Bilateral renal artery revascularisation in heart failure

Area of Science:

• Cardiology
• Nephrology
• Vascular Medicine

Background:

• Heart failure with reduced ejection fraction (HFrEF) management is complicated by renal artery stenosis (RAS).
• RAS is a contraindication for angiotensin-converting enzyme (ACE) inhibitors, a cornerstone therapy for HFrEF.
• Optimal medical therapy for HFrEF is often unattainable in patients with concurrent RAS.

Observation:

• A case of severe left ventricular systolic dysfunction with bilateral RAS is presented.
• The patient could not tolerate standard HFrEF medications due to RAS.
• Bilateral renal artery revascularization was performed.

Findings:

• Following revascularization, ACE inhibitors (enalapril) were safely reintroduced.
• The patient later tolerated sacubitril valsartan, a combination therapy.
• Successful revascularization enabled guideline-directed medical therapy for HFrEF.

Implications:

• Renal artery angioplasty and stenting can be a viable option for selected RAS patients with HFrEF.
• Revascularization may overcome contraindications to essential HFrEF medications.
• This approach can improve outcomes for patients with combined cardiovascular and renal conditions.