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Renal artery stenosis

From Surgopaedia

Presentations

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Incidental
Systemic HTN and worsening renal function
- Guidelines suggest screening for RAS as part of a secondary HTN workup if resistant HTN (on three anti-HTNs and SBP>180), HTN at <30yo, sudden worsening of HTN, or discrepant kidney length on imaging.
- Duplex USS is best first test. Normal peak systolic velocity should be 60-100cm/sec in renal arteries

Treatment

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Medical

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Revascularization

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Renovascular HTN not responsive to maximal medical therapy
Patients with worsening renal function
Young patients with flash pulmonary oedema caused by atherosclerotic RAS

Endovascular

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Probably best intervention
Procedure
- Femoral access
- Heparin
- Balloon angioplasty
- Stent
Post-procedure
- Clopidogrel for at least 30 days
- Aspirin indefinitely
- USS 1-2 weeks post-op
- USS 6-12 monthly
Complications
- Rapid post-intervention decline in renal function
  - Atheromatous embolization
  - Cpontrast nephropathy
- Renal artery rupture
- Access site complications

Open surgery

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Urgent salvage of endovascular technical failures
In combination with aortic reconstruction

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Vascular