Renal artery stenosis surgery: Difference between revisions

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/* Surgery for 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, White J, White RA, A...
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__NOTOC__
__NOTOC__
{{Renal artery stenosis}}
{{Renal artery stenosis}}
{{CMG}}; {{AE}} {{VVS}}
{{CMG}}; '''Associate Editor-In-Chief:''' {{Shivam Singla}}


==Overview==
==Overview==
While [[balloon angioplasty]] and [[surgery]] are associated with equal rates of improving renal function and [[hypertension]] in patients with [[renal artery stenosis]] (RAS), the higher rate of post-operative complications associated with the [[vascular]] surgical reconstruction makes [[angioplasty]] the preferred first-line treatment of [[RAS]] among [[patients]] requiring intervention. Vascular surgical reconstruction is reserved for a minority of cases.  The need for surgical reoperation is 5-15%.


==Surgery==
==Surgery==
If Renal artery stenosis (RAS) advances until the artery is nearly or completely blocked, the patient may need surgery to open up the flow of blood to the kidney. Different types of surgery for RAS include the following:
[[Vascular]] [[surgical]] [[reconstruction]] is reserved for a minority of cases. Similar to all surgeries, vascular [[surgical]] reconstruction is associated with complications. The need for reoperation is documented in 5-15% of all [[Renal artery stenosis]] patients who require [[surgical]] [[intervention]].<ref name="pmid3051450">{{cite journal| author=Novick AC| title=Surgical correction of renovascular hypertension. | journal=Surg Clin North Am | year= 1988 | volume= 68 | issue= 5 | pages= 1007-25 | pmid=3051450 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3051450 }} </ref><ref name="pmid8028093">{{cite journal| author=Cambria RP, Brewster DC, L'Italien GJ, Moncure A, Darling RC, Gertler JP et al.| title=The durability of different reconstructive techniques for [[atherosclerotic]] [[renal artery disease]]. | journal=J Vasc Surg | year= 1994 | volume= 20 | issue= 1 | pages= 76-85; discussion 86-7 | pmid=8028093 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8028093 }} </ref><ref name="pmid3795433">{{cite journal| author=Novick AC, Ziegelbaum M, Vidt DG, Gifford RW, Pohl MA, Goormastic M| title=Trends in surgical revascularization for renal artery disease. Ten years' experience. | journal=JAMA | year= 1987 | volume= 257 | issue= 4 | pages= 498-501 | pmid=3795433 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3795433 }} </ref><ref name="pmid1593670">{{cite journal| author=Libertino JA, Bosco PJ, Ying CY, Breslin DJ, Woods BO, Tsapatsaris NP et al.| title=Renal revascularization to preserve and restore renal function. | journal=J Urol | year= 1992 | volume= 147 | issue= 6 | pages= 1485-7 | pmid=1593670 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1593670 }} </ref><ref name="pmid7776472">{{cite journal| author=Clair DG, Belkin M, Whittemore AD, Mannick JA, Donaldson MC| title=Safety and efficacy of transaortic renal endarterectomy as an adjunct to aortic surgery. | journal=J Vasc Surg | year= 1995 | volume= 21 | issue= 6 | pages= 926-33; discussion 934 | pmid=7776472 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7776472 }} </ref>


===Endarterectomy===
===Indications===
In an [[endarterectomy]], a vascular surgeon removes the plaque.
[[Vascular]] [[surgical]] [[reconstruction]] is indicated in specific cases of [[atherosclerotic]] [[RAS]]<ref name="pmid3051450">{{cite journal| author=Novick AC| title=Surgical correction of renovascular hypertension. | journal=Surg Clin North Am | year= 1988 | volume= 68 | issue= 5 | pages= 1007-25 | pmid=3051450 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3051450 }} </ref><ref name="pmid8028093">{{cite journal| author=Cambria RP, Brewster DC, L'Italien GJ, Moncure A, Darling RC, Gertler JP et al.| title=The durability of different reconstructive techniques for atherosclerotic renal artery disease. | journal=J Vasc Surg | year= 1994 | volume= 20 | issue= 1 | pages= 76-85; discussion 86-7 | pmid=8028093 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8028093 }} </ref><ref name="pmid3795433">{{cite journal| author=Novick AC, Ziegelbaum M, Vidt DG, Gifford RW, Pohl MA, Goormastic M| title=Trends in surgical revascularization for renal artery disease. Ten years' experience. | journal=JAMA | year= 1987 | volume= 257 | issue= 4 | pages= 498-501 | pmid=3795433 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3795433 }} </ref><ref name="pmid1593670">{{cite journal| author=Libertino JA, Bosco PJ, Ying CY, Breslin DJ, Woods BO, Tsapatsaris NP et al.| title=Renal revascularization to preserve and restore renal function. | journal=J Urol | year= 1992 | volume= 147 | issue= 6 | pages= 1485-7 | pmid=1593670 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1593670 }} </ref><ref name="pmid7776472">{{cite journal| author=Clair DG, Belkin M, Whittemore AD, Mannick JA, Donaldson MC| title=Safety and efficacy of transaortic renal endarterectomy as an adjunct to aortic surgery. | journal=J Vasc Surg | year= 1995 | volume= 21 | issue= 6 | pages= 926-33; discussion 934 | pmid=7776472 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7776472 }} </ref>:


