RAS Epidemiology. Renal Artery Stenosis. Pathophysiology of RAS. Disclosure of Potential Conflicts. Background Pathophysiology of RAS.

Size: px
Start display at page:

Download "RAS Epidemiology. Renal Artery Stenosis. Pathophysiology of RAS. Disclosure of Potential Conflicts. Background Pathophysiology of RAS."

Transcription

1 Renal Artery Stenosis RAS Epidemiology Common Disease Incidence General Population 0.1% Hypertensive Population 4% HTN & Suspected CAD 10-20% Malignant HTN 20-30% Malignant HTN and CKD 30-40% Alexander S. Yevzlin, MD Associate Professor of Medicine (CHS) ASDIN 2012 Prevalence increases with age: 7% over 65 years old Disclosure of Potential Conflicts Pathophysiology of RAS Cytopherx, Inc. R4 Vascular, Inc. Bard Peripheral Vascular Courtesy of V. Chhokar Background Road Map Defining the Controversy The Nephrologists Perspective A More Selective Approach Background Pathophysiology of RAS Other actions of angiotensin II (Ang II) promote pressor mechanisms, vascular remodeling, cardiac dysfunction, and tissue fibrosis. 1

2 Background Progression of Disease RAS > 50% Ischemic Nephropathy (no fibrosis resulting from hemodynamic changes) Ischemic Nephropathy RAS > 50% (small vessel disease) It is almost certain that many, if not most, patients now being subjected to endovascular stenting of the renal arteries have only limited benefit, regarding either BP response or improvement in kidney function. * * Levin a, Linas SL, Luft FC, Chapman AB, Textor SC: Controversies in renal artery stenosis: A review by the American Society of Nephrology Advisory Group on Hypertension. Am J Nephrol 27 : , The Controversy RAS Interventions Why Are Nephrologists Averse to Nephrologists have moved toward a more conservative clinical stance in recent years, perhaps as a pragmatic counterweight to enthusiastic interventional specialties. * The largest portion of this increase derives from procedures undertaken by cardiologists.* * Levin a, Linas SL, Luft FC, Chapman AB, Textor SC: Controversies in renal artery stenosis: A review by the American Society of Nephrology Advisory Group on Hypertension. Am J Nephrol 27 : , 2007 * Murphy TP, Soares G, Kim M: Increase in utilization of percutaneous renal artery interventions by Medicare beneficiaries Am J Roentgenol 183 : , 2004 The Controversy Several large randomized controlled trials (RCTs) have evaluated medical therapy versus PTRAS. The results of the STAR study showed no difference in progression of renal failure in patients with impaired renal function. This has been confirmed by the results of the ASTRAL study. Bax L, Woittiez AJ, Kouwenberg HJ, Mali WP, Buskens E, Beek FJ, et al. Stent placement in patients with atherosclerotic renal artery stenosis and impaired renal function: a randomized trial. Ann Intern Med 2009; 150: ; W Schwarzwalder U, Hauk M, Zeller T. RADAR: a randomised, multicentre, prospective study comparing best medical treatment versus best medical treatment plus renal artery stenting in patients with haemodynamically relevant atherosclerotic renal artery stenosis. Trials 2009; 10:60. Wheatley K, Ives N, Gray R, Kalra PA, Moss JG, Baigent C, et al. Revascularization versus medical therapy for renal-artery stenosis. N Engl J Med 2009; 361:

3 A possible explanation for the recent RAS clinical trial findings is that these studies included patients who had little chance to improve anyway. Fifteen years experience of treating Atherosclerotic Renal Artery Stenosis by Interventional Nephrologists in India Overall, the observational study by Hegde et al witnessed improvement in renal function in 10% and stabilization in 60% of the subjects. Estimated glomerular filtration rate (egfr) improved significantly in bilateral RAS, and egfr improved or stabilized in % of the subjects. The authors noted a > 90% technical success rate.how do these findings compare to existing observational studies? It is important to mention that such studies have reported mixed results vis-à-vis renal function. Why Are Nephrologists Averse to New Algorithm A recognized drawback of clinical treatment trials is the intermixture of high-risk and low-risk patients into the "average" of the entire cohort.* A definition of the RF associated with good and bad outcomes is necessary. * Kent D, Hayward R: When averages hide individual differences in clinical trials. Am Sci 95 : 60 68, 2007 Risk Factors for Outcomes Pre-intervention GFR Initial size of the treated kidney Vascular resistive index Patient age Lateralization to the affected kidney Otcomes Zeller T, Muller C, Frank U, Burgelin K, Horn B, Schwarzwalder U, et al. Stent angioplasty of severe atherosclerotic ostial renal artery stenosis in patients with diabetes mellitus and nephrosclerosis. Catheter Cardiovasc Interv 2003; 58: Radermacher J, Chavan A, Bleck J, Vitzthum A, Stoess B, Gebel MJ, et al. Use of Doppler ultrasonography to predict the outcome of therapy for renalartery stenosis. N Engl J Med 2001; 344: Krijnen P, van Jaarsveld BC, Deinum J, Steyerberg EW, Habbema JD. Which patients with hypertension and atherosclerotic renal artery stenosis benefit from immediate intervention? J Hum Hypertens 2004; 18: van Jaarsveld BC, Krijnen P, Pieterman H, Derkx FH, Deinum J, Postma CT, et al. The effect of balloon angioplasty on hypertension in atherosclerotic renal-artery stenosis. Dutch Renal Artery Stenosis Intervention Cooperative Study Group. N Engl J Med 2000; 342:

