Atherosclerotic Renovascular Disease: Prevalence, Natural History, Noninvasiveive Diagnosis and Endovascular Therapy Using Palmaz Stents.

Atherosclerotic renovascular disease (RVD) occurs with a high prevalence in older patients who have severe hypertension and other vascular disease. Natural history studies of RVD have demonstrated progression with risk for occlusion. RVD leading to ischemic nephropathy and renal failure accounts for up to 14 % of all patients over the age of 50 years who are beginning dialysis. A number of clinical variables are helpful in identifying patients with a high likelihood of RVD. In addition, screening with noninvasiveive studies including renal artery duplex exam, as well as with abdominal aortography at the time of coronary angiography, may be warranted in patients at high risk for RVD. Balloon angioplasty for ostial RVD has produced disappointing results, and surgical bypass has been associated with significant morbidity and mortality risks, especially in elderly patients with generalized atherosclerosis. The recent use of Palmaz stents as primary therapy for ostial RVD has resulted in restenosis rates as low as 8 %, with markedly reduced risks compared to surgery. Suggested guidelines for screening for RVD by performing abdominal aortography at the time of coronary angiography are outlined, along with a review of the preliminary data available regarding the use of Palmaz stents for ostial RVD.