Revascularization as a treatment to improve renal function

Helen V Alderson, James P Ritchie, Philip A Kalra The University of Manchester, Manchester Academic Health Sciences Centre, Vascular Research Group, Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, UK Abstract: An aging atherosclerosis-prone population has led to an increase in the prevalence of atherosclerotic renovascular disease (ARVD). Medical management of this disease, as with other atherosclerotic conditions, has improved over the past decade. Despite the widespread availability of endovascular revascularization procedures, there is inconsistent evidence of benefit in ARVD and no clear consensus of opinion as to the best way to select suitable patients for revascularization. Several published randomized controlled trials have attempted to provide clearer evidence for best practice in ARVD, but they have done so with varying clarity and success. In this review, we provide an overview of ARVD and its effect on renal function. We present the currently available evidence for best practice in the management of patients with ARVD with a particular focus on revascularization as a treatment to improve renal function. We provide a brief overview of the evidence for revascularization in other causes of renal artery stenosis. Keywords: renal artery stenosis, revascularization, atherosclerotic renovascular disease, fibromuscular dysplasi