4 2/29/2012 Outcomes 4

5 Thank you 5

Disclosure of Potential Conflicts. Renal Artery Stenosis. RAS Epidemiology. Road Map. Background. ASDIN 7th Annual Scientific Meeting

Disclosure of Potential Conflicts. Renal Artery Stenosis. RAS Epidemiology. Road Map. Background. ASDIN 7th Annual Scientific Meeting Renal Artery Stenosis Disclosure of Potential Conflicts Cytopherx, Inc. R4 Vascular, Inc. Bard Peripheral Vascular Spectranetics, Inc. Alexander S. Yevzlin, MD Associate Professor of Medicine (CHS) ASDIN

More information

Life After CORAL: What Did CORAL Prove? David Paul Slovut, MD, PhD Co-director TAVR, Dir of Advanced Intervention

Life After CORAL: What Did CORAL Prove? David Paul Slovut, MD, PhD Co-director TAVR, Dir of Advanced Intervention Life After CORAL: What Did CORAL Prove? David Paul Slovut, MD, PhD Co-director TAVR, Dir of Advanced Intervention No Relationships to Disclose The Need for Modern Renal Trials Increased rate of RAS diagnosis

More information

A Closer Look: Renal Artery Stenosis. Renal artery stenosis (RAS) is defined as a TOPICS FROM CHEP. Shawn s stenosis

A Closer Look: Renal Artery Stenosis. Renal artery stenosis (RAS) is defined as a TOPICS FROM CHEP. Shawn s stenosis TOPICS FROM CHEP A Closer Look: Renal Artery Stenosis On behalf of the Canadian Hypertension Education Program (CHEP), Dr. Tobe gives an overview of renal artery stenosis, including the prevalence, screening

More information

Renal Artery Stenting

Renal Artery Stenting Renal Artery Stenting J.P. Reilly, MD, FSCAI Ochsner Medical Center Speaker s bureau: Astra Zeneca and Lilly/Diachi Sankyo Prevalence of RAS is high in cath population. Renal artery intervention can help

More information

Atherosclerotic Renovascular Hypertension : Lessons from Recent Clinical Studies

Atherosclerotic Renovascular Hypertension : Lessons from Recent Clinical Studies Review ISSN 1738-5997 (Print) ISSN 2092-9935 (Online) Electrolyte Blood Press 8:87-91, 2010 doi: 10.5049/EBP.2010.8.2.87 Atherosclerotic Renovascular Hypertension : Lessons from Recent Clinical Studies

More information

Coral Trials: A personal experience that challenges its results in patients with uncontrolled blood pressure.

Coral Trials: A personal experience that challenges its results in patients with uncontrolled blood pressure. Coral Trials: A personal experience that challenges its results in patients with uncontrolled blood pressure.. Dr. Javier Ruiz Aburto, FACS, FICS Assistant Professor Ponce School of Medicine Puerto Rico

More information

Atherosclerotic renal artery stenosis (RAS) is a common. Original Articles

Atherosclerotic renal artery stenosis (RAS) is a common. Original Articles Original Articles Validity of Estimated Glomerular Filtration Rates for Assessment of Baseline and Serial Renal Function in Patients With Atherosclerotic Renal Artery Stenosis Implications for Clinical

More information

Endovascular treatment

Endovascular treatment 210..217 NEPHROLOGY 2010; 15, S210 S217 doi:10.1111/j.1440-1797.2009.01243.x Endovascular treatment Date written: February 2009nep_1243 Final submission: August 2009 Authors: Robert MacGinley, Subramanian

More information

Atherosclerotic renal artery stenosis and reconstruction

Atherosclerotic renal artery stenosis and reconstruction http://www.kidney-international.org & 2006 International Society of Nephrology mini review Atherosclerotic renal artery stenosis and reconstruction B Krumme 1 and J Donauer 2 1 Deutsche Klinik für Diagnostik,

More information

Renal artery stenosis, defined as a narrowing

Renal artery stenosis, defined as a narrowing IN THE LITERATURE Is There Any Reason to Stent Atherosclerotic Renal Artery Stenosis? Commentary on ASTRAL Investigators. Revascularization versus medical therapy for renal artery stenosis. N Engl J Med.

More information

Angioplasty with stent in renal artery stenosis: our experience

Angioplasty with stent in renal artery stenosis: our experience Rev Chil Radiol 2016; 22(1): 13-19. Angioplasty with stent in renal artery stenosis: our experience Johanna Marcela Vasquez Veloza *, José Luis Abades Vázquez, José Luis Cordero Castro. Interventional

More information

Renal artery stenosis (RAS) is a widely recognized

Renal artery stenosis (RAS) is a widely recognized The Renal Stenting Downturn Why are we stenting less? By George V. Moukarbel, MD, and Mark W. Burket, MD Renal artery stenosis (RAS) is a widely recognized cause of secondary hypertension, renal dysfunction,

More information

Primary stenting for atherosclerotic renal artery stenosis

Primary stenting for atherosclerotic renal artery stenosis Primary stenting for atherosclerotic renal artery stenosis Olivier Steichen, Laurence Amar, Pierre-François Plouin To cite this version: Olivier Steichen, Laurence Amar, Pierre-François Plouin. Primary

More information

Current Role of Renal Artery Stenting in Patients with Renal Artery Stenosis

Current Role of Renal Artery Stenting in Patients with Renal Artery Stenosis Current Role of Renal Artery Stenting in Patients with Renal Artery Stenosis Young-Guk Ko, M.D. Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea Etiology Fibromuscular

