Renal Arterial Hypertension Treatment

The kidneys are the body’s filters, removing wastes, concentrating urine, and conserving electrolytes (mineral salts) as blood flows through these organs. In a condition called renal artery stenosis, plaque made up of cholesterol or lipids (fats), calcium, and fibrous scar tissue accumulates in the arteries supplying blood to the kidneys, narrowing and stiffening them—a process called atherosclerosis. Renal artery stenosis causes high blood pressure (hypertension), and potentially, kidney failure. If you have been diagnosed with renal artery stenosis, your doctor may refer you to an interventional radiologist for a procedure called renal angioplasty and stenting.

What are angioplasty and stenting?

Angioplasty is a minimally invasive procedure during which an interventional radiologist temporarily inflates a small balloon inside a blood vessel to eliminate or reduce areas of narrowing. The goal is to restore adequate blood flow to the kidneys, a process called revascularization. During the procedure your interventional radiologist may also implant a tiny mesh-metal tube called a stent into the narrowed area, which remains as a permanent support.

How do I get ready for the procedure?

On the night before the procedure eat a light meal, then do not eat or drink anything after midnight. We will provide you with more detailed information about which medications you may take in days before and on the morning of the procedure. Plan to have someone drive you home after the procedure.

What will happen during the procedure?

After you arrive at the interventional radiology suite and change into a gown, you will lie face up on the procedure table. To relax you and block any pain we will intravenously give you a combination of medicines called “conscious sedation.” Using X-ray and/or ultrasound image guidance, we will insert a long, very thin tube called a catheter into a small incision above an artery in your arm or leg and thread it through the artery to the blocked area. Once the catheter reaches the blockage, we will inflate and deflate a tiny balloon attached to the catheter tip several times to push the plaque against the artery walls and widen the vessel. If your doctor is also placing a stent, he or she will insert it through the artery using the catheter; once at the site of the blockage it will automatically expand or we will use an attached balloon to expand it. The entire procedure takes about an hour.

Are there any risks?

Angioplasty is a safe procedure and any serious complications (reaction to contrast dye used before the procedure; a blood clot in the treated artery; a ruptured blood vessel) occur in less than 2 to 4 percent of cases. Other complications can include bleeding at the site of catheter insertion; blood pooling in the soft tissue around the affected artery (pseudoaneurysm); or arteriovenous fistula, an abnormal connection created between the artery and vein when the needle placed in the artery during the procedure passes through a vein.

After the procedure

Most people go home the same day as the procedure, but remain in bed for six to 24 hours following angioplasty to allow the access site to heal. You should avoid lifting more than 10 pounds for the first few days to avoid putting undue pressure on the insertion site. We will give you additional instructions before you go home from the interventional radiology suite.