Renal angioplasty
What is it?
Renal angioplasty is a procedure that involves selective endovascular catheterization of the stenotic renal artery and ballooning of the lesion with eventual stent placement in order to improve perfusion of the renal parenchyma.
When is this procedure indicated?
Narrowing of the arteries that carry blood to the kidneys can cause:
- renovascular hypertension (elevation of blood pressure that cannot be controlled by medication);
- progressive renal failure (elevation of azotemia and creatinineemia);
- acute renal failure from embolization by atheromasic plaque to the renal parenchyma (acute organ dysfunction associated with elevation of creatinine and azotemia)
How is it performed?
Renal stenoses are treated by angioplasty and, if determined by atherosclerosis, by stent implantation.
These procedures are performed under local anesthesia, through percutaneous accesses (arterial puncture without surgical access) at the level of the femoral or radial artery.
Recovery
The post-operative stay, in the absence of complications, is short and the post-procedural observation period is useful for monitoring urine in 24 hours and blood tests as an index of renal function (creatinine, electrolytes and azotemia). Echocolordoppler control of percutaneous accesses is performed after about 12 h. If the procedure has been performed by surgical access, the quality and quantity of the material collected in the drain placed in the surgical access site is evaluated and an indication is given for its removal, after which the patient can be discharged, in the absence of complications.
Short-term complications
Complete occlusion of the intra- or periprocedural renal artery due to thrombosis or dissection resulting in acute ischemia of the renal parenchyma. This situation can lead to acute renal failure or worsening of pre-existing renal failure, sometimes of such severity as to require dialysis treatment, even definitive. Embolization of the renal parenchyma by fragments of plaque resulting in renal ischemia and loss of organ function, also in this case possible cause of terminal renal failure and therefore dialysis.
Rupture of the artery resulting in bleeding and the need for surgical conversion of the endovascular procedure.
Adverse reactions to the contrast medium with possible severe allergic reactions up to anaphylactic shock or toxicity, also capable of causing onset or worsening of renal failure with possible problems of recovery.
Long-term complications
Disease recurrence even after some time (intimal hyperplasia, atherosclerosis) requiring new endovascular or surgical treatment
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