| Renal artery stenosis (RAS) is usually not evident to the patient, and is difficult to detect clinically. These patients frequently present with hypertension, which is difficult to control, often requiring multiple medications. Although an uncommon cause of hypertension, RAS can contribute to stroke, congestive failure and/or kidney failure. Further complicating the diagnosis is the frequent association of RAS with carotid arterial occlusive disease and coronary artery disease. Combining the expertise of cardiologists, vascular surgeons and interventional radiologists, additional studies can be selected to further evaluate the extent of disease suspected from a thorough medical history and physical exam findings.
When RAS is suspected, magnetic resonance angiography (MRA) or duplex color Doppler ultrasound may confirm the presence of RAS. Renal angiography is the definitive study for diagnosing RAS. Once diagnosed, interventional endovascular treatment usually is performed at the same time to improve renal artery blood flow.
If identified early, improving RAS frequently stabilizes or improves hypertension. In patients with reduced renal function, correcting RAS frequently leads to improvement or stabilization in renal function, ultimately preventing or delaying the need for dialysis treatment.
At the University of Virginia, in order to improve the safety of this procedure, alternative contrast agents such as carbon dioxide and/or gadolinium-based contrast agents are used in place of traditional iodinated contrast material. These alternative contrast agents have resulted in a significant decrease in the incidence of contrast induced nephropathy which has been reported to occur when iodinated contrast material is administered to patients with renal insufficiency.
|
