State-of-the-Art Paper
Refining the Approach to Renal Artery Revascularization

https://doi.org/10.1016/j.jcin.2008.10.014Get rights and content
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Renal artery stenosis (RAS) is caused by a heterogenous group of diseases with different pathophysiology, clinical manifestations, treatment approaches, and outcomes. The 2 most common forms of RAS are fibromuscular dysplasia (FMD) and atherosclerosis (ARAS). Renovascular syndromes are broadly classified into renovascular hypertension and ischemic nephropathy, but these terms are misleading, because they imply a causal relationship between RAS, hypertension, and renal dysfunction, which is difficult to prove in humans. Data supporting renal revascularization are limited by heterogeneous causes of hypertension and renal dysfunction, insufficient understanding of the relationship between RAS and nephropathy, inconsistent techniques for revascularization, ambiguous terminology and end points to assess benefit, and lack of large-scale randomized trials. The purpose of this review is to enhance understanding of the epidemiology, clinical markers, and diagnosis of RAS; the relationship between RAS and important disease states; the distinction between renal ischemia and nephropathy; optimal revascularization techniques; and avoidance of renal injury.

Key Words

renal angioplasty and stenting
renal artery stenosis

Abbreviations and Acronyms

ACC
American College of Cardiology
AHA
American Heart Association
ARAS
atherosclerotic renal artery stenosis
CTA
computerized tomography angiography
FMD
fibromuscular dysplasia
GFR
glomerular filtration rate
MRA
magnetic resonance angiography
RAS
renal artery stenosis
RRI
renal resistive index
TLG
translesional pressure gradient
99MTc-DTPA
technetium-labeled pentetic acid

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