n n n Causes of renal artery Atherosclerosis

n n n Causes of renal artery Atherosclerosis stenosis Fibromuscular dysplasia Vasculitis (mainly Takayasu’s arteritis) or other collagen vascular disease Neurofibromatosis Dissection of the renal artery/aorta Thromboembolic disease Trauma Post-transplantation graft stenosis Renal artery aneurysm Renal artery coarctation Extrinsic compression (mass, nutcracker syndrome

“Renal Arterial Disease and Hypertension” Stephen C. Textor, M. D. Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota 55905 Med Clin North Am. 2017 January ; 101(1): 65– 79.

Renal Artery Stenosis Management Strategies An Updated Comparative Effectiveness Reviews, No. 179 Brown Evidence-based Practice Center. Rockville (MD): Agency for Healthcare Research and Quality (US); 2016 Aug. Report No. : 16 EHC 026 -EF n Objectives: Compare the effectiveness and safety of n n n PTRAS versus medical therapy, and also versus surgical revascularization, to treat ARAS. Conclusions: There is a low strength of evidence of no statistically significant or minimal clinically important differences in important clinical outcomes (death, cardiovascular events, RRT) or BP control between PTRAS and medical therapy alone. The RCTs had limited applicability to many patients for whom PTRAS is recommended, particularly those who present with pulmonary edema or rapidly declining kidney function. New studies or reanalyses of data in existing studies are

Renal Artery Stenosis in Patients with Resistant Hypertension: Stent It or Not? Van der Niepen P 1, et al. 2017 n n n After three large neutral trials in which renal artery revascularization failed to reduce cardiovascular and renal morbidity and mortality, renal artery stenting became a therapeutic taboo. Effective pharmacological combination treatment can control blood pressure in most patients with renovascular hypertension. However, it may also induce further renal hypoperfusion and thus accelerate progressive loss of renal tissue. Furthermore, case reports of patients with resistant hypertension showing substantial blood pressure improvement after successful revascularization are published over again. To identify those patients who would definitely respond to renal artery stenting, properly designed randomized

Left: TRAS Right: Post PTAS

Fig. 1: Left: TRAS Right: Post PTAS

(a) Transplant renal artery stenosis at the bifurcation, affecting mostly the inner ramus. (b). Postballoon angioplasty; dilatation of the segmental renal artery with dissection of the main renal artery lumen. Right. Image Post balloon expandable stent placement.

Right: Common and external iliac artery stenoses provoking claudication and renal insuficiency Left: Image after angioplasty and stenting of the common and external iliac artery stenoses

Interventional Therapy for Transplant Renal Artery Stenosis Is Safe and Effective in Preserving Allograft Function and Improving Hypertension. Wang L 1, et al, 2017 n n n PURPOSE: To evaluate the outcomes of percutaneous intervention (PI) for transplant renal artery stenosis (TRAS). RESULTS: From October 2009 to July 2015, a total of 660 patients had kidney transplantation and 22 cases underwent PI. The technical success was 100%. CONCLUSIONS: Percutaneous intervention for TRAS is safe and results in significant improvement both in allograft function and in BP.

Renal artery stent in solitary functioning kidneys: 77% of benefit: A systematic review with meta-analysis. Ma Z 1, et al, 2017 n n METHODS: All related papers published in Pub. Med, Web of Science, EMBASE, and Cochrane Library were searched. Studies or subsets were included only if they satisfied certain criteria. The benefit rate which equaled the rate of improvement subjoining the rate of stabilization was calculated. All analyses were conducted with Stata version 12. 0 (Stata Corporation, College Station, TX). CONCLUSIONS: With proper patient selection, renal artery stent could benefit SFK patients with a percentage odd of 0. 77 to improve or stabilize the RF.

Endovascular Management of Atherosclerotic Renal Artery Stenosis: Post-Cardiovascular Outcomes in Renal Atherosclerotic Lesions Era Winner or False Alarm? Evridiki Karanikola et. al Hippocration, Laikon General Hospital, Athens, Greece n In general, patients with ARAS will be referred for refractory hypertension, deteriorating renal function, abrupt congestive heart failure, or a combination of these symptoms. Revascularization shows no additional benefit, at least in low-risk and stable ARAS, where optimal medical treatment seems to be the ‘golden standard’. However, patients of higher risk, especially those with recurrent flash pulmonary edema or truly resistant hypertension, could benefit from angioplasty or stenting, although there is no definitive evidence and the selection of treatment should take into consideration the potential risks and benefits of the procedure. Finally, evidence suggests that stenting is not detrimental to

Split renal function in patients with unilateral atherosclerotic renal artery stenosis— effect of renal angioplasty Aso Saeed, et al, Clinical Kidney Journal, 2017, 496– 502 In patients with unilateral ARAS, PTRA significantly improved e. GFR in stenotic kidneys and decreased filtration in contralateral, non-stenotic kidneys. These potentially beneficial effects may not be apparent when total renal function remains stable. The clinical significance of these findings needs to be evaluated further.

Spontaneous Renal Artery Thrombosis Successfully Intervened with Drug Eluting Stent: A Primary Renal Artery Angioplasty Basant Kumar, Savita Kumari: Journal of Clinical and Diagnostic Research. 2017 Sep, Vol-11(9): OD 14 -OD 15 n Renal artery thrombosis is a rare entity and its diagnosis require high index of clinical suspicion. Percutaneous transluminal renal angioplasty with drug eluting stent is a viable option in emergency situation to prevent renal loss and further stent restenosis.