Skip to main content
NCBI home page
The Texas Heart Institute Journal logoLink to The Texas Heart Institute Journal
. 1998;25(1):34–39.

Atherosclerotic stenosis of the renal arteries. Indications for intervention.

M R Jaff 1, J W Olin 1
PMCID: PMC325499  PMID: 9566061

Abstract

Advances in the ability to diagnose atherosclerotic stenosis of the renal arteries have increased awareness of this disorder over the past decade, and several medical specialties have become interested in its pathophysiology, diagnosis, and therapy. Improved surgical and anesthetic techniques and the development of endovascular technology have paved the way for more aggressive management of atherosclerotic renal artery stenosis. However, there is a lack of prospective data supporting this aggressive approach, and there is little agreement among physician groups concerning the appropriateness of revascularization in many patient scenarios. We will examine the available data and make recommendations about which patient groups might benefit most from renal artery revascularization (surgical or endovascular).

Full text

PDF
34

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ascer E., Gennaro M., Rogers D. Unilateral renal artery revascularization can salvage renal function and terminate dialysis in selected patients with uremia. J Vasc Surg. 1993 Dec;18(6):1012–1018. doi: 10.1067/mva.1993.50138. [DOI] [PubMed] [Google Scholar]
  2. Barri Y. M., Davidson R. A., Senler S., Flynn T. C., Seger J. M., Harward T. R., Wilcox C. S. Prediction of cure of hypertension in atherosclerotic renal artery stenosis. South Med J. 1996 Jul;89(7):679–683. doi: 10.1097/00007611-199607000-00006. [DOI] [PubMed] [Google Scholar]
  3. Blum U., Krumme B., Flügel P., Gabelmann A., Lehnert T., Buitrago-Tellez C., Schollmeyer P., Langer M. Treatment of ostial renal-artery stenoses with vascular endoprostheses after unsuccessful balloon angioplasty. N Engl J Med. 1997 Feb 13;336(7):459–465. doi: 10.1056/NEJM199702133360702. [DOI] [PubMed] [Google Scholar]
  4. Bonelli F. S., McKusick M. A., Textor S. C., Kos P. B., Stanson A. W., Johnson C. M., Sheedy P. F., 2nd, Welch T. J., Schirger A. Renal artery angioplasty: technical results and clinical outcome in 320 patients. Mayo Clin Proc. 1995 Nov;70(11):1041–1052. doi: 10.4065/70.11.1041. [DOI] [PubMed] [Google Scholar]
  5. Cambria R. P., Brewster D. C., L'Italien G. J., Gertler J. P., Abbott W. M., LaMuraglia G. M., Moncure A. C., Vignati J., Bazari H., Fang L. T. Renal artery reconstruction for the preservation of renal function. J Vasc Surg. 1996 Sep;24(3):371–382. doi: 10.1016/s0741-5214(96)70193-3. [DOI] [PubMed] [Google Scholar]
  6. Canzanello V. J., Millan V. G., Spiegel J. E., Ponce P. S., Kopelman R. I., Madias N. E. Percutaneous transluminal renal angioplasty in management of atherosclerotic renovascular hypertension: results in 100 patients. Hypertension. 1989 Feb;13(2):163–172. doi: 10.1161/01.hyp.13.2.163. [DOI] [PubMed] [Google Scholar]
  7. Chaikof E. L., Smith R. B., 3rd, Salam A. A., Dodson T. F., Lumsden A. B., Chapman R., Kosinski A. S. Empirical reconstruction of the renal artery: long-term outcome. J Vasc Surg. 1996 Sep;24(3):406–414. doi: 10.1016/s0741-5214(96)70196-9. [DOI] [PubMed] [Google Scholar]
  8. Connolly J. O., Higgins R. M., Walters H. L., Mackie A. D., Drury P. L., Hendry B. M., Scoble J. E. Presentation, clinical features and outcome in different patterns of atherosclerotic renovascular disease. QJM. 1994 Jul;87(7):413–421. [PubMed] [Google Scholar]
  9. DUSTAN H. P., HUMPHRIES A. W., DEWOLFE V. G., PAGE I. H. NORMAL ARTERIAL PRESSURE IN PATIENTS WITH RENAL ARTERIAL STENOSIS. JAMA. 1964 Mar 28;187:1028–1029. doi: 10.1001/jama.1964.03060260056020. [DOI] [PubMed] [Google Scholar]
  10. Dean R. H., Kieffer R. W., Smith B. M., Oates J. A., Nadeau J. H., Hollifield J. W., DuPont W. D. Renovascular hypertension: anatomic and renal function changes during drug therapy. Arch Surg. 1981 Nov;116(11):1408–1415. doi: 10.1001/archsurg.1981.01380230032005. [DOI] [PubMed] [Google Scholar]
