Current thoughts on the management of renovascular disease

Renal artery stenosis has long been recognized as a cause of systemic hypertension, and has more recently been identified as a cause of progressive renal insufficiency. The diagnosis of renal artery stenosis often has been overlooked because of the difficulty in establishing the diagnosis. Until recently, surgical intervention has been the only therapeutic modality available. This article will review some recent advances in imaging modalities, particularly duplex ultrasound and magnetic resonance angiography, which have allowed easier visibility of the renal vessels. Second, the introduction of renal percutaneous transluminal angioplasty, with and without stent placement, has made operative intervention more attractive. The early and short-term results of this procedure are discussed and compared with surgical experience. Finally, the implications for using these newer interventional techniques for minimally symptomatic renal artery stenosis are reviewed.