Predictors for Clinical Success at One Year following Renal Artery Stent Placement

2002 ◽  
Vol 9 (4) ◽  
pp. 495-502 ◽  
Author(s):  
Trude C. Gill-Leertouwer ◽  
Elma J. Gussenhoven ◽  
Johanna L. Bosch ◽  
Jaap Deinum ◽  
Hans van Overhagen ◽  
...  
Keyword(s):  
Renal Function ◽  
Serum Creatinine ◽  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Stent Placement ◽  
Clinical Success ◽  
Artery Stenosis ◽  
Renal Function Impairment ◽  
Function Impairment ◽  
Renal Artery Stent

Purpose: To determine pretreatment variables that may predict 1-year clinical outcome of stent placement for renal artery stenosis. Methods: In a prospective study, 40 consecutive patients (29 men; mean age 60 ± 9.1 years) with angiographically proven atherosclerotic renal artery stenosis were treated with stent placement because of drug resistant hypertension (n=14), renal function impairment (n=14), or both (n=12). Clinical success at 1 year was defined as a decrease of diastolic blood pressure ≥10 mmHg or a decrease in serum creatinine ≥20%, depending on the indication for treatment. Regression analysis was performed using anatomical parameters from angiography and intravascular ultrasound, estimates of renal blood flow from renal scintigraphy, and single-kidney renal function measurements. Results: Patients treated for hypertension had better outcome than those treated for renal function impairment, with clinical success rates of 85% and 35%, respectively. Preserved renal function, with low serum creatinine and high 2-kidney glomerular filtration rate at baseline, was associated with clinical success in the entire patient group at follow-up (p=0.02 and p=0.03, respectively). An elevated vein-to-artery renin ratio on the affected side was borderline predictive (p=0.06). In patients treated for renal impairment, lateralization to the affected kidney (affected kidney—to–2-kidney count ratio ≤0.45) on the scintigram emerged as a significant predictor for clinical success, with an odds ratio of 15 (p=0.048). Conclusions: Clinical success of renal artery stent placement is better for the treatment of hypertension than for preserving renal function. In patients with renal function impairment, lateralization to the affected kidney on the scintigram appears to be a predictor of clinical success.

Renal Artery Stent Placement for Restoration of Renal Function in Hemodialysis Recipients with Renal Artery Stenosis

2008 ◽  
Vol 19 (11) ◽  
pp. 1563-1568 ◽  
Author(s):  
Mallik Thatipelli ◽  
Sanjay Misra ◽  
C. Michael Johnson ◽  
James C. Andrews ◽  
Anthony W. Stanson ◽  
...  
Keyword(s):  
Renal Function ◽  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Stent Placement ◽  
Artery Stenosis ◽  
Renal Artery Stent

Endovascular Treatment of Transplant Renal Artery Stenosis: A Systematic Review and Meta-analysis

2021 ◽  
pp. 152660282110385
Author(s):  
David Eugenio Hinojosa-Gonzalez ◽  
Gustavo Salgado-Garza ◽  
Mauricio Torres-Martinez ◽  
Sergio Uriel Villegas-De Leon ◽  
Luis Carlos Bueno-Gutierrez ◽  
...  
Keyword(s):  
Systematic Review ◽  
Renal Function ◽  
Serum Creatinine ◽  
Renal Artery ◽  
Serum Creatinine Level ◽  
Endovascular Treatment ◽  
Renal Artery Stenosis ◽  
Creatinine Level ◽  
Mean Difference ◽  
Artery Stenosis

Objective Endovascular treatment through either percutaneous transluminal angioplasty (PTA) alone or stenting has been previously used as a treatment for transplant renal artery stenosis (TRAS). This review aimed to investigate the results of endovascular treatment for renal artery stenosis in transplanted kidneys as compared with the outcomes of interventions, medical management, and graft survival in non-TRAS patients. Methods A systematic review of PubMed, Google Scholar, Cochrane, and Scopus was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in which studies that reported outcomes of the treatment of TRAS via the endoluminal approach were identified, and their results were meta-analyzed. Results Fifty-four studies with a total of 1522 patients were included. A significant reduction of serum creatinine level was found, favoring the stenting group, with a mean difference of 0.68 mg/dL (95% confidence interval (CI), 0.17–1.19; Z=2.60, p=0.0009). Comparison of pre- and post-intervention values of any intervention revealed a significant decrease in overall serum creatinine level (0.65 mg/dL; 95% CI, 0.40–0.90; Z=5.09, p=0.00001), overall blood pressure, with a mean difference of 11.12 mmHg (95% CI, 7.29–14.95; Z=5.59, p=0.00001), mean difference in the use of medications (0.77; 95% CI, 0.29–1.24; p=0.002), and peak systolic velocity (190.05; 95% CI, 128.41–251.69; p<0.00001). The comparison of serum creatinine level between endovascular interventions and best medical therapy favored endovascular intervention, with a mean difference of 0.23 mg/dL (95% CI, 0.14–0.32; Z=5.07, p<0.00001). Graft survival was similar between the treated patients and those without TRAS (hazard ratio, 0.98; 95% CI, 0.75–1.28; p=0.091). The overall pooled success rate was 89%, and the overall complication rate was 10.4%, with the most prevalent complication being arterial dissection. Conclusion The endovascular treatment of TRAS improves graft preservation and renal function and hemodynamic parameters. PTA + stenting appears to be a more effective option to PTA alone in the stabilization of renal function, with additional benefits from decreased restenosis rates. Further high-quality studies could expand on these findings.

scholarly journals Standardized Duplex Ultrasound-Based Protocol for Early Diagnosis of Transplant Renal Artery Stenosis: Results of a Single-Institution Retrospective Cohort Study

