Renal artery stenosis angioplasty and stenting: Difference between revisions
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(/* Preservation of Renal Function in RAS (DO NOT EDIT){{cite journal |author=Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, Hiratzka LF, Murphy WR, Olin JW, Puschett JB, Rosenfield KA, Sacks D, Stanley JC, Taylor LM, White CJ...) |
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==Angioplasty and stenting== | ==Angioplasty and stenting== | ||
In 2005, the ACC/AHA Guidelines for the Management of PAD mentioned revascularization among 2 groups of patients: Asymptomatic patients and those with impaired renal function or cardiovascular symptoms. | |||
===Asymptomatic Patients=== | |||
The 2005 ACC/AHA guidelines showed class C evidence to revascularize asymptomatic patients only with hemodynamically significant RAS. Nonethless, the report mentioned no known benefit or risk at the time for such procedure in asymptomatic patients. | |||
===Hypertension=== | |||
Revascularization was recommended by ACC/AHA guidelines, with class B evidence, in hypertensive patients who have hemodynamically significant RAS, malignant, resistant, and/or accelerated hypertension, and among those with unexplained unilateral small kidneys or intolerance to anti-hypertensive medications. | |||
===Impaired Renal Function=== | |||
Revascularization was recommended with level B evidence for patients with bilateral RAS, for those with a solitary kidney and RAS, and for those with RAS and progressive chronic kidney disease (CKD). For patients with CKD and unilateral RAS, percutaneous revascularization was still considered reasonable, but with a level C evidence. | |||
===Congestive Heart Failure=== | |||
Revascularization was indicated at level B evidence in patients with hemodynamically significant RAS and recurrent congestive heart failure of undefined cause or in cases of sudden flash pulmonary edema with unexplained etiology. | |||
===Unstable Angina=== | |||
There was level B evidence to recommend revascularization among patients known to have unstable angina with hemodynamically significant RAS. | |||
==2005 ACC/AHA Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) (DO NOT EDIT)<ref name="pmid16549646">{{cite journal |author=Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, Hiratzka LF, Murphy WR, Olin JW, Puschett JB, Rosenfield KA, Sacks D, Stanley JC, Taylor LM, White CJ, White J, White RA, Antman EM, Smith SC, Adams CD, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B |title=ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation |journal=[[Circulation]] |volume=113 |issue=11 |pages=e463–654 |year=2006 |month=March |pmid=16549646 |doi=10.1161/CIRCULATIONAHA.106.174526 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=16549646 |accessdate=2012-10-09}}</ref>== | ==2005 ACC/AHA Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) (DO NOT EDIT)<ref name="pmid16549646">{{cite journal |author=Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, Hiratzka LF, Murphy WR, Olin JW, Puschett JB, Rosenfield KA, Sacks D, Stanley JC, Taylor LM, White CJ, White J, White RA, Antman EM, Smith SC, Adams CD, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B |title=ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation |journal=[[Circulation]] |volume=113 |issue=11 |pages=e463–654 |year=2006 |month=March |pmid=16549646 |doi=10.1161/CIRCULATIONAHA.106.174526 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=16549646 |accessdate=2012-10-09}}</ref>== | ||
Revision as of 06:22, 8 November 2013
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Renal artery stenosis Microchapters |
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Renal artery stenosis angioplasty and stenting On the Web |
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American Roentgen Ray Society Images of Renal artery stenosis angioplasty and stenting |
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Risk calculators and risk factors for Renal artery stenosis angioplasty and stenting |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vishnu Vardhan Serla M.B.B.S. [2]
Overview
Angioplasty is a procedure in which a catheter is put into the renal artery, usually through the groin, just as in a conventional angiogram. In addition, for angioplasty, a tiny balloon at the end of the catheter can be inflated to flatten the plaque against the wall of the artery. Then your doctor may position a small mesh tube, called a stent, to keep plaque flattened and the artery open.