  11. Diamond J. R. Flash pulmonary edema and the diagnostic suspicion of occult renal artery stenosis. Am J Kidney Dis. 1993 Mar;21(3):328–330. doi: 10.1016/s0272-6386(12)80756-6. [DOI] [PubMed] [Google Scholar]
  12. Dorros G., Jaff M., Jain A., Dufek C., Mathiak L. Follow-up of primary Palmaz-Schatz stent placement for atherosclerotic renal artery stenosis. Am J Cardiol. 1995 May 15;75(15):1051–1055. doi: 10.1016/s0002-9149(99)80723-1. [DOI] [PubMed] [Google Scholar]
  13. Gross C. M., Krämer J., Waigand J., Luft F. C., Dietz R. Relation between arteriosclerosis in the coronary and renal arteries. Am J Cardiol. 1997 Dec 1;80(11):1478–1481. doi: 10.1016/s0002-9149(97)00727-3. [DOI] [PubMed] [Google Scholar]
  14. HOLLEY K. E., HUNT J. C., BROWN A. L., Jr, KINCAID O. W., SHEPS S. G. RENAL ARTERY STENOSIS. A CLINICAL-PATHOLOGIC STUDY IN NORMOTENSIVE AND HYPERTENSIVE PATIENTS. Am J Med. 1964 Jul;37:14–22. doi: 10.1016/0002-9343(64)90208-6. [DOI] [PubMed] [Google Scholar]
  15. Hallett J. W., Jr, Textor S. C., Kos P. B., Nicpon G., Bower T. C., Cherry K. J., Jr, Gloviczki P., Pairolero P. C. Advanced renovascular hypertension and renal insufficiency: trends in medical comorbidity and surgical approach from 1970 to 1993. J Vasc Surg. 1995 May;21(5):750–760. doi: 10.1016/s0741-5214(05)80006-0. [DOI] [PubMed] [Google Scholar]
  16. Hansen K. J., Starr S. M., Sands R. E., Burkart J. M., Plonk G. W., Jr, Dean R. H. Contemporary surgical management of renovascular disease. J Vasc Surg. 1992 Sep;16(3):319–331. [PubMed] [Google Scholar]
  17. Hansen K. J., Thomason R. B., Craven T. E., Fuller S. B., Keith D. R., Appel R. G., Dean R. H. Surgical management of dialysis-dependent ischemic nephropathy. J Vasc Surg. 1995 Feb;21(2):197–211. doi: 10.1016/s0741-5214(95)70262-8. [DOI] [PubMed] [Google Scholar]
  18. Harden P. N., MacLeod M. J., Rodger R. S., Baxter G. M., Connell J. M., Dominiczak A. F., Junor B. J., Briggs J. D., Moss J. G. Effect of renal-artery stenting on progression of renovascular renal failure. Lancet. 1997 Apr 19;349(9059):1133–1136. doi: 10.1016/s0140-6736(96)10093-3. [DOI] [PubMed] [Google Scholar]
  19. Harding M. B., Smith L. R., Himmelstein S. I., Harrison K., Phillips H. R., Schwab S. J., Hermiller J. B., Davidson C. J., Bashore T. M. Renal artery stenosis: prevalence and associated risk factors in patients undergoing routine cardiac catheterization. J Am Soc Nephrol. 1992 May;2(11):1608–1616. doi: 10.1681/ASN.V2111608. [DOI] [PubMed] [Google Scholar]
  20. Kaylor W. M., Novick A. C., Ziegelbaum M., Vidt D. G. Reversal of end stage renal failure with surgical revascularization in patients with atherosclerotic renal artery occlusion. J Urol. 1989 Mar;141(3):486–488. doi: 10.1016/s0022-5347(17)40867-6. [DOI] [PubMed] [Google Scholar]
  21. Losinno F., Zuccalà A., Busato F., Zucchelli P. Renal artery angioplasty for renovascular hypertension and preservation of renal function: long-term angiographic and clinical follow-up. AJR Am J Roentgenol. 1994 Apr;162(4):853–857. doi: 10.2214/ajr.162.4.8141007. [DOI] [PubMed] [Google Scholar]
  22. Mailloux L. U., Napolitano B., Bellucci A. G., Vernace M., Wilkes B. M., Mossey R. T. Renal vascular disease causing end-stage renal disease, incidence, clinical correlates, and outcomes: a 20-year clinical experience. Am J Kidney Dis. 1994 Oct;24(4):622–629. doi: 10.1016/s0272-6386(12)80223-x. [DOI] [PubMed] [Google Scholar]
  23. Messina L. M., Zelenock G. B., Yao K. A., Stanley J. C. Renal revascularization for recurrent pulmonary edema in patients with poorly controlled hypertension and renal insufficiency: a distinct subgroup of patients with arteriosclerotic renal artery occlusive disease. J Vasc Surg. 1992 Jan;15(1):73–82. doi: 10.1067/mva.1992.33257. [DOI] [PubMed] [Google Scholar]
  24. Novick A. C., Pohl M. A., Schreiber M., Gifford R. W., Jr, Vidt D. G. Revascularization for preservation of renal function in patients with atherosclerotic renovascular disease. J Urol. 1983 May;129(5):907–912. doi: 10.1016/s0022-5347(17)52453-2. [DOI] [PubMed] [Google Scholar]
