Vikram S. Kashyap, MD, Ricardo N. Sepulveda, MD, James F

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Presentation transcript:

The management of renal artery atherosclerosis for renal salvage: Does stenting help? Vikram S. Kashyap, MD, Ricardo N. Sepulveda, MD, James F. Bena, MS, Joseph V. Nally, MD, Emilio D. Poggio, MD, Roy K. Greenberg, MD, Jay S. Yadav, MD, Kenneth Ouriel, MD Journal of Vascular Surgery Volume 45, Issue 1, Pages 101-108 (January 2007) DOI: 10.1016/j.jvs.2006.08.068 Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 1 A, A representative magnetic resonance angiography image of a patient in this series. The right renal artery is occluded, and the right kidney is atretic. The left kidney size is preserved, but there is a high-grade proximal renal artery stenosis. The baseline serum creatinine level was 2.0 mg/dL. The patient was treated with primary stenting of the left renal artery stenosis, with improvement of renal function and blood pressure control. B, A distal protection device was used in this case and captured embolic debris. Journal of Vascular Surgery 2007 45, 101-108DOI: (10.1016/j.jvs.2006.08.068) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 2 Mean estimated glomerular filtration rate (±SE) for all patients undergoing percutaneous transluminal angioplasty and stenting (n = 125). The y-axis represents months, with time 0 representing the renal intervention. At each interval, serum creatinine levels were obtained in approximately 57% of patients (range, 41%-100%; n = 64 at –4 months; n = 77 at −1 month; n = 125 at intervention; n = 69 at 1 month; n = 53 at 3 months; n = 63 at 6 months; n = 51 at 12 months). Journal of Vascular Surgery 2007 45, 101-108DOI: (10.1016/j.jvs.2006.08.068) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 3 Glomerular filtration rate (GFR) in patients stratified by response to intervention. Negative months represent the preoperative time frame for all patients. Patients who responded or stabilized after intervention had significant decreases in GFR before the intervention (P < .01), whereas nonresponders had no significant change. Journal of Vascular Surgery 2007 45, 101-108DOI: (10.1016/j.jvs.2006.08.068) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 4 Kaplan-Meier estimates of long-term survival and dialysis-free survival. Survival was 88% and 76% at 1 and 3 years, respectively, whereas dialysis-free survival was 85% and 63% for the same intervals. Journal of Vascular Surgery 2007 45, 101-108DOI: (10.1016/j.jvs.2006.08.068) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions