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Kądziela J, Jóźwik-Plebanek K, Pappaccogli M, van der Niepen P, Prejbisz A, Dobrowolski P, Michałowska I, Talarowska P, Warchoł-Celińska E, Stryczyński Ł, Krekora J, Andziak P, Szczerbo-Trojanowska M, Maciąg R, Sterliński I, Witkowski A, Januszewicz A, Adlam D, Januszewicz M, Persu A. Risks and benefits of renal artery stenting in fibromuscular dysplasia: Lessons from the ARCADIA-POL study. Vasc Med 2024; 29:50-57. [PMID: 38084723 DOI: 10.1177/1358863x231210523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
INTRODUCTION Although renal stenting is the standard revascularization method for atherosclerotic renal artery stenosis (RAS) (FMD-RAS), stenting in fibromuscular dysplasia (FMD) RAS is usually limited to periprocedural complications of angioplasty and primary arterial dissection. The main aim of the study was to retrospectively analyze the immediate and long-term results of renal stenting versus angioplasty in patients with FMD. METHODS Of 343 patients in the ARCADIA-POL registry, 58 patients underwent percutaneous treatment due to FMD-RAS (in 70 arteries). Percutaneous transluminal renal angioplasty (PTRA) was performed as an initial treatment in 61 arteries (PTRA-group), whereas primary stenting was undertaken in nine arteries (stent-group). Stent-related complications were defined as: in-stent restenosis > 50% (ISR); stent fracture; under-expansion; or migration. RESULTS In the PTRA-group, the initial restenosis rate was 50.8%. A second procedure was then performed in 22 arteries: re-PTRA (12 arteries) or stenting (10 arteries). The incidence of recurrent restenosis after re-PTRA was 41.7%. Complications occurred in seven of 10 (70%) arteries secondarily treated by stenting: two with under-expansion and five with ISR. In the stent-group, stent under-expansion occurred in one case (11.1%) and ISR in three of nine stents (33.3%). In combined analysis of stented arteries, either primarily or secondarily, stent-related complications occurred in 11/19 stenting procedures (57.9%): three due to under-expansion and eight due to ISRs. Finally, despite several revascularization attempts, four of 19 (21%) stented arteries were totally occluded and one was significantly stenosed at follow-up imaging. CONCLUSION Our study indicates that renal stenting in FMD-RAS may carry a high risk of late complications, including stent occlusion. Further observational data from large-scale registries are required.
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Affiliation(s)
- Jacek Kądziela
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland
| | | | - Marco Pappaccogli
- Division of Cardiology, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
- Department of Medical Sciences, Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, Turin, Italy
| | - Patricia van der Niepen
- Department of Nephrology and Hypertension, Universitair Ziekenhuis Brussel (VUB), Brussels, Belgium
| | - Aleksander Prejbisz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| | - Piotr Dobrowolski
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| | - Ilona Michałowska
- Department of Radiology, National Institute of Cardiology, Warsaw, Poland
| | - Paulina Talarowska
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| | | | - Łukasz Stryczyński
- Department of Hypertension, Angiology and Internal Medicine, Poznan University of Medical Sciences, Poznań, Poland
| | - Jan Krekora
- Department of Cardiology, Medical University of Łódź, Łódź, Poland
| | - Piotr Andziak
- 2nd Second Department of Vascular Surgery and Angiology, Centre of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Internal Affairs, Warsaw, Poland
| | | | - Rafał Maciąg
- 2nd Department of Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Ignacy Sterliński
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
- Medical University of Warsaw, Warsaw, Poland
| | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland
| | - Andrzej Januszewicz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| | - David Adlam
- Department of Cardiovascular Sciences and Leicester NIHR Biomedical Research Centre, Glenfield Hospital, Leicester University, Leicester, UK
| | | | - Alexandre Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