More information

RENAL ARTERY STENOSIS. Grand Rounds 10/11/2011

RENAL ARTERY STENOSIS. Grand Rounds 10/11/2011 RENAL ARTERY STENOSIS Grand Rounds 10/11/2011 ARAS Prevalence- 0.5% overall population, 5.5% in ckd pts No correlation between ischemic nephropathy and severity of stenosis Increased risk of vascular events-

More information

Original paper. Introduction. treatment of atherosclerotic RAS is controversial. Percutaneous

Original paper. Introduction. treatment of atherosclerotic RAS is controversial. Percutaneous Original paper Clinical outcomes and effectiveness of renal artery stenting in patients with critical atherosclerotic renal artery stenosis: does it improve blood control and renal function assessed by

More information

Predicting blood pressure response after renal artery stenting

Predicting blood pressure response after renal artery stenting From the Southern Association for Vascular Surgery Predicting blood pressure response after renal artery stenting Adam W. Beck, MD, a Brian W. Nolan, MD, a,b Randall De Martino, MD, a Theodore H. Yuo,

More information

RENAL ARTERY PTA. JH PEREGRIN IKEM, Prague

RENAL ARTERY PTA. JH PEREGRIN IKEM, Prague RENAL ARTERY PTA JH PEREGRIN IKEM, Prague PTRA/Stenting PTRA technical success rate > 90 % In some patients helps control hypertension In some patients can improve kidney function Serious complications

More information

Controversies in the management of the renal artery stenosis

Controversies in the management of the renal artery stenosis REVIEW ARTICLE Cardiology Journal 2013, Vol. 20, No. 1, pp. 11 16 10.5603/CJ.2013.0003 Copyright 2013 Via Medica ISSN 1897 5593 Controversies in the management of the renal artery stenosis Khalil Kanjwal

More information

Is Renal Artery Stenting Still Relevant? A Cohort Analysis

Is Renal Artery Stenting Still Relevant? A Cohort Analysis Is Renal Artery Stenting Still Relevant? A Cohort Analysis Sunil Naik, MD*, Brijesh Patel, DO, Anas Souqiyyeh, MD, Marc Zughaib, David Eastes, MPH, Marcel Zughaib, MD Abstract Atherosclerotic renal artery

More information

Renal artery stenosis is the most common cause of secondary hypertension. Over 90% of renal

Renal artery stenosis is the most common cause of secondary hypertension. Over 90% of renal General cardiology ARTERIOSCLEROTIC RENAL ARTERY STENOSIS: CONSERVATIVE VERSUS INTERVENTIONAL MANAGEMENT c RENAL Additional references appear on the Heart website Correspondence to: Priv. Doz. Dr C Haller,

More information

Renal artery stenosis

Renal artery stenosis Renal artery stenosis Dr. Alexander Woywodt Consultant Renal Physician, Royal Preston Hospital Preston, 31.10.2007 Menu anatomy of the renal arteries diseases of the large renal arteries atherosclerotic

More information

KEY WORDS: Bilateral Renal Artery Stenosis, Cardiac Catherization, Incidental Findings, Associated Co- morbidity

KEY WORDS: Bilateral Renal Artery Stenosis, Cardiac Catherization, Incidental Findings, Associated Co- morbidity BILATERAL RENAL ARTERY STENOSIS - AN INCIDENTAL FINDING DURING CARDIAC CATHETERIZATION Review of 15 Cases of BRAS Stenting at Queen Alia Heart Institute in Jordan Hatem Hamdan Salaheen Abbadi 1 ABSTRACT:

More information

Ischemic nephropathy: Detection and therapeutic intervention

Ischemic nephropathy: Detection and therapeutic intervention Kidney International, Vol. 68, Supplement 99 (2005), pp. S131 S136 Ischemic nephropathy: Detection and therapeutic intervention JOSÉ A. GARCíA-DONAIRE and JOSÉ M. ALCÁZAR Department of Nephrology, Hospital

More information

Michael Meuse, M.D. Vascular and Interventional Radiology

Michael Meuse, M.D. Vascular and Interventional Radiology Michael Meuse, M.D. Vascular and Interventional Radiology Which patient would likely benefit from renal artery revascularization? Patient A- 60 y/o male with 20 year hx of htn; on 2 drug therapy for 10

More information

Atherosclerotic renovascular disease in United States patients. aged 67 years or older: Risk factors, revascularization, and prognosis.

Atherosclerotic renovascular disease in United States patients. aged 67 years or older: Risk factors, revascularization, and prognosis. Kidney International, Vol. 8 (2005), pp. 2 01 Atherosclerotic renovascular disease in United States patients aged 7 years or older: Risk factors, revascularization, and prognosis PHILIP A. KALRA, HAIFENG

More information

Bernard Ashby-PGY2 ICCR IRB Proposal December 18, 2008

Bernard Ashby-PGY2 ICCR IRB Proposal December 18, 2008 Treatment of Refractory Hypertension Due to Tertiary Hyperaldosteronism with Spironolactone Following Percutaneous Renal Artery Intervention (PTRI): A Prospective Randomized Control Trial A. Study Purpose

More information

Renal Intervention. Douglas E. Drachman, MD, FSCAI Division of Cardiology Vascular Medicine Section December 9, 2014

Renal Intervention. Douglas E. Drachman, MD, FSCAI Division of Cardiology Vascular Medicine Section December 9, 2014 Renal Intervention Douglas E. Drachman, MD, FSCAI Division of Cardiology Vascular Medicine Section December 9, 2014 Disclosure Information Douglas E. Drachman, MD, FACC Abbott Vascular, Inc.: Advisory

