Therefore, if the general anesthesia is impossible or equipment, such as fluoroscopy and laparoscopy, were not available, this method may be an alternative choice for PD catheter placement. “
“Date written: November 2008 Final submission: August 2009 No recommendations possible based on Level I or II evidence (Suggestions are based primarily
on Level III and IV evidence) Distal protection devices should be considered for patients requiring renal artery angioplasty to prevent renal atheroembolism. Discussion between the nephrologist PD98059 chemical structure and interventional radiologist (and other relevant specialists) regarding the benefits and harms of distal protection in this context is strongly encouraged. A registry of the use of distal protection devices would contribute to our knowledge of the benefits and harms of distal protection. This would work best within a larger registry of renovascular intervention procedures. Atherosclerotic
renal artery stenosis (ARAS) is often associated with vascular disease in other vessels and is becoming increasingly common as the population ages and more people are investigated for reduced kidney function.1 The major clinical manifestations of ARAS are hypertension and reduced kidney function. Treatment options for ARAS include phosphatase inhibitor library medical management and revascularization. Although restoration of perfusion of the kidney should in theory help preserve kidney function, it remains unclear whether patients should undergo revascularization of the kidney or not. Revascularization is predominantly performed by percutaneous transluminal angioplasty of the vessel with insertion of a stent to reduce the rate of restenosis.2 In contrast to other vascular beds, such as the coronary or lower limb circulation, there are no symptoms to improve by restoring perfusion to the kidney. One risk of this procedure that is difficult to precisely quantify is the release of cholesterol fragments from atheromatous plaque, which travel distally into smaller renal vessels.3 The release of such
fragments has been demonstrated in an ex vivo model of renal artery angioplasty and PTK6 stent.4 The best estimate of this risk comes from the ASTRAL study in which the risk of renal or stent embolisation at 24 hours post-procedure without distal protection devices was 1.5% and the risk of non-renal embolisation at 24 hours was 1%.5 This complication can lead to permanent loss of kidney function and even end-stage kidney disease requiring dialysis, and can occur even weeks to months after the procedure. In order to prevent this complication, distal protection devices that are placed distal to the stenosis have been developed to trap embolic material that may be released during the angioplasty and stent insertion.