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Vincenzo Li Marzi ◽  
Riccardo Campi ◽  
Francesco Sessa ◽  
Alessandro Pili ◽  
Graziano Vignolini ◽  
...  
Keyword(s):  
Early Diagnosis ◽  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Stent Placement ◽  
Clinical Success ◽  
Duplex Ultrasound ◽  
Artery Stenosis ◽  
Refractory Hypertension ◽  
Transplant Renal Artery Stenosis

Transplant renal artery stenosis (TRAS) is the most frequent vascular complication after kidney transplantation (KT) and has been associated with potentially reversible refractory hypertension, graft dysfunction, and reduced patient survival. The aim of the study is to describe the outcomes of a standardized Duplex Ultrasound- (DU-) based screening protocol for early diagnosis of TRAS and for selection of patients potentially requiring endovascular intervention. We retrospectively reviewed our prospectively collected database of KT from January 1998 to select patients diagnosed with TRAS. The follow-up protocol was based on a risk-adapted, dynamic subdivision of eligible KT patients in different risk categories (RC) with different protocol strategies (PS). Of 598 patients included in the study, 52 (9%) patients had hemodynamically significant TRAS and underwent percutaneous angioplasty (PTA) and stent placement. Technical and clinical success rates were 97% and 90%, respectively. 7 cases of restenosis were recorded at follow-up and treated with re-PTA plus stenting. Both DU imaging and clinical parameters improved after stent placement. Prospective high-quality studies are needed to test the efficacy and safety of our protocol in larger series. Accurate trial design and standardized reporting of patient outcomes will be key to address the current clinical needs.

scholarly journals Endovascular management of renal artery stenosis in renal transplantation

2020 ◽  
Vol 3 (2) ◽  
Author(s):  
Maria Peaire Lores
Keyword(s):  
Renal Function ◽  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Stent Placement ◽  
Artery Stenosis ◽  
Endovascular Management ◽  
Renal Angioplasty ◽  
Allograft Dysfunction ◽  
Percutaneous Transluminal Renal Angioplasty ◽  
Percutaneous Transluminal

INTRODUCTION: Transplant renal artery stenosis is a recognized complication of kidney transplantation associated with allograft dysfunction and even graft loss. It is a commonly missed but potentially treatable complication that may present from months to years after transplant surgery. Its prompt diagnosis and adequate therapeutic management are essential to avoid renal function loss. MATERIAL AND METHODS: We retrospectively analysed the data from two 72-year-old patients transplanted in 2017 at our institution. Both with arterial hypertension, chronic ischemic heart disease and end-stage renal disease due to nephroangiosclerosis and membranous glomerulonephritis, respectively; presented allograft dysfunction in the immediate postoperative period. With this finding and the evidence of peak systolic velocity of >200 cm/s in the transplant renal artery we suspected transplant renal artery stenosis, confirmed by angiography and CT scan. An endovascular management with stent placement was performed. RESULTS: Both patients were managed by percutaneous transluminal renal angioplasty and stent placement with good morphological outcomes. After the procedure both patients presented a progressive renal function improvement, being discharged after 8 and 11 days, respectively. Since then, both patients have remained with stable renal function, presenting a glomerular filtration rate of 67 mL/min/1.73m2 and 60 mL/min/1.73m2 12 months after the surgery. No complications have been noticed after 14 months. CONCLUSION: Percutaneous transluminal renal angioplasty and stent placement is an effective and safe technique. Nevertheless, high experience is mandatory to reduce the number of complications and optimize the results of this technique.

Evaluation of Endovascular Therapy for Unilateral Atherosclerotic Renal Artery Stenosis Using Measurements of Differential Renal Function

2021 ◽  
Vol 34 (9) ◽  
pp. 1009-1009
Author(s):  
You Zhou ◽  
Lei Kou ◽  
Yao-guo Yang ◽  
Jian Jiao ◽  
Xiao-bin Tang ◽  
...  
Keyword(s):  
Renal Function ◽  
Renal Insufficiency ◽  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Patency Rate ◽  
Dynamic Imaging ◽  
Artery Stenosis ◽  
Affected Side ◽  
Renal Artery Stent ◽  
One Year

Abstract Background To evaluate the efficacy of endovascular therapy in patients with unilateral arteriosclerotic renal artery stenosis using nuclide renal dynamic imaging and to analyze the influencing factors that may affect the renal function. Methods A retrospective analysis was made on 60 patients with &gt;70% unilateral arteriosclerotic renal artery stenosis who underwent renal artery stent implantation. Serum creatinine, urea nitrogen, renal artery color Doppler ultrasonography, and renal dynamic imaging results were obtained before and after 1 year of operation. A regression model was used to analyze the influencing factors. Results All patients underwent balloon dilatation and stenting of the affected renal artery. The immediate intervention success rate was 100%. The residual stenosis of the affected renal artery was less than 20%. No serious complications occurred during the perioperative period. After operation, systolic blood and diastolic blood pressures were improved (P &lt; 0.01), the serum creatinine was stable (P = 0.25), and the degree of renal artery stenosis of the affected side was relieved significantly (P &lt; 0.01). One year after operation, the patency rate of renal artery stent was 85%. Based on the changes of differential glomerular filtration rate of the affected side, 40 patients (66.7%) were improved while 20 patients (33.3%) were not. A linear regression analysis showed that the renal insufficiency of the affected side before operation was the only significant influencing factor (B = 0.50, P &lt; 0.01). Conclusions Renal artery stenting is safe and effective in the treatment of unilateral renal artery stenosis. One-year patency rate is 85%. Two-thirds of the patients have an improved renal function after operation. The patients with preoperative renal insufficiency of affected side are more likely to benefit from renal artery stenting.

Sign in / Sign up

Export Citation Format

Share Document