Arterial Interventions for Renovascular Hypertension

ABSTRACT

Renovascular hypertension is a major cause of secondary hypertension. It affects relatively younger patients. The unifying pathology is renal artery stenosis. The most common cause is atherosclerosis accounting for about 90% of cases with fibromuscular dysplasia being the second most common cause. Both of these are amenable to percutaneous interventional therapy. With the advent of new medical therapies, the control of blood pressure has improved significantly. In well-selected patients, renal arterial intervention has a good outcome. The intervention includes renal angioplasty and stenting. In this article, the authors review the role of percutaneous intervention and the techniques involved with renal angioplasty and stenting for the treatment of renovascular hypertension.

KEYWORDS

Renal artery stenosis - renovascular hypertension - atherosclerosis - fibromuscular dysplasia - renal artery angioplasty - renal artery stenting

REFERENCES

• 1 Simon N, Franklin S S, Bleifer K H, Maxwell M H. Clinical characteristics of renovascular hypertension.  JAMA. 1972;  220 1209-1218
• 2 Safian R D, Textor S C. Renal-artery stenosis.  N Engl J Med. 2001;  344 431-442
• 3 Tollefson D F, Ernst C B. Natural history of atherosclerotic renal artery stenosis associated with aortic disease.  J Vasc Surg. 1991;  14 327-331
• 4 Mwipatayi B P, Beningfield S J, White L E, Irish A, Abbas M, Sieunarine K. A review of the current treatment of renal artery stenosis.  Eur J Vasc Endovasc Surg. 2005;  29 479-488
• 5 Novick A C, Ziegelbaum M, Vidt D G, Gifford Jr R W, Pohl M A, Goormastic M. Trends in surgical revascularization for renal artery disease. Ten years' experience.  JAMA. 1987;  257 498-501
• 6 Weibull H, Bergqvist D, Bergentz S E, Jonsson K, Hulthen L, Manhem P. Percutaneous transluminal renal angioplasty versus surgical reconstruction of atherosclerotic renal artery stenosis: a prospective randomized study.  J Vasc Surg. 1993;  18 841-850 discussion 50-52
• 7 Henry M, Henry I, Polydorou A, Polydorou A D, Hugel M. Recent advances in renal artery stenting.  J Cardiovasc Surg (Torino). 2007;  48 411-442
• 8 Kiernan T J, Yan B P, Jaff M R. Renal artery revascularization: collaborative approaches for specialists.  Adv Chronic Kidney Dis. 2008;  15 363-369
• 9 Levin A, Linas S, Luft F C, Chapman A B, Textor S. Controversies in renal artery stenosis: a review by the American Society of Nephrology Advisory Group on Hypertension.  Am J Nephrol. 2007;  27 212-220
• 10 McLaughlin K, Jardine A G, Moss J G. ABC of arterial and venous disease. Renal artery stenosis.  BMJ. 2000;  320 1124-1127
• 11 Stéphan D, Griffon C, Hamade A, Jahn C, Welsch M, Mounier-Vehier C. Why screening for a renal artery stenosis?.  Arch Mal Coeur Vaiss. 2007;  100 872-877
• 12 Murphy T P, Soares G, Kim M. Increase in utilization of percutaneous renal artery interventions by Medicare beneficiaries, 1996–2000.  AJR Am J Roentgenol. 2004;  183 561-568
• 13 Rihal C S, Textor S C, Breen J F et al.. Incidental renal artery stenosis among a prospective cohort of hypertensive patients undergoing coronary angiography.  Mayo Clin Proc. 2002;  77 309-316
• 14 Tynes W I. Unusual renovascular disorders.  Urol Clin North Am. 1984;  11 529-542
• 15 Zierler R E, Bergelin R O, Davidson R C, Cantwell-Gab K, Polissar N L, Strandness Jr D E. A prospective study of disease progression in patients with atherosclerotic renal artery stenosis.  Am J Hypertens. 1996;  9 1055-1061
• 16 Bergentz S E. Natural history of renal artery stenosis.  Ann Chir Gynaecol. 1992;  81 98-101
• 17 Dubel G J, Murphy T P. The role of percutaneous revascularization for renal artery stenosis.  Vasc Med. 2008;  13 141-156
• 18 Krijnen P, van Jaarsveld B C, Steyerberg E W. Man in 't Veld AJ, Schalekamp MA, Habbema JD. A clinical prediction rule for renal artery stenosis.  Ann Intern Med. 1998;  129 705-711
• 19 Chobanian A V, Bakris G L, Black H R et al.. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.  Hypertension. 2003;  42 1206-1252
• 20 White C J. Catheter-based therapy for atherosclerotic renal artery stenosis.  Circulation. 2006;  113 1464-1473
• 21 Dellegrottaglie S, Sanz J, Rajagopalan S. Technology insight: Clinical role of magnetic resonance angiography in the diagnosis and management of renal artery stenosis.  Nat Clin Pract Cardiovasc Med. 2006;  3 329-338
• 22 Radermacher J, Chavan A, Bleck J et al.. Use of Doppler ultrasonography to predict the outcome of therapy for renal-artery stenosis.  N Engl J Med. 2001;  344 410-417
• 23 Meola M. Color-Doppler of renovascular diseases.  G Ital Nefrol. 2007;  24 425-445