Cath Lab Digest

Renal angioplasty and stenting has lost some of its luster with the recent data presented. I would like to argue that there is still a value in treating some patients with renal artery occlusive disease. The idea for this blog came from a recent discussion with one of my old patients from Atlanta.

I previously partnered very closely with the transplant surgeons at Emory. We evaluated many patients with aorto-iliac occlusive disease prior to clearing them to be listed for renal transplantation. We would decide together if an intervention was warranted to assist with a successful renal transplant being performed.

One patient was a prior patient of mine on whom I performed a popliteal-to-posterior tibial artery bypass for gangrene. His toe amputations healed after the bypass and was doing very well until he developed renal failure 2 years later. He was started on peritoneal dialysis and listed for transplant. During his transplant evaluation, there was concern raised regarding worsening arterial disease. I did an arteriogram and incidentally discovered an occluded left renal artery with a high-grade right renal artery stenosis. I treated this with an angioplasty and stent almost 1 year ago. He has not had dialysis since that time. His creatinine has remained in the low 3 range for this past year.

The reason this was brought back to my attention was an accident. I was driving the Eisenhower Expressway to Loyola early one morning. It was dreary and cold (it is Chicago) and got a phone call from an Atlanta area code that I did not recognize. It was this patient trying to reach my old clinical assistant, but he had my cell phone number programmed into his phone by mistake. He told me he was still off dialysis and doing well. The dreary, cold day seemed a lot brighter and warmer. An endovascular solution completely changed this man’s life.

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Ross Milner, MD, FACS is associate professor of surgery at Loyola University Chicago Stritch School of Medicine. He was recruited to Loyola from Emory University School of Medicine in Atlanta, where he was associate professor of surgery.

Dr. Milner graduated Cum Laude from the University of Pennsylvania, where he also completed medical school. He was chief resident in surgery at the Hospital of the University of Pennsylvania. He completed fellowships at the University of Pennsylvania and University Medical Center in Utrecht in the Netherlands. Dr. Milner is currently Chief of the Division of Vascular Surgery and Endovascular Therapy at Loyola University Medical Center, Stritch School of Medicine in Chicago, Illinois.