More information

Revascularization versus Medical Therapy for Renal-Artery Stenosis

Revascularization versus Medical Therapy for Renal-Artery Stenosis The new england journal of medicine original article versus Medical Therapy for Renal-Artery Stenosis The ASTRAL Investigators* Abstract Background Percutaneous revascularization of the renal arteries

More information

Masahiko Fujihara, MD

Masahiko Fujihara, MD Verify the efficacy of renal artery stenting to define the predictive factors by physiological assessment with pressure wire gradient VERDICT study Masahiko Fujihara, MD Kishiwada Tokushukai Hospital Osaka,

More information

Renal Artery Stenosis: Insights from the CORAL Trial

Renal Artery Stenosis: Insights from the CORAL Trial Renal Artery Stenosis: Insights from the CORAL Trial Christopher J. Cooper, M.D., FACC, FACP Dean and Senior Vice President University of Toledo, College of Medicine President, Ohio Chapter ACC State of

More information

Diagnosis of Renal Artery Stenosis (RAS)

Diagnosis of Renal Artery Stenosis (RAS) May 2001 Diagnosis of Renal Artery Stenosis (RAS) Kurt Fink, Harvard Medical School, Year III Epidemiology Hypertension -Affects 60 million Americans Essential HTN >95% of cases Secondary HTN 1-5% of cases

More information

Case yr old lady; type 2 Diabetes 10 yrs; PVD; hypertension

Case yr old lady; type 2 Diabetes 10 yrs; PVD; hypertension Does this patient have flash pulmonary oedema? Philip A Kalra Professor of Nephrology, Salford Royal Hospital and University of Manchester, UK 73 yr old lady; type 2 Diabetes 1 yrs; PVD; hypertension Acute

More information

Clinical Medicine Insights: Cardiology

Clinical Medicine Insights: Cardiology Clinical Medicine Insights: Cardiology Original Research Open Access Full open access to this and thousands of other papers at http://www.la-press.com. Relationship between Distribution of Coronary Artery

More information

Renal Artery Stenting Associated With Improvement in Renal Function and Blood Pressure Control in Long-Term Follow-Up

Renal Artery Stenting Associated With Improvement in Renal Function and Blood Pressure Control in Long-Term Follow-Up 2016 The Author(s). 2016 Published The Author(s) by S. Karger AG, Basel www.karger.com/kbr Published by S. Karger AG, Basel 278 1423-0143/16/0413-0278$39.50/0 Accepted: February 08, 2016 www.karger.com/kbr

More information

The Centers for Medicare & Medicaid Services

The Centers for Medicare & Medicaid Services Percutaneous Renal Revascularization and Medicare Coverage The Society of Interventional Radiology s position on the current CMS coverage of renal interventions. BY DAVID SACKS, MD, AND TIMOTHY P. MURPHY,

More information

Chapter 2: Identification and Care of Patients With Chronic Kidney Disease

Chapter 2: Identification and Care of Patients With Chronic Kidney Disease Chapter 2: Identification and Care of Patients With Chronic Kidney Disease Introduction The examination of care in patients with chronic kidney disease (CKD) is a significant challenge, as most large datasets

More information

Appropriate Patient Identification For Renal Artery Intervention Remains Challenging

Appropriate Patient Identification For Renal Artery Intervention Remains Challenging Renal Intervention Herbert D. Aronow, MD, MPH, FACC, FSCAI, FSVM Director, Interventional Cardiology, Cardiovascular Institute Director, Cardiac Cath Labs, Rhode Island &The Miriam Hospitals None Disclosures

More information

Atherosclerotic renovascular disease

Atherosclerotic renovascular disease Cardiology 69 Atherosclerotic renal artery stenosis Atherosclerotic renal artery stenosis is largely a disease of the elderly and is commonly associated with hypertension and renal dysfunction. Blood pressure

More information

Corporate Medical Policy

Corporate Medical Policy Corporate Medical Policy Endovascular Therapies for Extracranial Vertebral Artery Disease File Name: Origination: Last CAP Review: Next CAP Review: Last Review: endovascular_therapies_for_extracranial_vertebral_artery_disease

More information

Renal Artery Stenting With Embolic Protection

Renal Artery Stenting With Embolic Protection Renal Artery Stenting With Embolic Protection Embolic protection during renal stenting may be beneficial, but new device designs are necessary. BY RAJESH M. DAVE, MD Renal artery stenosis (RAS) is the

More information

MEET /06/2013 SESSION : RENAL AND VISCERAL

MEET /06/2013 SESSION : RENAL AND VISCERAL MEET 2003 11/06/2013 SESSION : RENAL AND VISCERAL AFTER 35 YEARS, WHAT ARE THE INDICATIONS AND RESULTS OF PTRA IN PATIENTS WITH RI OR RVH? THOMAS SOS, MD NYPH CORNELL New York, NY THOMAS SOS, MD NYPH CORNELL

More information

Renal PEI: critical appraisal

Renal PEI: critical appraisal Renal PEI: critical appraisal On Topaz M.D., F.A.C.C.,F.S.V.M. Professor of Medicine & Pathology Director, Interventional Cardiology McGuire Veterans Medical Center Virginia Commonwealth University Richmond,

More information

The New England Journal of Medicine USE OF DOPPLER ULTRASONOGRAPHY TO PREDICT THE OUTCOME OF THERAPY FOR RENAL-ARTERY STENOSIS