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Aboyans V, Ricco JB, Bartelink MLEL, Björck M, Brodmann M, Cohnert T, Collet JP, Czerny M, De Carlo M, Debus S, Espinola-Klein C, Kahan T, Kownator S, Mazzolai L, Naylor AR, Roffi M, Röther J, Sprynger M, Tendera M, Tepe G, Venermo M, Vlachopoulos C, Desormais I. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteriesEndorsed by: the European Stroke Organization (ESO)The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J 2019; 39:763-816. [PMID: 28886620 DOI: 10.1093/eurheartj/ehx095] [Citation(s) in RCA: 1973] [Impact Index Per Article: 394.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Surgical Renovascular Reconstruction for Renal Artery Stenosis and Aneurysm: Long-Term Durability and Survival. Eur J Vasc Endovasc Surg 2019; 57:562-568. [DOI: 10.1016/j.ejvs.2018.09.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 09/11/2018] [Indexed: 12/11/2022]
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Editor's Choice - 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2017; 55:305-368. [PMID: 28851596 DOI: 10.1016/j.ejvs.2017.07.018] [Citation(s) in RCA: 662] [Impact Index Per Article: 94.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Somalanka S, Harris FE, Chemla E, Suckling RJ, Swift PA. Spleno-renal artery transposition in a solitary functioning kidney for treatment-resistant hypertension and acute kidney injury. BMJ Case Rep 2017; 2017:bcr-2017-220438. [PMID: 28814591 DOI: 10.1136/bcr-2017-220438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Renal Artery Stenosis (RAS) is an important cause of treatment-resistant hypertension. Uncontrolled hypertension with RAS can cause progressive chronic kidney disease (CKD) leading to end-stage kidney disease. Therapeutic revascularisation can be helpful in appropriate circumstances where pharmaceutical intervention has failed and significant renovascular disease contributes to resistant hypertension. We present an interesting case of a Caucasian male with peripheral vasculopathy, abdominal aortic aneurysm (AAA), single functioning kidney and ostial RAS caused by stent struts from an endovascular AAA stent graft. He had escalating medications requirement, with repeated failed attempts at percutaneous radiological intervention that led to an episode of contrast-induced acute kidney injury (AKI), before undergoing successful surgical revascularisation by a splenic artery transposition graft to the left renal artery that was performed to improve kidney function and the blood pressure. This report highlights the challenges faced with regard to the management of severe hypertension and progressive CKD.
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Affiliation(s)
- Subash Somalanka
- Department of Nephrology, South West Thames Renal & Transplantation Unit, St Helier Hospital, Carshalton, UK
| | - Fiona E Harris
- Department of Nephrology, South West Thames Renal & Transplantation Unit, St Helier Hospital, Carshalton, UK
| | - Eric Chemla
- Department of Vascular Surgery, St George's Healthcare NHS Trust, London, UK
| | - Rebecca Jo Suckling
- Department of Nephrology, South West Thames Renal & Transplantation Unit, St Helier Hospital, Carshalton, UK
| | - Pauline A Swift
- Department of Nephrology, South West Thames Renal & Transplantation Unit, St Helier Hospital, Carshalton, UK
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Karanikola E, Karaolanis G, Galyfos G, Barbaressos E, Palla V, Filis K. Endovascular Management of Atherosclerotic Renal Artery Stenosis: Post-Cardiovascular Outcomes in Renal Atherosclerotic Lesions Era Winner or False Alarm? Vasc Specialist Int 2017; 33:1-15. [PMID: 28377906 PMCID: PMC5374954 DOI: 10.5758/vsi.2017.33.1.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 01/10/2017] [Accepted: 01/10/2017] [Indexed: 12/25/2022] Open
Abstract
Renal artery stenosis (RAS) is frequently associated with severe comorbidities such as reduced renal perfusion, hypertension, and end-stage renal failure. In approximately 90% of patients, renal artery atherosclerosis is the main cause for RAS, and it is associated with an increased risk for fatal and non-fatal cardiovascular and renal complications. Endovascular management of atherosclerotic RAS (ARAS) has been recently evaluated by several randomized controlled trials that failed to demonstrate benefit of stenting. Furthermore, the Cardiovascular Outcomes in Renal Atherosclerotic Lesions study did not demonstrate any benefit over the revascularization approach. In this review, we summarized the available data from retrospective, prospective and randomized trials on ARAS to provide clinicians with sufficient data in order to produce useful conclusions for everyday clinical practice.