===Bypass surgery===
*Involvement of multiple [[small arteries]]
To create a bypass, a vascular surgeon uses a vein or synthetic tube to connect the kidney to the aorta. This new path serves as an alternate route for blood to flow around the blocked artery into the kidney.
*Involvement of early primary branching of the main [[renal artery]]
*[[Renal artery]] reconstruction during [[pararenal]] [[aortic reconstruction]] in cases such as [[aortic aneurysms]] or aortoiliac occlusive disease


==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>==
===Risk Factors===
===Surgery (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>===
The risk of complications associated with [[renal artery]] [[reconstruction]] [[increases]] in the following conditions:<ref name="pmid3051450">{{cite journal| author=Novick AC| title=Surgical correction of renovascular hypertension. | journal=Surg Clin North Am | year= 1988 | volume= 68 | issue= 5 | pages= 1007-25 | pmid=3051450 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3051450 }} </ref><ref name="pmid8028093">{{cite journal| author=Cambria RP, Brewster DC, L'Italien GJ, Moncure A, Darling RC, Gertler JP et al.| title=The durability of different reconstructive techniques for atherosclerotic renal artery disease. | journal=J Vasc Surg | year= 1994 | volume= 20 | issue= 1 | pages= 76-85; discussion 86-7 | pmid=8028093 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8028093 }} </ref><ref name="pmid3795433">{{cite journal| author=Novick AC, Ziegelbaum M, Vidt DG, Gifford RW, Pohl MA, Goormastic M| title=Trends in surgical revascularization for renal artery disease. Ten years' experience. | journal=JAMA | year= 1987 | volume= 257 | issue= 4 | pages= 498-501 | pmid=3795433 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3795433 }} </ref><ref name="pmid1593670">{{cite journal| author=Libertino JA, Bosco PJ, Ying CY, Breslin DJ, Woods BO, Tsapatsaris NP et al.| title=Renal revascularization to preserve and restore renal function. | journal=J Urol | year= 1992 | volume= 147 | issue= 6 | pages= 1485-7 | pmid=1593670 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1593670 }} </ref><ref name="pmid7776472">{{cite journal| author=Clair DG, Belkin M, Whittemore AD, Mannick JA, Donaldson MC| title=Safety and efficacy of transaortic renal endarterectomy as an adjunct to aortic surgery. | journal=J Vasc Surg | year= 1995 | volume= 21 | issue= 6 | pages= 926-33; discussion 934 | pmid=7776472 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7776472 }} </ref>:


{|class="wikitable"
*Concomitant aortic reconstruction
|-
*[[Renal insufficiency]]
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA Guidelines Classification Scheme#Classification of Recommendations|Class I]]
*Use of aortic grafts as bypass graft


|-
==Management of Patients With [[Peripheral]] [[Artery]] [[Disease]] (Compilation of 2005 and 2011 ACCF/AHA Guideline Recommendations) : A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines<ref name="pmid23473760">{{cite journal| author=Rooke TW, Hirsch AT, Misra S, Sidawy AN, Beckman JA, Findeiss L et al.| title=Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA Guideline Recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2013 | volume= 61 | issue= 14 | pages= 1555-70 | pmid=23473760 | doi=10.1016/j.jacc.2013.01.004 | pmc=4492473 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23473760  }} </ref>==
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Vascular surgical reconstruction is indicated for patients with [[Fibromuscular dysplasia|fibromuscular dysplastic RAS]] with clinical indications for interventions (same as for PTA), especially those exhibiting complex disease that extends into the segmental arteries and those having macroaneurysms. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
{| class="wikitable"
|+
!Class I               
!<nowiki>"</nowiki>'''1.''' Vascular surgical reconstruction is indicated for patients with [[Fibromuscular dysplasia|fibromuscular dysplastic RAS]] with clinical indications for interventions (same as for PTA), especially those exhibiting complex disease that extends into the segmental arteries and those having macroaneurysms. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
 