The New England Journal of Medicine USE OF DOPPLER ULTRASONOGRAPHY TO PREDICT THE OUTCOME OF THERAPY FOR RENAL-ARTERY STENOSIS USE OF DOPPLER ULTRASONOGRAPHY TO PREDICT THE OUTCOME OF THERAPY FOR RENAL-ARTERY STENOSIS JÖRG RADERMACHER, M.D., AJAY CHAVAN, M.D., JÖRG BLECK, M.D., ANNABEL VITZTHUM, BIRTE STOESS, MICHAEL JAN GEBEL,

More information

PERIPHERAL VASCULAR DISEASE. Original Studies

PERIPHERAL VASCULAR DISEASE. Original Studies PERIPHERAL VASCULAR DISEASE Original Studies Catheterization and Cardiovascular Interventions 80:343 350 (2012) Significant Reduction in Systolic Blood Pressure Following Renal Artery Stenting in Patients

More information

Original Studies. Catheterization and Cardiovascular Interventions 00: (2012)

Original Studies. Catheterization and Cardiovascular Interventions 00: (2012) Catheterization and Cardiovascular Interventions 00:000 000 (2012) Original Studies Significant Reduction in Systolic Blood Pressure Following Renal Artery Stenting in Patients With Uncontrolled Hypertension:

More information

Stages of Chronic Kidney Disease (CKD)

Stages of Chronic Kidney Disease (CKD) Early Treatment is the Key Stages of Chronic Kidney Disease (CKD) Stage Description GFR (ml/min/1.73 m 2 ) >90 1 Kidney damage with normal or GFR 2 Mild decrease in GFR 60-89 3 Moderate decrease in GFR

More information

NOT FOR PUBLICATION, QUOTATION, OR CITATION RESOLUTION NO. 22

NOT FOR PUBLICATION, QUOTATION, OR CITATION RESOLUTION NO. 22 BE IT RESOLVED, Sponsored By: RESOLUTION NO. 22 that the American College of Radiology adopt the ACR SIR Practice Parameter for the Performance of Angiography, Angioplasty, and Stenting for the Diagnosis

More information

The Medical and Endovascular Treatment of Atherosclerotic Renal Artery Stenosis (METRAS) study: rationale and study design

The Medical and Endovascular Treatment of Atherosclerotic Renal Artery Stenosis (METRAS) study: rationale and study design (2012) 26, 507 516 & 2012 Macmillan Publishers Limited All rights reserved 0950-9240/12 www.nature.com/jhh ORIGINAL ARTICLE The Medical and Endovascular Treatment of Atherosclerotic Renal Artery Stenosis

More information

IN.PACT AV Access IDE Study Full Baseline Data. Robert Lookstein, MD MHCDL New York, NY On Behalf of the IN.PACT AV ACCESS Investigators

IN.PACT AV Access IDE Study Full Baseline Data. Robert Lookstein, MD MHCDL New York, NY On Behalf of the IN.PACT AV ACCESS Investigators IN.PACT AV Access IDE Study Full Baseline Data Robert Lookstein, MD MHCDL New York, NY On Behalf of the IN.PACT AV ACCESS Investigators Disclosures Speaker name: Robert Lookstein, MD... I have the following

More information

Effective Health Care

Effective Health Care Number 5 Effective Health Care Comparative Effectiveness of Management Strategies for Renal Artery Stenosis Executive Summary Background Renal artery stenosis (RAS) is defined as the narrowing of the lumen

More information

How to assess the hemodynamic importance of a renal artery stenosis. Felix Mahfoud, MD Saarland University Hospital Homburg/Saar, Germany

How to assess the hemodynamic importance of a renal artery stenosis. Felix Mahfoud, MD Saarland University Hospital Homburg/Saar, Germany How to assess the hemodynamic importance of a renal artery stenosis Felix Mahfoud, MD Saarland University Hospital Homburg/Saar, Germany How to assess renal artery stenosis severity 1. Non-invasive assessments

More information

Treatment of atherosclerotic renovascular hypertension: review of observational studies and a meta-analysis of randomized clinical trials

Treatment of atherosclerotic renovascular hypertension: review of observational studies and a meta-analysis of randomized clinical trials Nephrol Dial Transplant (2015) 30: 541 553 doi: 10.1093/ndt/gfu072 Advance Access publication 16 April 2014 Full Reviews Treatment of atherosclerotic renovascular hypertension: review of observational

More information

Percutaneous renal artery stent implantation in the treatment of atherosclerotic renal artery stenosis

Percutaneous renal artery stent implantation in the treatment of atherosclerotic renal artery stenosis EXPERIMENTAL AND THERAPEUTIC MEDICINE Percutaneous renal artery stent implantation in the treatment of atherosclerotic renal artery stenosis YOUBIN HU 1*, YONGGUANG ZHANG 1*, HUA WANG 2, YONG YIN 2, CHUNHUA

More information

Deakin Research Online

Deakin Research Online Deakin Research Online This is the published version: MacGinley, Rob and Mangos, George 2010, Renal artery stenosis and hypertension: whom and how to screen and treat, Medicine today, vol. 11, no. 2, pp.

