Use of registries to complement clinical trials in renal artery stenting

Renal Artery Revascularization a controversial treatment strategy for Renal Artery Stenosis. A case series and a brief review of current literature

Renal artery stenosis (RAS) may cause secondary hypertension, progressive decline in renal function, and cardiac destabilization syndromes including "flash" pulmonary edema, recurrent congestive heart failure, and cerebro-cardiovascular disease. Atherosclerotic lesions, fibromuscular dysplasia and vasculitides are the pathophysiologic basis of the disease. Common therapeutic pathways for RAS include medical therapy and revascularization with or without stenting. Randomized controlled trials evaluating renal revascularization, did not report any advantage of revascularization over medical therapy alone in terms of renal function improvement or prevention of cardiovascular events. However, mounting clinical experience suggests that the best strategy in RAS management is identifying which patients are most likely to benefit from renal artery stenting and also optimizing the safety and durability of the procedure. This review presents 3 cases of patients who undergone renal revascularization and discusses the available clinical evidence for identification of RAS patients who will potentially respond well to revascularization.

A European venous registry: pitfalls and opportunities

Introduction:

Evidence based medicine is not the ideal way to assess and evaluate treatment success, failure and outcomes. Modern technology makes it possible to register a multitude of information. Advances in the venous field are fast and require a more efficient way to allow selection based on outcomes and quality. Registries are theoretically contain the data needed to investigate venous treatments and instruments.

Materials and methods:

A literature review was performed and twenty-five articles were selected for review.

Results:

Current registries fail to perform as needed and do not deliver the needed information. Separate frameworks and applications are available, but up until now no centralized and combined effort has been made to create a true all encompassing European venous registry.

Conclusions:

A European venous registry containing standardized variables regarding all aspects of venous disease is needed to truly investigate and improve our care. An intuitive and integrated EHR application can facilitate the gathering of data needed to create such a registry. A number of rules apply though.