Benefits and risks of percutaneous revascularization of renal artery stenosis
What are the potential benefits and risks associated with percutaneous revascularization of renal artery stenosis?
Percutaneous revascularization (angioplasty with or without stenting) can potentially correct stenotic lesions in a relatively noninvasive procedure, but it is certainly not without risk.
Patients are at risk for bleeding complications, contrast nephropathy, and renal artery dissection, occlusion, or perforation. Acute kidney injury associated with any of these events may require dialysis and is not necessarily reversible. One other potential complication of conventional angiography and percutaneous revascularization procedures that deserves special mention is cholesterol atheroembolic disease.
This disorder occurs when cholesterol fragments from atheromatous plaques embolize to distal arterial blood vessels, causing ischemic injury. This embolic event most often occurs in the context of anticoagulation/thrombolytic therapy or some procedure, such as vascular surgery or conventional angiography, where mechanical trauma to the atherosclerotic vessels with vulnerable plaques may be unavoidable. The clinical manifestations vary depending on where the cholesterol-laden fragments embolize and may include stroke, mesenteric ischemia, acute kidney injury, and ischemic digits. Atheroembolic disease affecting the kidneys should be suspected in patients who have a decline in kidney function following an arterial intervention or angiography who also demonstrate any of the following:
- • Livedo reticularis
- • Ischemic digits
- • Peripheral eosinophilia
- • Hypocomplementemia
Patients with cholesterol atheroembolic disease may lose kidney function over the course of weeks to months in a stepwise fashion, and this may not be reversible. Although treatment is mainly supportive, it is important to avoid anticoagulation if possible because it is believed this may predispose the patient to further embolic events. Cholesterol-lowering agents may be of some benefit.