  25. Olin J. W., Piedmonte M. R., Young J. R., DeAnna S., Grubb M., Childs M. B. The utility of duplex ultrasound scanning of the renal arteries for diagnosing significant renal artery stenosis. Ann Intern Med. 1995 Jun 1;122(11):833–838. doi: 10.7326/0003-4819-122-11-199506010-00004. [DOI] [PubMed] [Google Scholar]
  26. Pickering T. G., Herman L., Devereux R. B., Sotelo J. E., James G. D., Sos T. A., Silane M. F., Laragh J. H. Recurrent pulmonary oedema in hypertension due to bilateral renal artery stenosis: treatment by angioplasty or surgical revascularisation. Lancet. 1988 Sep 3;2(8610):551–552. doi: 10.1016/s0140-6736(88)92668-2. [DOI] [PubMed] [Google Scholar]
  27. Schreiber M. J., Pohl M. A., Novick A. C. The natural history of atherosclerotic and fibrous renal artery disease. Urol Clin North Am. 1984 Aug;11(3):383–392. [PubMed] [Google Scholar]
  28. Scoble J. E. Is the 'wait-and-see' approach justified in atherosclerotic renal artery stenosis? Nephrol Dial Transplant. 1995;10(5):588–589. [PubMed] [Google Scholar]
  29. Scoble J. E., Sweny P., Stansby G., Hamilton G. Patients with atherosclerotic renovascular disease presenting to a renal unit: an audit of outcome. Postgrad Med J. 1993 Jun;69(812):461–465. doi: 10.1136/pgmj.69.812.461. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Servois V., Laissy J. P., Feger C., Sibert A., Delahousse M., Baleynaud S., Mery J. P., Menu Y. Two-dimensional time-of-flight magnetic resonance angiography of renal arteries without maximum intensity projection: a prospective comparison with angiography in 21 patients screened for renovascular hypertension. Cardiovasc Intervent Radiol. 1994 May-Jun;17(3):138–142. doi: 10.1007/BF00195506. [DOI] [PubMed] [Google Scholar]
  31. Steinbach F., Novick A. C., Campbell S., Dykstra D. Long-term survival after surgical revascularization for atherosclerotic renal artery disease. J Urol. 1997 Jul;158(1):38–41. doi: 10.1097/00005392-199707000-00011. [DOI] [PubMed] [Google Scholar]
  32. Tami L. F., McElderry M. W., al-Adli N. M., Rubin M., Condos W. R. Renal artery stenosis presenting as crescendo angina pectoris. Cathet Cardiovasc Diagn. 1995 Jul;35(3):252–256. doi: 10.1002/ccd.1810350321. [DOI] [PubMed] [Google Scholar]
  33. Tarazi R. Y., Hertzer N. R., Beven E. G., O'Hara P. J., Anton G. E., Krajewski L. P. Simultaneous aortic reconstruction and renal revascularization: risk factors and late results in eighty-nine patients. J Vasc Surg. 1987 May;5(5):707–714. doi: 10.1067/mva.1987.avs0050707. [DOI] [PubMed] [Google Scholar]
  34. Textor S. C. Pathophysiology of renal failure in renovascular disease. Am J Kidney Dis. 1994 Oct;24(4):642–651. doi: 10.1016/s0272-6386(12)80226-5. [DOI] [PubMed] [Google Scholar]
  35. Uzu T., Inoue T., Fujii T., Nakamura S., Inenaga T., Yutani C., Kimura G. Prevalence and predictors of renal artery stenosis in patients with myocardial infarction. Am J Kidney Dis. 1997 May;29(5):733–738. doi: 10.1016/s0272-6386(97)90127-x. [DOI] [PubMed] [Google Scholar]
  36. White C. J., Ramee S. R., Collins T. J., Jenkins J. S., Escobar A., Shaw D. Renal artery stent placement: utility in lesions difficult to treat with balloon angioplasty. J Am Coll Cardiol. 1997 Nov 15;30(6):1445–1450. doi: 10.1016/s0735-1097(97)00348-3. [DOI] [PubMed] [Google Scholar]
  37. White C. J. The renal oculosten(t)otic reflex. Cathet Cardiovasc Diagn. 1996 Mar;37(3):251–251. doi: 10.1002/(SICI)1097-0304(199603)37:3<251::AID-CCD4>3.0.CO;2-B. [DOI] [PubMed] [Google Scholar]
  38. Zierler R. E., Bergelin R. O., Davidson R. C., Cantwell-Gab K., Polissar N. L., Strandness D. E., Jr A prospective study of disease progression in patients with atherosclerotic renal artery stenosis. Am J Hypertens. 1996 Nov;9(11):1055–1061. doi: 10.1016/0895-7061(96)00196-3. [DOI] [PubMed] [Google Scholar]
  39. van Damme H., Jeusette F., Pans A., Defraigne J. O., Creemers E., Albert A., Limet R. The impact of renal revascularisation on renal dysfunction. Eur J Vasc Endovasc Surg. 1995 Oct;10(3):330–337. doi: 10.1016/s1078-5884(05)80052-8. [DOI] [PubMed] [Google Scholar]

Articles from Texas Heart Institute Journal are provided here courtesy of Texas Heart Institute

RESOURCES