Atherosclerotic plaque composition and specific endovascular considerations in the end stage renal disease patients:
Christer Ruff1,2, Christoph Artzner2, Konstantin Nikoalou2
1Department of Neuroradiology, University Hospital Tuebingen, Tuebingen, Germany.
Insights
Vascular calcification in chronic kidney disease (CKD) patients significantly predicts endovascular treatment failure and cardiovascular events. Advanced techniques and CO2 angiography offer safer options for managing peripheral arterial disease (PAD) in these complex cases.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Vascular Surgery
Background:
- Chronic kidney disease (CKD) is a significant risk factor for cardiovascular morbidity and mortality, particularly concerning vascular calcification (VC) and peripheral arterial disease (PAD).
- Patients with end-stage renal disease (ESRD) exhibit a high prevalence of atherosclerotic lesions, complicating endovascular interventions and increasing the risk of adverse cardiovascular events.
- Vascular calcification is a major predictor of poor outcomes in endovascular treatments for PAD.
Purpose of the Study:
- To examine atherosclerotic plaque composition and endovascular considerations in end-stage renal disease (ESRD) patients.
- To review current medical and interventional management strategies for arteriosclerotic disease in CKD patients.
- To present representative cases of endovascular treatment options for ESRD patients.
Main Methods:
- A comprehensive literature search was conducted on PubMed up to September 2021.
- Discussions with field experts were incorporated into the review.
- Analysis of current medical and interventional management of arteriosclerotic disease in CKD patients.
Main Results:
- High vascular calcium load is a key predictor of endovascular treatment failure and future cardiovascular events in CKD patients.
- CKD patients face increased risks of major vascular adverse events and poorer revascularization outcomes.
- Carbon dioxide (CO2) angiography is presented as a safe alternative to iodine-based contrast media, mitigating the risk of contrast-induced nephropathy (CIN) in CKD patients.
Conclusions:
- Management of vascular disease in ESRD patients is complex, requiring tailored endovascular approaches.
- New techniques like directional atherectomy and "pave-and-crack" address high vascular calcium burden.
- Aggressive medical management alongside interventional therapy is crucial for vascular patients with CKD.
Background And Objective:
Vascular calcification (VC) and resulting vascular disease is one of the major causes of cardiovascular morbidity and mortality in patients with chronic kidney disease (CKD). CKD itself is increasingly recognized as a risk factor for cardiac and peripheral arterial disease (PAD). This paper examines the atherosclerotic plaque composition and specific endovascular considerations in the end stage renal disease (ESRD) patients. The literature was reviewed regarding the current status of medical and interventional management arteriosclerotic disease in patients with CKD. Lastly, three representative cases displaying typical endovascular treatment options are provided.
Methods:
A literature search was performed in PubMed covering publications up to September 2021 as well as discussion with experts in the field.
Key Content And Findings:
The high prevalence of atherosclerotic lesions in patients with chronic renal failure and high (re-)stenosis cause problems in the medium and long term as vascular calcium load represents one of the most widely encountered predictors of failure of endovascular treatment of PAD and future cardiovascular events (e.g., coronary calcium score). Patients with CKD also suffer from a greater risk for major vascular adverse events in general and worse revascularization outcomes following peripheral vascular intervention. A correlation between calcium burden and drug-coated balloon (DCB) performance has been established for PAD necessitating the need for different tools to cope with vascular calcium such as endoprosthesis or braided stents. Patients with CKD are at a higher risk of developing contrast-induced nephropathy (CIN). In addition to recommendations such as the administration of intravenous fluids, carbon dioxide (CO2) angiography is one option to potentially provide an effective and safe alternative both to iodine-based contrast media allergy and to the use of iodine-based contrast media in patients with CKD.
Conclusions:
Management and endovascular procedures of patients with ESRD are complex. In the course of time, new endovascular therapy methods have been developed such as directional atherectomy (DA) and the so-called "pave-and-crack" technique to deal with high vascular calcium burden. Besides interventional therapy, vascular patients with CKD benefit from aggressive medical management.
More Related Videos
09:43In vivo Near Infrared Fluorescence NIRF Intravascular Molecular Imaging of Inflammatory Plaque, a Multimodal Approach to Imaging of Atherosclerosis
Published on: August 4, 2011
09:14The Rabbit Model of Accelerated Atherosclerosis: A Methodological Perspective of the Iliac Artery Balloon Injury
Published on: October 3, 2017