 
<nowiki>"</nowiki>'''2.''' Vascular surgical reconstruction is indicated for patients with atherosclerotic RAS and clinical indications for intervention, especially those with multiple small [[renal arteries]] or early primary branching of the main renal artery. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
 
 
<nowiki>"</nowiki>'''3.''' Vascular surgical reconstruction is indicated for patients with atherosclerotic RAS in combination with pararenal aortic reconstructions (in treatment of aortic aneurysms or severe [[aortoiliac occlusive disease]]). ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>


|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Vascular surgical reconstruction is indicated for patients with atherosclerotic RAS and clinical indications for intervention, especially those with multiple small [[renal arteries]] or early primary branching of the main renal artery. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>


|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' Vascular surgical reconstruction is indicated for patients with atherosclerotic RAS in combination with pararenal aortic reconstructions (in treatment of aortic aneurysms or severe [[aortoiliac occlusive disease]]). ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
|}
 
<br />
==References==
==References==


Latest revision as of 23:42, 15 December 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Shivam Singla, M.D.[2]

Overview

While balloon angioplasty and surgery are associated with equal rates of improving renal function and hypertension in patients with renal artery stenosis (RAS), the higher rate of post-operative complications associated with the vascular surgical reconstruction makes angioplasty the preferred first-line treatment of RAS among patients requiring intervention. Vascular surgical reconstruction is reserved for a minority of cases. The need for surgical reoperation is 5-15%.

Surgery

Vascular surgical reconstruction is reserved for a minority of cases. Similar to all surgeries, vascular surgical reconstruction is associated with complications. The need for reoperation is documented in 5-15% of all Renal artery stenosis patients who require surgical intervention.[1][2][3][4][5]

Indications

Vascular surgical reconstruction is indicated in specific cases of atherosclerotic RAS[1][2][3][4][5]:

Risk Factors

The risk of complications associated with renal artery reconstruction increases in the following conditions:[1][2][3][4][5]:

Management of Patients With Peripheral Artery Disease (Compilation of 2005 and 2011 ACCF/AHA Guideline Recommendations) : A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[6]

Class I "1. Vascular surgical reconstruction is indicated for patients with fibromuscular dysplastic RAS with clinical indications for interventions (same as for PTA), especially those exhibiting complex disease that extends into the segmental arteries and those having macroaneurysms. (Level of Evidence: B)"


"2. Vascular surgical reconstruction is indicated for patients with atherosclerotic RAS and clinical indications for intervention, especially those with multiple small renal arteries or early primary branching of the main renal artery. (Level of Evidence: B)"


"3. Vascular surgical reconstruction is indicated for patients with atherosclerotic RAS in combination with pararenal aortic reconstructions (in treatment of aortic aneurysms or severe aortoiliac occlusive disease). (Level of Evidence: C)"



References

  1. ↑ 1.0 1.1 1.2 Novick AC (1988). "Surgical correction of renovascular hypertension". Surg Clin North Am. 68 (5): 1007–25. PMID 3051450.
  2. ↑ 2.0 2.1 2.2 Cambria RP, Brewster DC, L'Italien GJ, Moncure A, Darling RC, Gertler JP; et al. (1994). "The durability of different reconstructive techniques for [[atherosclerotic]] [[renal artery disease]]". J Vasc Surg. 20 (1): 76–85, discussion 86-7. PMID 8028093. URL–wikilink conflict (help)
  3. ↑ 3.0 3.1 3.2 Novick AC, Ziegelbaum M, Vidt DG, Gifford RW, Pohl MA, Goormastic M (1987). "Trends in surgical revascularization for renal artery disease. Ten years' experience". JAMA. 257 (4): 498–501. PMID 3795433.
  4. ↑ 4.0 4.1 4.2 Libertino JA, Bosco PJ, Ying CY, Breslin DJ, Woods BO, Tsapatsaris NP; et al. (1992). "Renal revascularization to preserve and restore renal function". J Urol. 147 (6): 1485–7. PMID 1593670.
  5. ↑ 5.0 5.1 5.2 Clair DG, Belkin M, Whittemore AD, Mannick JA, Donaldson MC (1995). "Safety and efficacy of transaortic renal endarterectomy as an adjunct to aortic surgery". J Vasc Surg. 21 (6): 926–33, discussion 934. PMID 7776472.
  6. ↑ Rooke TW, Hirsch AT, Misra S, Sidawy AN, Beckman JA, Findeiss L; et al. (2013). "Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA Guideline Recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". J Am Coll Cardiol. 61 (14): 1555–70. doi:10.1016/j.jacc.2013.01.004. PMC 4492473. PMID 23473760.

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