Clinical study
Spontaneous Renal Artery Dissection: Long-term Outcomes after Endovascular Stent Placement

https://doi.org/10.1016/j.jvir.2009.04.069Get rights and content

Purpose

To report long-term clinical and morphologic results after stent placement for spontaneous renal artery dissection (SRAD).

Materials and Methods

Between 1991 and 2006, 16 consecutive patients (13 men; mean age, 42 y ± 12) presented with SRAD in 17 arteries. All patients had uncontrolled hypertension at the time of presentation. Nine patients had lower back pain, 10 had progressive renal insufficiency, and three had both. All patients underwent renal angiography and stent implantation. They were followed up clinically and with renal imaging.

Results

Baseline blood pressure and plasma creatinine levels were 176/107 mm Hg and 142 μmol/L, respectively. Successful renal artery recanalization and stent implantation were achieved in all patients. After a mean follow-up of 8.6 years ± 3.4, mean blood pressure was 118/78 mm Hg, with Seven patients were taking no antihypertensive medication, with five and four patients taking single or double antihypertensive agents, respectively. The most recent follow-up showed that plasma creatinine levels were normal, and imaging of the renal arteries showed no sign of restenosis or occlusion in all patients.

Conclusions

Stent implantation for symptomatic SRAD is an effective treatment in the long term and represents a safe alternative to surgery.

Section snippets

Materials and Methods

Between 1991 and 2006, 16 consecutive patients presenting with SRAD in 17 arteries were treated by stent implantation and followed up until December 2006. This study was reviewed and approved by our institutional review board as a retrospective study, which does not require informed consent from patients.

In this study, SRAD was defined as dissection of the renal artery in the absence of trauma or renal artery intervention. The anatomy of this lesion, as described in historical surgical series (2

Periprocedural Results

In 16 consecutive patients, we found an SRAD in 20 arteries (11 right and nine left renal arteries) on diagnostic angiography. In three of 20 arteries, the SRAD was responsible for less than 30% stenosis and therefore was not treated.

An interval of 2–120 days (mean, 8 d ± 4.5) separated the onset of symptoms from stent implantation. Seventeen severe dissections received percutaneous treatment: 10 right renal arteries, five left renal arteries, and one case of bilateral dissections. The arterial

Discussion

We report favorable long-term clinical and morphologic outcomes in a group of consecutive patients treated with stent implantation for SRAD. Clinical success was obtained in the treatment of hypertension and renal failure. We experienced no case of nephrectomy, and it is noteworthy that more than 40% of the patients were cured and remained normotensive in the absence of antihypertensive drug therapy during a follow-up period of more than 8 years. These observations confirm preliminary results

Acknowledgment

The authors thank M. Lee of Beaumont Hospital and Royal College of Surgeons, Dublin, Ireland, for manuscript editing.

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Copyright © 2009 SIR. Published by Elsevier Inc. All rights reserved.