ABSTRACT: ASTRAL and the four randomized, controlled trials preceding have shown that unselected revascularization in atherosclerotic renovascular disease (ARVD) is not an appropriate intervention. Despite this, there are clinical situations where renal artery revascularization is of great benefit to the patient. In this review we discuss the different presentations of ARVD and the effects of revascularization for each.

VASCULAR DISEASE MANAGEMENT 2011;8:E12–E20

Introduction

Hemodynamically significant renal artery stenosis (RAS) induces hypoperfusion of the affected kidney leading to a constellation of physiologic responses.¹ Upregulation of the renin-angiotensin-aldosterone system (RAAS) results in arterial vasoconstriction, impaired natriuresis, and fluid retention.² Over time, hypoperfusion can lead to renal atrophy and fibrosis.³ Renal artery revascularization can restore perfusion to ischemic kidneys and prevent further injury.⁴

One of the challenges facing medicine today is how to best allocate resources. As medical costs continue to rise, agencies such as the Centers for Medicare & Medicaid Services (CMS) must ensure that money is spent in a responsible manner. This requirement has resulted in the development of the Medicare Evidence Development and Coverage Advisory Committee (MEDCAC). MEDCAC was established to provide “independent guidance and expert advice” to the CMS on various topics. MEDCAC evaluates strength of evidence and makes recommendations to the CMS based upon the evidence.

ABSTRACT: Renal artery aneurysms (RAAs) are being diagnosed with increasing frequency. They can be incidental or symptomatic. Rupture is the most feared complication. RAAs can be managed conservatively or treated with either surgery or an endovascular approach. We present the case of a 48-year-old female who had a large RAA with a distal stenosis that was treated with a stent-graft. Two-year follow-up is available on this patient. A review of the literature is also presented.

VASCULAR DISEASE MANAGEMENT 2011;8:E45–E49