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Revascularization for Renovascular Disease: A Scientific Statement From the American Heart Association

Vivek Bhalla, Stephen C Textor, Joshua A Beckman

    Hypertension (Dallas, Tex. : 1979)
    |June 16, 2022
    PubMed

    Insights

    Renal revascularization may benefit select patients with renovascular disease, despite mixed trial results. This statement clarifies which patients can benefit from diagnostic workup and intervention.

    Area of Science:

    • Cardiovascular Medicine
    • Nephrology
    • Hypertension

    Background:

    • Renovascular disease causes secondary hypertension and renal ischemia.
    • Randomized trials show renal revascularization is not superior to medical therapy for most atherosclerotic cases.
    • This has led to reduced diagnostic workup and revascularization use.

    Purpose of the Study:

    • To review randomized trial limitations in renal revascularization.
    • To identify specific patient populations who benefit from revascularization.
    • To guide healthcare professionals and the public on diagnostic workup and treatment.

    Main Methods:

    • Review of randomized trials on renal revascularization.
    • Analysis of clinical experience from hypertension centers.
    • Synthesis of evidence for selective revascularization scenarios.

    Main Results:

    • Most trials fail to show broad benefit of revascularization over medical therapy.
    • Specific patient groups may still benefit from diagnostic workup and intervention.
    • Identification of criteria for selective referral and revascularization is needed.

    Conclusions:

    • Selective renal revascularization can be beneficial for specific patient populations.
    • Further research is needed to define optimal patient selection and treatment strategies.
    • Guidelines should be updated to reflect evidence for selective revascularization.

    Keywords:
    AHA Scientific Statementsheart failurehypertension, renovascularrenal artery obstruction

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