More information

Renal Artery Stenosis Current Management Perspectives

Renal Artery Stenosis Current Management Perspectives 128 Medicine Update 23 Renal Artery Stenosis Current Management Perspectives NN KHANNA, K ROSHAN RAO, SARITA YADAV RAO, SANGEETA KHANNA INTRODUCTION Renal artery stenosis (RAS) is often overlooked and

More information

USRDS UNITED STATES RENAL DATA SYSTEM

USRDS UNITED STATES RENAL DATA SYSTEM USRDS UNITED STATES RENAL DATA SYSTEM Chapter 2: Identification and Care of Patients With CKD Over half of patients from the Medicare 5 percent sample have either a diagnosis of chronic kidney disease

More information

Secondary Hypertension: A Real World Approach

Secondary Hypertension: A Real World Approach Secondary Hypertension: A Real World Approach Evan Brittain, MD December 7, 2012 Kingston, Jamaica Disclosures None Real World Causes Renovascular Hypertension Endocrine Obstructive Sleep Apnea Pseudosecondary

More information

ORIGINAL ARTICLE. Department of Nephrology, Endocrinology and Metabolic Diseases, Silesian Medical University, Katowice, Poland

ORIGINAL ARTICLE. Department of Nephrology, Endocrinology and Metabolic Diseases, Silesian Medical University, Katowice, Poland ORIGINAL ARTICLE Cardiology Journal 2009, Vol. 16, No. 6, pp. 514 520 Copyright 2009 Via Medica ISSN 1897 5593 Comparison of early and late efficacy of percutaneous transluminal renal angioplasty with

More information

av ailab le at jou rn al h om epa g e:

av ailab le at   jou rn al h om epa g e: Journal of Cardiology Cases (2011) 4, e163 e167 av ailab le at www.sciencedirect.com jou rn al h om epa g e: www.elsevier.com/locate/jccase Case Report In vivo intravascular ultrasound imaging of fibromuscular

More information

Coronary anatomy predicts presence or absence of renal artery stenosis

Coronary anatomy predicts presence or absence of renal artery stenosis European Heart Journal (2002) 23, 1684 1691 doi:10.1053/euhj.2002.3314, available online at http://www.idealibrary.com on Coronary anatomy predicts presence or absence of renal artery stenosis A prospective

More information

Fibromuscular Dysplasia (FMD) of the renal arteries Angiographic features and therapeutic options

Fibromuscular Dysplasia (FMD) of the renal arteries Angiographic features and therapeutic options Fibromuscular Dysplasia (FMD) of the renal arteries Angiographic features and therapeutic options Poster No.: C-0630 Congress: ECR 2012 Type: Educational Exhibit Authors: K. I. Ringe, B. Meyer, F. Wacker,

More information

AJNT. Review. Management of Renovascular Disease. Sarra Elamin a* Abstract. Introduction

AJNT. Review. Management of Renovascular Disease. Sarra Elamin a* Abstract. Introduction Review AJNT Management of Renovascular Disease Sarra Elamin a* a. MRCP, Ahmed Gasim Kidney Transplant Center, Khartoum, Sudan Abstract Introduction: Renal artery stenosis (RAS) is not rare, but is often

More information

Catheter-Based Renal Denervation Reduces Total Body and Renal Noradrenaline Spillover and Blood Pressure in Resistant Hypertension

Catheter-Based Renal Denervation Reduces Total Body and Renal Noradrenaline Spillover and Blood Pressure in Resistant Hypertension Catheter-Based Renal Denervation Reduces Total Body and Renal Noradrenaline Spillover and Blood Pressure in Resistant Hypertension Murray Esler, Markus Schlaich, Paul Sobotka, Rob Whitbourn, Jerzy Sadowski,

More information

Flow Quantification from 2D Phase Contrast MRI in Renal Arteries using Clustering

Flow Quantification from 2D Phase Contrast MRI in Renal Arteries using Clustering Flow Quantification from 2D Phase Contrast MRI in Renal Arteries using Clustering Frank G. Zöllner 1,2, Jan Ankar Monnsen 1, Arvid Lundervold 2, Jarle Rørvik 1 1 Department for Radiology, University of

More information

Trans-Atlantic Debate: The Role of Interventions for Atherosclerotic Renal Artery Stenoses *

Trans-Atlantic Debate: The Role of Interventions for Atherosclerotic Renal Artery Stenoses * Eur J Vasc Endovasc Surg (2011) 42, 135e143 EDITORS INTRODUCTION Trans-Atlantic Debate: The Role of Interventions for Atherosclerotic Renal Artery Stenoses * J.-B. Ricco a, *, T.L. Forbes b Part One: The

More information

CARDIOVASCULAR ULTRASOUND. Bruno et al. Cardiovascular Ultrasound 2014, 12:9

CARDIOVASCULAR ULTRASOUND. Bruno et al. Cardiovascular Ultrasound 2014, 12:9 Bruno et al. Cardiovascular Ultrasound 2014, 12:9 CARDIOVASCULAR ULTRASOUND RESEARCH Open Access Predictive role of renal resistive index for clinical outcome after revascularization in hypertensive patients

More information

Treatment of renal artery in-stent restenosis with sirolimus-eluting stents

Treatment of renal artery in-stent restenosis with sirolimus-eluting stents Treatment of renal artery in-stent restenosis with sirolimus-eluting stents Vascular Medicine 15(1) 3 7 The Author(s) 2009 Reprints and permission: http://www. sagepub.co.uk/journalspermission.nav DOI:

More information

Immediate Normalisation of Blood Pressure following Intervention in Functional Total Occlusion of Unilateral Renal Artery with an Atrophic Kidney

Immediate Normalisation of Blood Pressure following Intervention in Functional Total Occlusion of Unilateral Renal Artery with an Atrophic Kidney Immediate Normalisation of Blood Pressure following Intervention in Functional Total Occlusion of Unilateral Renal Artery with an Atrophic Kidney Dr Parminder Singh Otaal Assistant Professor Department

More information

Major improvements in imaging, medical therapy, and

Major improvements in imaging, medical therapy, and Contemporary Reviews in Cardiovascular Medicine Renovascular Hypertension and Ischemic Nephropathy Vesna D. Garovic, MD; Stephen C. Textor, MD Major improvements in imaging, medical therapy, and techniques