Angioplasty and stenting
In 2005, the ACC/AHA Guidelines for the Management of PAD mentioned revascularization among 2 groups of patients: Asymptomatic patients and those with impaired renal function or cardiovascular symptoms.
Asymptomatic Patients
The 2005 ACC/AHA guidelines showed class C evidence to revascularize asymptomatic patients only with hemodynamically significant RAS. Nonethless, the report mentioned no known benefit or risk at the time for such procedure in asymptomatic patients.
Hypertension
Revascularization was recommended by ACC/AHA guidelines, with class B evidence, in hypertensive patients who have hemodynamically significant RAS, malignant, resistant, and/or accelerated hypertension, and among those with unexplained unilateral small kidneys or intolerance to anti-hypertensive medications.
Impaired Renal Function
Revascularization was recommended with level B evidence for patients with bilateral RAS, for those with a solitary kidney and RAS, and for those with RAS and progressive chronic kidney disease (CKD). For patients with CKD and unilateral RAS, percutaneous revascularization was still considered reasonable, but with a level C evidence.
Congestive Heart Failure
Revascularization was indicated at level B evidence in patients with hemodynamically significant RAS and recurrent congestive heart failure of undefined cause or in cases of sudden flash pulmonary edema with unexplained etiology.
Unstable Angina
There was level B evidence to recommend revascularization among patients known to have unstable angina with hemodynamically significant RAS.
2005 ACC/AHA Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) (DO NOT EDIT)[1]
Indications for Revascularization of Asymptomatic Stenosis (DO NOT EDIT)[1]
| Class IIb |
| "1. Percutaneous revascularization may be considered for treatment of an asymptomatic bilateral or solitary viable kidney with a hemodynamically significant RAS. (Level of Evidence: C)" |
| "2. The usefulness of percutaneous revascularization of an asymptomatic unilateral hemodynamically significant RAS in a viable kidney is not well established and is presently clinically unproven. (Level of Evidence: C)" |
Hypertension (DO NOT EDIT)[1]
| Class IIa |
| "1. Percutaneous revascularization is reasonable for patients with hemodynamically significant RAS and accelerated hypertension, resistant hypertension, malignant hypertension, hypertension with an unexplained unilateral small kidney, and hypertension with intolerance to medication. (Level of Evidence: B)" |
Preservation of Renal Function (DO NOT EDIT)[1]
| Class IIa |
| "1. Percutaneous revascularization is reasonable for patients with RAS and progressive chronic kidney disease with bilateral RAS or a RAS to a solitary functioning kidney. (Level of Evidence: B)" |
| Class IIb |
| "1. Percutaneous revascularization may be considered for patients with RAS and chronic renal insufficiency with unilateral RAS. (Level of Evidence: C)" |
Impact of RAS on Congestive Heart Failure and Unstable Angina (DO NOT EDIT)[1]
| Class I |
| "1. Percutaneous revascularization is indicated for patients with hemodynamically significant RAS and recurrent, unexplained congestive heart failure or sudden, unexplained pulmonary edema (see text). (Level of Evidence: B)" |
| Class IIa |
| "1. Percutaneous revascularization is reasonable for patients with hemodynamically significant RAS and unstable angina (see text). (Level of Evidence: B)" |
Catheter-Based Interventions (DO NOT EDIT)[1]
| Class I |
| "1. Renal stent placement is indicated for ostial atherosclerotic RAS lesions that meet the clinical criteria for intervention. (Level of Evidence: B)" |
| "2. Balloon angioplasty with bailout stent placement if necessary is recommended for FMD lesions. (Level of Evidence: B)" |
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, Hiratzka LF, Murphy WR, Olin JW, Puschett JB, Rosenfield KA, Sacks D, Stanley JC, Taylor LM, White CJ, White J, White RA, Antman EM, Smith SC, Adams CD, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B (2006). "ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation". Circulation. 113 (11): e463–654. doi:10.1161/CIRCULATIONAHA.106.174526. PMID 16549646. Retrieved 2012-10-09. Unknown parameter
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