal artery stenosis were managed successfully by stenting and kidney transplant. This is consistent with the safety of stenting and its capacity to restore renal function [28]. …”

Section: Discussionsupporting

confidence: 84%

Pattern of Hypertensive Kidney Disease in a Black Kenyan Population

Ogeng’o

Gatonga²,

Olabu³

et al. 2011

Cardiology

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Background: Hypertensive kidney disease is a major cause of morbidity and mortality. Its pattern displays geographical and ethnic variations. Data on these patterns are important for informing management and prevention strategies, but on Kenyans such data are scarce. Objective: By means of a retrospective study at Kenyatta National Hospital, Nairobi, we aimed to describe the pattern of hypertensive kidney disease in a black Kenyan population. Methods: Records of hypertensive patients who had impaired kidney function between January 2000 and December 2010 were examined for mode of diagnosis, age, gender, comorbid factors, treatment and outcome. Data were analyzed using the Statistical Package for Social Sciences, version 16.0 for Windows, and are presented using tables and bar charts. Results: A total of 114 cases (72 males, 42 females) were analyzed. The mean age was 42.7 years (range 12–83), peaking at 51–70 years. The male to female ratio was 1.7:1. Comorbid factors included left ventricular hypertrophy (21.1%), congestive heart failure (15.8%), alcohol (11.4%), cerebrovascular accidents, smoking and retinopathy (10.5% each). Multiple comorbid factors were present in 8.8% of the cases. The majority (52.6%) of the patients survived on hemodialysis, 8.8% underwent successful renal transplant and 22.8% died. Conclusion: Hypertensive kidney disease affects all age groups, males more than females. It is commonly associated with other cardiovascular conditions and carries a high morbidity. Vigilant control of blood pressure is recommended.

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Section: Discussionsupporting

confidence: 84%

Pattern of Hypertensive Kidney Disease in a Black Kenyan Population

Ogeng’o

Gatonga²,

Olabu³

et al. 2011

Cardiology

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“…Some studies have shown that revascularization is efficacious in improving hypertension control in 50–85% of patients [18], but these experiences are not replicated in the literature, and results in terms of renal functional outcome have been even more variable. Most of these studies have been retrospective [19], observational or non-randomised, and results have been conflicting [20,21]. Review of the many retrospective and prospective case series reported in the literature indicates that approximately 25% of patients show renal functional improvement, 25% deteriorate and 50% remain unchanged [12,22] following revascularization.…”

Section: Renal Revascularization In Arvdmentioning

confidence: 99%

Current Management of Atherosclerotic Renovascular Disease – What Have We Learned from ASTRAL?

Chrysochou

Kalra

2010

Nephron Clin Pract

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With an increasingly ageing and atherosclerotic-prone population, clinical encounters with patients with atheromatous renovascular disease (ARVD) are commonplace. ARVD is frequently associated with chronic kidney disease (CKD) and hypertension, but evidence suggests that causality only occurs in the minority and it is likely that many atherosclerotic renal artery stenosis (RAS) lesions are incidental. Its association with extensive cardiovascular co-morbidity predisposes to a high patient mortality. The availability of renal angioplasty and stenting, which are generally safe techniques for dilating RAS lesions, has led to widespread use of these endovascular therapies in ARVD, but the outcomes after treatment have been inconsistent, with no clear evidence of benefit in many patients. There has been a great need for a large and appropriately powered randomised control trial to help guide clinical practice. In this review, we present an interpretation of the results of the recently reported Angioplasty and Stenting for Renal Artery Lesions (ASTRAL) trial as well as a brief review of the latest literature, so as to provide the latest guidance regarding the management of this common condition.

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“…Five-year patency following aortorenal bypass is 95.0%, compared to 55.6% for renal artery stenting. 7,10,[18][19][20] The five-year patency was assumed to be similar between patients who had no complications and those who experienced one or more complications. A primary patency of 75% was identified in the literature and used for aortorenal bypass patients who developed complications to determine whether this significantly influenced cost or value for aortorenal bypass compared to renal artery stenting, but none was found (Figure 2).…”

Section: Resultsmentioning

confidence: 99%

“…Patients have a 63% three-year dialysis-free survival, however up to 25% of patients experience a decline in renal function with negligible long-term improvement in hypertension. [5][6][7][8][9] Open surgical options include aortorenal bypass, iliorenal bypass, hepatorenal bypass, and splenorenal bypass. Other options include endarterectomy with patch angioplasty, and reimplantation of the renal artery.…”

Section: Introductionmentioning

confidence: 99%

Renal artery stenting may not be appropriate for patients with atherosclerotic renal artery stenosis

Dua

Desai²,

Upchurch

et al. 2015

Vascular

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Introduction: This study compared aortorenal bypass to renal artery stenting to determine the most efficacious and financially sound method for treating patients with atherosclerotic renal artery stenosis (RAS). Methods: A decision analysis using direct and indirect costs, and value of statistical life (VSL) was completed. Direct costs were obtained using the Nationwide Inpatient Sample (NIS), indirect costs from the National Institute of Diabetes and Digestive and Kidney Diseases, and VSL from the Department of Transportation. A variance-based sensitivity analysis was completed to assess the accuracy of the decision analysis. Results: Aortorenal bypass has a 95% five-year patency, a 98% 30-day survival, a 26% rate of overall complications, and a 70% five-year dialysis-free survival. Renal artery stenting has a 56% five-year patency, a 99% 30-day survival, a 40% rate of complications, and a 65% five-year dialysis-free survival. Renal artery stenting has an overall cost of $305,370 and aortorenal bypass has an overall cost of $103,453 per patient. After accounting for VSL, renal artery stenting has a negative value of À$182,270 and aortorenal bypass has a value of $415,881. Conclusions: Lower five-year patency and higher rate of complications from renal artery stenting that ultimately lead to significantly lower five-year dialysis-free survival.

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The management of renal artery atherosclerosis for renal salvage: Does stenting help?

Abstract: Renal artery stenoses causing renal dysfunction can be safely treated via endovascular means. Rapidly decreasing renal function is associated with the response to renal artery angioplasty/stenting and helps identify patients for renal salvage.

Cited by 46 publications

References 26 publications

Pattern of Hypertensive Kidney Disease in a Black Kenyan Population

Pattern of Hypertensive Kidney Disease in a Black Kenyan Population

Current Management of Atherosclerotic Renovascular Disease – What Have We Learned from ASTRAL?

Renal artery stenting may not be appropriate for patients with atherosclerotic renal artery stenosis

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