More information

Outline. Introduction. Outline CHRONIC KIDNEY DISEASE UPDATE: WHAT THE GENERALIST NEEDS TO KNOW 6/26/2012

Outline. Introduction. Outline CHRONIC KIDNEY DISEASE UPDATE: WHAT THE GENERALIST NEEDS TO KNOW 6/26/2012 CHRONIC KIDNEY DISEASE UPDATE: WHAT THE GENERALIST NEEDS TO KNOW MICHAEL G. SHLIPAK, MD, MPH CHIEF-GENERAL INTERNAL MEDICINE, SAN FRANCISCO VA MEDICAL CENTER PROFESSOR OF MEDICINE, EPIDEMIOLOGY AND BIOSTATISTICS,

More information

Renal Artery Disease. None > 65,000,000. Learning objectives: Renal Artery Disease

Renal Artery Disease. None > 65,000,000. Learning objectives: Renal Artery Disease Renal Artery Disease Robert D. McBane, M.D. Division of Cardiology Mayo Clinic Rochester Financial Disclosure Information Renal Artery Disease Robert McBane, MD None To appreciate: Learning objectives:

More information

Chapter 2: Identification and Care of Patients With CKD

Chapter 2: Identification and Care of Patients With CKD Chapter 2: Identification and Care of Patients With CKD Over half of patients in the Medicare 5% sample (aged 65 and older) had at least one of three diagnosed chronic conditions chronic kidney disease

More information

Arterial stenting and balloon angioplasty in ostial atherosclerotic renovascular disease: a randomised trial

Arterial stenting and balloon angioplasty in ostial atherosclerotic renovascular disease: a randomised trial Early reports Arterial stenting and balloon angioplasty in ostial atherosclerotic renovascular disease: a randomised trial Peter J G van de Ven, Robert Kaatee, Jaap J Beutler, Frederick J A Beek, Arend-Jan

More information

Percutaneous revascularization for ischemic nephropathy: the past, present, and future

Percutaneous revascularization for ischemic nephropathy: the past, present, and future http://www.kidney-international.org & 2012 International Society of Nephrology Percutaneous revascularization for ischemic nephropathy: the past, present, and future Stephen C. Textor 1, Sanjay Misra 2

More information

Chapter 2: Identification and Care of Patients with CKD

Chapter 2: Identification and Care of Patients with CKD Chapter 2: Identification and Care of Patients with CKD Over half of patients in the Medicare 5% sample (aged 65 and older) had at least one of three diagnosed chronic conditions chronic kidney disease

More information

Interventional Cardiology

Interventional Cardiology nal Review Interventional Cardiology Selecting patients likely to benefit from renal artery stenting Patients with refractory hypertension, progressive ischemic nephropathy and cardiac destabilization

More information

Renal artery stenosis (RAS) is a relatively common

Renal artery stenosis (RAS) is a relatively common The Importance of Appropriate Renal Artery Stenting Considerations for diagnosis and treatment of patients with renal artery stenosis. By Massoud A. Leesar, MD, FACC, FSCAI Renal artery stenosis (RAS)

More information

CORAL Trial Aftermath: What Do We Do Now? Renal Revascularization in Perspective

CORAL Trial Aftermath: What Do We Do Now? Renal Revascularization in Perspective CORAL Trial Aftermath: What Do We Do Now? Renal Revascularization in Perspective Michael R. Jaff, DO Massachusetts General Hospital Boston, Massachusetts, USA Michael R. Jaff, DO Conflicts of Interest

More information

Objectives. Pre-dialysis CKD: The Problem. Pre-dialysis CKD: The Problem. Objectives

Objectives. Pre-dialysis CKD: The Problem. Pre-dialysis CKD: The Problem. Objectives The Role of the Primary Physician and the Nephrologist in the Management of Chronic Kidney Disease () By Brian Young, M.D. Assistant Clinical Professor of Medicine David Geffen School of Medicine at UCLA

More information

Contrast Induced Nephropathy

Contrast Induced Nephropathy Contrast Induced Nephropathy O CIAKI refers to an abrupt deterioration in renal function associated with the administration of iodinated contrast media O CIAKI is characterized by an acute (within 48 hours)

More information

Multimarker assessment for the prediction of renal function improvement after percutaneous revascularization for renal artery stenosis

Multimarker assessment for the prediction of renal function improvement after percutaneous revascularization for renal artery stenosis Original Article Multimarker assessment for the prediction of renal function improvement after percutaneous revascularization for renal artery stenosis Daniel Staub 1, Sasan Partovi 2, Thomas Zeller 3,

More information

Clinical bene t of renal artery angioplasty with stenting for the control of recurrent and refractory congestive heart failure

Clinical bene t of renal artery angioplasty with stenting for the control of recurrent and refractory congestive heart failure Clinical bene t of renal artery angioplasty with stenting for the control of recurrent and refractory congestive heart failure Bruce H Gray a, Jeffrey W Olin b, Mary Beth Childs c, Timothy M Sullivan d

More information

Physician Self-referral and Health Care Utilization. Rita F. Redberg, MD, MSc Professor of Medicine UCSF Medical Center

Physician Self-referral and Health Care Utilization. Rita F. Redberg, MD, MSc Professor of Medicine UCSF Medical Center Physician Self-referral and Health Care Utilization Rita F. Redberg, MD, MSc Professor of Medicine UCSF Medical Center Physician self-referral why should we care? Extent of occurrences Impact of physician

