**2.4.2 Interventional treatment**

Renal artery revascularization for bilateral or unilateral disease in a single viable kidney is indicated in the following situations (Greco & Breyer, 1997; Textor, 2004).


Beyond these criteria mentioned above, the procedure of revascularization should be performed after weighing the benefits against the hazards. Therefore revascularization

Fig. 1. A: MR angiography demonstrates a right ostial renal artery stenosis (an arrowhead);

presence of systemic atherosclerosis and many risk factors is important. On the other hand, a critically unilateral or bilateral stenosis of renal artery disease may need further mechanical manipulations such as renal angioplasty, stenting and bypass surgery. We will

Life style modification and a control of established risk factors is the golden rule for most atherosclerotic vascular disease including diabetes, obesity, hypertension, low density lipoprotein cholesterol (LDL-C), inflammation and smoking. However, no reports prove the effect of medical control to reduce the occurrence of ARVD or prevent disease progression. It is reasonable that medical treatment should be started in middle-aged persons at risk to prevent ARVD. The choice of pharmacological agents and the goal aimed to achieve with or

Among the antihypertensive agents, ACE inhibitors or angiotensin II receptor blockers (ARBs) are observed with the most effectiveness in control of the blood pressure for patients with ARVD (Dworkin & Jamerson, 2007). Surgical intervention should be considered if refractory hypertension persisits. However, adequate control of blood pressure by chronic administration of antihypertensive drugs can not be guarantteed the prevention of stenotic

Renal artery revascularization for bilateral or unilateral disease in a single viable kidney is

Beyond these criteria mentioned above, the procedure of revascularization should be performed after weighing the benefits against the hazards. Therefore revascularization

indicated in the following situations (Greco & Breyer, 1997; Textor, 2004).

4. Progressive renal function impairment with optimal blood pressure control.

B: MDCT angiography demonstrates diffuse atherosclerosis of left renal artery (an

arrowhead indicate the proximal lesion of left renal artery).

without vascular events will be listed in table 5.

lesions progression and post-stenotic renal.atrophy.

2. Recurrent episodes of acute pulmonary edema 3. Unexplained progressive renal insufficiency

**2.4.2 Interventional treatment** 

1. Severe or refractory hypertension

**2.4.1 Medical treatment** 

describe the two parts of therapy in detail in the following paragraphs.


Table 5. Modifiable risk factors for ARVD. CVD: cardiovascular disease including myocardial infarction and ischemic stroke; ACEI: ACE inhibitors; ARB: angiotensin II receptor blockers; BP: blood pressure; BB: beta-blocker; CB: calcium receptor blocker; JUPITER: Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin trial; CRP: C-reactive protein.

should be aimed for patients with a reversible status of chronic renal insufficiency and resistant hypertension instead of reduing their mortality. A review literature has demonstrated that half of patients with ARVD have no change in renal function, while one fourth improve and one fifth deterioate their renal function after renal stenting (Fig.1A & B) (Leertouwer et al, 2000).

Fig. 2. An atherosclerotic ostial lesion at right renal artery. Panel A: catheter renal angiography (An arrowhead indicates a lesion from ostial to proximal right renal artery; Panel B: post-percutaneous transluminal angioplasty with stenting (An arrowhead indicates stenting site of right renal artery).

Atherosclerotic Renovascular Disease 157

We thank Dr. Yu-Guang Chen, Tri-Service General Hospital for his kindly providing the

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**4. Acknowledgement** 

**5. References** 

image of MDCT angiography.

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Accordingly, only 20-25% of patients may be eligible for elective renal revascularization. There have some image, histology and clinical evidence to select patients with ARVD having benefits to undergo renal artery revascularization which is described as follow (Novick et al, 1987; Muray et al, 2002).


There are three methods for renal artery revascularization (table 6).


Table 6. Comparison of three types of revascularization intervention. PTA: percutaneous transluminal angioplasty; TVR: target vessel revascularization; ASTRAL: Angioplasty and Stenting for Renal Artery Lesions; ACC/AHA: American College of Cardiology Foundation/American Heart Association.