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Affiliation(s)
- Evridiki Karanikola
- Division of Vascular Surgery, 1st Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration General Hospital, Athens, Greece
| | - Georgios Karaolanis
- Vascular Surgery Unit, 1st Department of Surgery, University of Athens Medical School, Laikon General Hospital, Athens, Greece
| | - George Galyfos
- Division of Vascular Surgery, 1st Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration General Hospital, Athens, Greece
| | - Emmanuel Barbaressos
- Division of Vascular Surgery, 1st Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration General Hospital, Athens, Greece
| | - Viktoria Palla
- Vascular Surgery Unit, 1st Department of Surgery, University of Athens Medical School, Laikon General Hospital, Athens, Greece
| | - Konstantinos Filis
- Division of Vascular Surgery, 1st Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration General Hospital, Athens, Greece
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The Diagnosis and Treatment of Fibromuscular Dysplasia: An Update for Cardiologists. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2016; 18:37. [DOI: 10.1007/s11936-016-0460-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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He Y, Xu Z, Fu H, Chen B, Wang S, Chen B, Zhou M, Cai Y. Combined Microencapsulated Islet Transplantation and Revascularization of Aortorenal Bypass in a Diabetic Nephropathy Rat Model. J Diabetes Res 2016; 2016:9706321. [PMID: 27119088 PMCID: PMC4826923 DOI: 10.1155/2016/9706321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 03/08/2016] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Revascularization of aortorenal bypass is a preferred technique for renal artery stenosis (RAS) in diabetic nephropathy (DN) patients. Restenosis of graft vessels also should be considered in patients lacking good control of blood glucose. In this study, we explored a combined strategy to prevent the recurrence of RAS in the DN rat model. METHODS A model of DN was established by intraperitoneal injection of streptozotocin. Rats were divided into 4 groups: SR group, MIT group, Com group, and the untreated group. The levels of blood glucose and urine protein were measured, and changes in renal pathology were observed. The expression of monocyte chemoattractant protein-1 (MCP-1) in graft vessels was assessed by immunohistochemical staining. Histopathological staining was performed to assess the pathological changes of glomeruli and tubules. RESULTS The levels of urine protein and the expression of MCP-1 in graft vessels were decreased after islet transplantation. The injury of glomerular basement membrane and podocytes was significantly ameliorated. CONCLUSIONS The combined strategy of revascularization and microencapsulated islet transplantation had multiple protective effects on diabetic nephropathy, including preventing atherosclerosis in the graft vessels and alleviating injury to the glomerular filtration barrier. This combined strategy may be helpful for DN patients with RAS.
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Affiliation(s)
- Yunqiang He
- Zhejiang Provincial Top Key Discipline in Surgery, Wenzhou Key Laboratory of Surgery, Department of Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Ziqiang Xu
- Department of Transplantation, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Hongxing Fu
- School of Pharmacy, Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Bin Chen
- Department of B-Mode Ultrasound, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Silu Wang
- Zhejiang Provincial Top Key Discipline in Surgery, Wenzhou Key Laboratory of Surgery, Department of Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Bicheng Chen
- Zhejiang Provincial Top Key Discipline in Surgery, Wenzhou Key Laboratory of Surgery, Department of Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Mengtao Zhou
- Zhejiang Provincial Top Key Discipline in Surgery, Wenzhou Key Laboratory of Surgery, Department of Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
- *Mengtao Zhou: and
| | - Yong Cai
- Department of Transplantation, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
- *Yong Cai:
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Inferior Mesenteric to Renal Artery Transposition for Revascularization of a Solitary Functioning Kidney. Ann Vasc Surg 2015; 29:1321.e5-8. [DOI: 10.1016/j.avsg.2015.03.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 03/12/2015] [Indexed: 11/18/2022]
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Barth U, Meyer F, Halloul Z. Aortorenaler Prothesenbypass bei drohender Dialyse und Hypertension. GEFÄSSCHIRURGIE 2013; 18:35-40. [DOI: 10.1007/s00772-012-1080-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Rump LC, Sellin L. [Medicinal or instrumental (corrected) therapy of renal artery stenosis?]. Internist (Berl) 2012; 53:760-5. [PMID: 22450771 DOI: 10.1007/s00108-012-3038-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Arteriosclerotic renal artery stenosis (RAS) has an increased incidence in patients with cardiovascular risk factors. Clinically RAS presents in some patients as secondary, sometimes resistant arterial hypertension and in others as chronic renal insufficiency, sometimes with acute renal failure and in a third group both symptoms are observed. Doppler ultrasound plays a central role in the diagnosis of RAS. Therapeutically, it is important to identify hemodynamically relevant RAS before interventional therapy is initiated. The therapy of RAS has been under intensive debate since the publication of randomized controlled trials (RCT) which showed that only a subset of RAS can be successfully treated by interventional therapy. Since then the medicinal therapy of RAS has gained more and more impact. The following questions are raised: which forms of RAS can be treated by which therapy? What is the best medicinal therapy to treat RAS? What substances are recommended?
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Affiliation(s)
- L C Rump
- Klinik für Nephrologie, Universitätsklinikum Düsseldorf, Moorenstrasse 5, Düsseldorf, Germany.
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