More information

Protecting the heart and kidney: implications from the SHARP trial

Protecting the heart and kidney: implications from the SHARP trial Cardiology Update, Davos, 2013: Satellite Symposium Protecting the heart and kidney: implications from the SHARP trial Colin Baigent Professor of Epidemiology CTSU, University of Oxford S1 First CTT cycle:

More information

Renal artery revascularization: Outcomes stratified by indication for intervention

Renal artery revascularization: Outcomes stratified by indication for intervention Renal artery revascularization: Outcomes stratified by indication for intervention Virendra I. Patel, MD, Mark F. Conrad, MD, Christopher J. Kwolek, MD, Glenn M. LaMuraglia, MD, Thomas K. Chung, MS, and

More information

Restenosis after renal artery angioplasty and stenting: Incidence and risk factors

Restenosis after renal artery angioplasty and stenting: Incidence and risk factors From the Southern Association for Vascular Surgery Restenosis after renal artery angioplasty and stenting: Incidence and risk factors Matthew A. Corriere, MD, MS, a Matthew S. Edwards, MD, MS, a Jeffrey

More information

Effective Date: TBD Version: 1.0 (Revised: 6/11/2014)

Effective Date: TBD Version: 1.0 (Revised: 6/11/2014) Protocol Title: Hypertension Effective Date: TBD Version: 1.0 (Revised: 6/11/2014) Approval By: TBD Planned Review Date: TBD 1 Purpose & Objective This protocol provides evidence-based care recommendations

More information

With an unrestricted educational grant from. The Interventional Treatment of Resistant Hypertension

With an unrestricted educational grant from. The Interventional Treatment of Resistant Hypertension With an unrestricted educational grant from The Interventional Treatment of Resistant Hypertension Felix Mahfoud Interventional Cardiology University Hospital Homburg/Saar Germany Dr. Mahfoud graduated

More information

Chapter 2: Identification and Care of Patients With CKD

Chapter 2: Identification and Care of Patients With CKD Chapter 2: Identification and Care of Patients With Over half of patients from the Medicare 5% sample (restricted to age 65 and older) have a diagnosis of chronic kidney disease (), cardiovascular disease,

More information

DCB in my practice: How the evidence influences my strategy. Yang-Jin Park

DCB in my practice: How the evidence influences my strategy. Yang-Jin Park DCB in my practice: How the evidence influences my strategy Yang-Jin Park Associate Professor Division of Vascular Surgery, Department of Surgery Samsung Medical Center Sungkyunkwan University School of

More information

Figure 1 LVH: Allowed Cost by Claim Volume (Data generated from a Populytics analysis).

Figure 1 LVH: Allowed Cost by Claim Volume (Data generated from a Populytics analysis). Chronic Kidney Disease (CKD): The New Silent Killer Nelson Kopyt D.O. Chief of Nephrology, LVH Valley Kidney Specialists For the past several decades, the health care needs of Americans have shifted from

More information

Long-term clinical outcome of patients with severe atherosclerotic renal artery stenosis after percutaneous transluminal renal angioplasty

Long-term clinical outcome of patients with severe atherosclerotic renal artery stenosis after percutaneous transluminal renal angioplasty Mochida et al. Renal Replacement Therapy (2018) 4:5 DOI 10.1186/s41100-018-0147-x RESEARCH Open Access Long-term clinical outcome of patients with severe atherosclerotic renal artery stenosis after percutaneous

More information

Index. cardiology.theclinics.com. Note: Page numbers of article titles are in boldface type.

Index. cardiology.theclinics.com. Note: Page numbers of article titles are in boldface type. Index Note: Page numbers of article titles are in boldface type. A ABI. See Ankle-brachial index (ABI). Afterload, deconstructing of, in ventricular vascular interaction in heart failure, 449 Air plethysmography

More information

JOURNAL OF VASCULAR SURGERY Volume 50, Number 3 Davis et al 565 no CHS participant demonstrated severe hypertension or renal insufficiency consistent

JOURNAL OF VASCULAR SURGERY Volume 50, Number 3 Davis et al 565 no CHS participant demonstrated severe hypertension or renal insufficiency consistent From the Southern Association for Vascular Surgery Atherosclerotic renovascular disease among hypertensive adults Ross P. Davis, MD, a Jeffrey D. Pearce, MD, a Timothy E. Craven, MSPH, b Phillip S. Moore,

More information

Hypertension is an important global public

Hypertension is an important global public IN THE LITERATURE Blood Pressure Target in Individuals Without Diabetes: What Is the Evidence? Commentary on Verdecchia P, Staessen JA, Angeli F, et al; on behalf of the Cardio-Sis Investigators. Usual

More information

Outline. Outline. Introduction CHRONIC KIDNEY DISEASE UPDATE: WHAT THE GENERALIST NEEDS TO KNOW 8/11/2011

Outline. Outline. Introduction CHRONIC KIDNEY DISEASE UPDATE: WHAT THE GENERALIST NEEDS TO KNOW 8/11/2011 CHRONIC KIDNEY DISEASE UPDATE: WHAT THE GENERALIST NEEDS TO KNOW MICHAEL G. SHLIPAK, MD, MPH CHIEF-GENERAL INTERNAL MEDICINE, SAN FRANCISCO VA MEDICAL CENTER PROFESSOR OF MEDICINE, EPIDEMIOLOGY AND BIOSTATISTICS,

More information

The role of percutaneous revascularization for renal artery stenosis

The role of percutaneous revascularization for renal artery stenosis The role of percutaneous revascularization for renal artery stenosis Gregory J Dubel and Timothy P Murphy Abstract: Renal artery stenosis (RAS) is usually caused by atherosclerosis or fibromuscular dysplasia.

More information