Article Figures & Data
Figures
- Figure 1
A percutaneously placed device creates an arteriovenous anastomosis.
- Figure 2
Renal artery denervation is performed using an intra-arterial catheter.
- Figure 3
A percutaneously placed implant is designed to stimulate the carotid barore-ceptors and thus lower blood pressure.
- Figure 4
Stenting is reasonable for treating resistant hypertension in patients with significant renal artery stenosis.
- Figure 5
Hemodynamic significance of angiographic renal artery stenosis.
Tables
Type of procedural therapy Advantages Limitations Arteriovenous coupling Improves measures of arterial stiffness
Reduces overall systemic vascular resistance
Increases cardiac output and arterial blood oxygen contentDevelopment of venous iliac stenosis proximal to the anastomosis
Potential risk of restenosis, and need for antithrombotic therapies
Compression stockings need to be used after device insertion
Potential for high-output cardiac failureRenal denervation therapy Potential reduction of increased sympathetic activity
Percutaneous ambulatory procedureLacks a procedural end point
Variable effects on blood pressure due to variability in degree of denervation achievedBaroreflex activation therapy Attenuates overall sympathetic activation
Potential for neurohormonal modulationNeed for subcutaneous internal pulse
generator with some systems
Heterogeneity in the response to carotid sinus stimulation
Requirement of surgical neck dissection
Potential of nerve injury with residual deficitRenal artery stenting Potential to avoid surgery to treat stenosis
Rapid improvement of global renal ischemia with bilateral lesions
Potential to lessen sudden cardiac disturbance syndromesDiscordance between procedural success and clinical improvement
Risk of contrast-induced nephropathy
Need for surveillance for stent restenosis
Complications related to femoral accessSuboptimal antihypertensive therapy Nonadherence Lifestyle choices (eg, high-sodium diet, smoking) Dietary indiscretion Over-the-counter medications and supplements Older age Intravascular and extracellular volume expansion Primary hyperaldosteronism Renal artery stenosis Renal parenchymal disease Obstructive sleep apnea Coarctation of the aorta Cushing disease Hyperparathyroidism Pheochromocytoma Atherosclerosis Fibromuscular dysplasia Nephroangiosclerosis (hypertensive injury) Diabetic nephropathy (small-vessel) Renal thromboembolic disease Atheroembolic renal disease Aortorenal dissection Renal artery vasculitis Trauma Neurofibromatosis Thromboangiitis obliterans Scleroderma Extrinsic compression Onset of hypertension before age 30 Onset of severe hypertension after age 55 Resistant hypertension Hypertensive urgencies New renal impairment after starting angiotensin-converting enzyme inhibitor therapy
