Contemporary management of atherosclerotic renovascular disease

Atherosclerotic renovascular disease (aRVD) is an increasingly recognized cause of severe hypertension and declining kidney function. Patients with aRVD have been demonstrated to have an increased risk of adverse cardiovascular events compared with patients without aRVD. For these reasons, >45,000 renal artery revascularization procedures are performed annually, with significant growth observed in the number of procedures performed each year. The efficacy of contemporary revascularization therapies in the treatment of aRVD is unproven and controversial, with no level I data to support current practices. Lower-level data suggest that kidney function improvement is a key indicator of subsequent improved survival free of adverse cardiovascular events and dialysis, and that observed improvements of hypertension confer, at best, limited benefit. This review focuses on existing data on the management of aRVD, including data from completed and ongoing randomized clinical trials. This review also examines other existing data regarding aRVD that may guide current treatment and future research efforts into this significant clinical and public health problem until widely accepted level I evidence emerges.