December 22, 2008

The Implications of Acute Anatomic Injury after Percutaneous Renal Angioplasty and Stenting.

Mark G. Davies, MD PhD MBA, Jean X. Bismuth, MD, Joseph J. Naoum, MD, Imran T. Mouhiddin, MD, Eric K. Peden, MD, Alan B. Lumsden, MD.
Methodist Debakey Heart and Vascular Center, Houston, TX, USA.

Background: Percutaneous renal artery revascularization for hypertension and renal dysfunction is now common. The frequency, cause and outcomes of anatomic injury associated with renal intervention are poorly delineated. The purpose of this study is to determine the
the frequency of acute anatomic renal injury after renal artery interventions, to identify factors associated with anatomic renal injury, and determine whether anatomic renal injury related to renal intervention is associated with late adverse clinical events.
Methods: A retrospective analysis of patients undergoing renal artery interventions for atherosclerotic renal artery disease between 1990 and 2008 was performed.. Acute anatomic renal injury was defined renal artery dissection, renal artery perforation, acute occlusion, renal parenchymal infarction, and renal parenchymal perforation. Freedom from renal related morbidity (increase in persistent creatinine >20% of baseline, progression to hemodialysis, death from renal-related causes) and patient survival were measured.
Results: 418 patients underwent 581 renal artery interventions: 57% for hypertension, 23% for hypertension associated with chronic renal insufficiency and 12% for renal insufficiency. Acute anatommic renal injury occurred in 5.2% of the patients. The occurrence of a anatomic injury was associated with a significant decrement in freedom from renal-related morbidity (mean±SEM, 88±2% vs. 72±19%, no injury vs. injury, p<0.01) and markedly decreased survival at 3 years follow up (77±2% vs. 56±9%, p0.8 and dissection was associated with lack of retained renal benefit.
Conclusion: Acute anatomic renal injury occurs in approximately 5% of patients undergoing percutaneous renal artery intervention and is a negative predictor of survival and is associated with subsequent renal failure, need for dialysis, and death.

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