Renal Artery Stenosis - Surgery

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Which patients can benefit from surgical procedures for renal artery stenosis?

In patients with renal failure due to bilateral renal artery stenosis (narrowing on both kidneys), angioplasty procedures for both renal arteries may improve or stabilize kidney function. Similarly, in hypertensive patients with unilateral (one-sided) renal artery stenosis, angioplasty procedures of the involved renal artery may cure or improve the high blood pressure. Patients with milder degrees of stenosis (less than a 75% reduction in the width of the renal artery lumen) usually do not benefit from angioplasty. These patients need to be followed by sequential imaging procedures to detect further narrowing (progression) to the point of treatable stenosis. At that point, angioplasty procedures can be done with the hope of a favorable response.

Some studies have suggested that patients with a very high degree of renal vascular resistance (which reflects permanent damage to the kidneys), even with a 75% or more stenosis of the renal artery, often have a poor response to the angioplasty procedures. (The tension of the blood vessels to the kidney, called renal vascular resistance, is measured by Doppler ultrasonography. A so-called resistive index over 0.8 is considered very high). In these patients, angioplasty is usually not done and the high blood pressure or renal failure is managed only by the customary therapeutic measures for these problems as described previously.

References:

eMedicine, "Renal Artery Stenosis."

eMedicine, "Renal Artery Stenosis/Renovascular Hypertension."

Previous contributing author and editor: Dwight Makoff, M.D. and Leslie J. Schoenfield, M.D., Ph.D.

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Comment from: EAGLEBECKY, 55-64 Female (Patient) Published: September 25

I was suffering from very uncontrollable high blood pressure for about nine months. We're talking 220/110. My cardiologist ran all the normal EKGs, Echo tests, etc., and could not find anything. He then did a heart cath and again didn't find anything. He decided to check my renal artery and found a 90 percent blockage, which got me a stent. My BP was great for almost two years when it started again, but all he found was a scarred-over stent, fixed it and once again I'm good. I hope that's the end of stents.

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