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Goodman J, Kulkarni S, Selvarajah V, Hilliard N, Russell N, Wilkinson IB. Renal Autotransplantation for Uncontrolled Hypertension in Nonatherosclerotic Renal Artery Stenosis-2 Case Reports and a Brief Review of the Literature. Hypertension 2024; 81:669-675. [PMID: 38507507 DOI: 10.1161/hypertensionaha.123.19878] [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: 03/22/2024]
Abstract
Fibromuscular dysplasia is the most common cause of renovascular hypertension in young adults under 40 years old. It is potentially amenable to renal artery angioplasty, which frequently normalizes blood pressure. However, limited options exist if angioplasty is not technically possible, or restenosis occurs. Here, we describe 2 patients who presented with hypertension secondary to renal artery stenosis. In the first case, a young adult with hypertension secondary to renal artery stenosis (fibromuscular dysplasia), developed restenosis 11 weeks after an initially successful renal artery angioplasty. In the second case, a patient with neurofibromatosis type 1 was diagnosed with hypertension secondary to renal artery stenosis. Angioplasty was not possible due to multiple branch occlusions. Both individuals went on to have successful renal autotransplantations, which ultimately cured their hypertension. In this article, we review the background, indications, and blood pressure outcomes in relation to renal autotransplantation in nonatherosclerotic renal artery stenosis.
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Affiliation(s)
- James Goodman
- Department of Clinical Pharmacology and Therapeutics (J.G., S.K., V.S., I.B.W.), Cambridge University Hospitals NHS Foundation Trust, United Kingdom
| | - Spoorthy Kulkarni
- Department of Clinical Pharmacology and Therapeutics (J.G., S.K., V.S., I.B.W.), Cambridge University Hospitals NHS Foundation Trust, United Kingdom
- Department of Medicine, Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (S.K., I.B.W.)
| | - Viknesh Selvarajah
- Department of Clinical Pharmacology and Therapeutics (J.G., S.K., V.S., I.B.W.), Cambridge University Hospitals NHS Foundation Trust, United Kingdom
| | - Nicholas Hilliard
- Department of Radiology (N.H.), Cambridge University Hospitals NHS Foundation Trust, United Kingdom
| | - Neil Russell
- Department of Transplant Surgery (N.R.), Cambridge University Hospitals NHS Foundation Trust, United Kingdom
| | - Ian B Wilkinson
- Department of Clinical Pharmacology and Therapeutics (J.G., S.K., V.S., I.B.W.), Cambridge University Hospitals NHS Foundation Trust, United Kingdom
- Department of Medicine, Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (S.K., I.B.W.)
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Feyen L, Artzner C, Paprottka P, Haage P, Kröger K, Alhmid B, Katoh M. Endovascular treatment of renal artery stenosis in Germany: a retrospective analysis of the DEGIR registry 2018-2021. ROFO-FORTSCHR RONTG 2024; 196:283-291. [PMID: 37995733 DOI: 10.1055/a-2193-1209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
PURPOSE To provide an overview of endovascular treatment of renal artery stenosis (RAS) using the data of the Deutsche Gesellschaft für interventionelle Radiologie (DeGIR) quality management system. MATERIALS AND METHODS A retrospective analysis was performed. Pre-, peri- and postprocedural data, technical success rates, complication rates, and clinical success rates at dismissal were examined. RESULTS Between 2018 and 2021, 2134 angiography examinations of the renal arteries were performed: diagnostic angiography in 70 patients (3 %), balloon angioplasty in 795 (37 %), stent implantation in 1166 (55 %) and miscellaneous procedures in 103 (5 %). The lesion length was less than or equal to 5 mm in 1837 patients (87 %), between 5 and 10 mm in 197 (9 %), and between 10 and 20 mm in 62 (3 %). The degree of stenosis was less than 50 % in 156 patients (7 %), greater than 50 % in 239 (11 %), and greater than 70 % in 1472 (70 %). Occlusion was treated in 235 patients (11 %). Symptoms at discharge resolved in 600 patients (29 %), improved in 1012 (49 %), were unchanged in 77 (4 %), and worsened in 5 (0.2 %). Complications were reported in 51 patients (2.5 %) and the mortality rate was 0.15 %. CONCLUSION A substantial number of patients with RAS and occlusions were treated by radiologists in Germany, with high technical success rates and low complication rates. The indication should be determined carefully as the current European guidelines for the treatment of RAS suggest that only carefully selected groups of patients will benefit from recanalizing treatment. KEY POINTS · Carefully selected patient groups may benefit from endovascular treatment of renal artery stenosis.. · Analysis of the DEGIR quality management database shows that treatment of renal artery stenosis was performed by radiologists in Germany with high technical success rates and low complication rates.. · Recanalization even led to symptom improvement in a large proportion of patients with occlusions..
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Affiliation(s)
- Ludger Feyen
- Department of Diagnostic and Interventional Radiology, HELIOS Hospital Krefeld, Germany
- School of Medicine, University Witten Herdecke Faculty of Health, Witten, Germany
- Department of Diagnostic and Interventional Radiology, HELIOS University Hospital Wuppertal, Germany
| | - Christoph Artzner
- Department of Diagnostic and Interventional Radiology, University Hospitals Tubingen, Tübingen, Germany
| | - Philipp Paprottka
- Department of Diagnostic and Interventional Radiology, Technical University of Munich Hospital Rechts der Isar, München, Germany
| | - Patrick Haage
- Department of Diagnostic and Interventional Radiology, HELIOS University Hospital Wuppertal, Germany
- School of Medicine, University Witten Herdecke Faculty of Health, Witten, Germany
| | - Knut Kröger
- Department of Angiology, HELIOS Hospital Krefeld, Germany
| | - Bachar Alhmid
- Department of Angiology, HELIOS Hospital Krefeld, Germany
| | - Marcus Katoh
- Department of Diagnostic and Interventional Radiology, HELIOS Hospital Krefeld, Germany
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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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