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Renal angioplasty

A renal angioplasty is a procedure used to widen the arteries that supply blood to your kidneys (your renal arteries). You may be offered this procedure if you have a condition called renal artery stenosis, which is when your renal arteries become very narrow.

If you have renal artery stenosis, your renal arteries can become so narrow that you don’t get enough blood to your kidneys. This can damage your kidneys and give you high blood pressure.

Renal artery stenosis is usually caused by fatty deposits (plaques) building up in the walls of your arteries, restricting blood flow. It can also be caused by a condition called fibromuscular dysplasia, which is when the wall of your renal artery becomes abnormally thick.

A renal angioplasty aims to widen your renal arteries to allow more blood to flow to your kidneys. The procedure involves inflating a special balloon inside your renal artery to open it up. At the same time, you may have a tiny tube called a stent put into your renal artery to keep it open.

Renal angioplasty is done by a radiologist (a doctor who specialises in using imaging methods to diagnose medical conditions). You’ll have your renal angioplasty in the X-ray department of a hospital, and you’ll probably stay overnight so the medical staff can keep an eye on you.

We’ve given a general overview of what to expect if you’re having this procedure, but the details may vary depending on your circumstances. You can discuss this more with the healthcare staff treating you.

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Image showing a blood vessel treated with balloon angioplasty and stent

Details

  • Preparation Preparing for renal angioplasty

    Your radiologist will explain how to prepare for your renal angioplasty. You’ll probably be asked not to eat or drink for a certain length of time before you have the angioplasty. This is usually for about four hours beforehand, however, it’s important to follow your radiologist’s advice.

    The procedure is usually done through a big artery in your groin, so you may be asked to shave this area. But don’t do this unless you’re asked to do so.

    It's possible to have an allergic reaction to contrast medium (the dye used during the procedure). Tell your radiologist if you know that you’re allergic to contrast medium, or have any other allergies.

    Your radiologist will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to ask questions so that you understand what will be happening. You don’t have to go ahead with the procedure if you decide you don’t want it. Once you understand the procedure and if you agree to it, you’ll be asked to sign a consent form.

  • Alternatives What are the alternatives to renal angioplasty?

    Renal angioplasty is used to treat a condition called renal artery stenosis, which can give you high blood pressure. If you have high blood pressure because of renal artery stenosis, you will be given medicines to help reduce your blood pressure. Treatment with medicines alone may be enough to manage your condition.

    You may be offered bypass surgery instead of renal angioplasty if you’re having surgery on the main arteries in your abdomen (tummy) for other reasons. Bypass surgery is an operation to make your blood flow around the blocked artery instead of through it.

    If you’re offered renal angioplasty, it’s normally in addition to taking medicines for high blood pressure. Renal angioplasty doesn’t work well for everyone. Your doctor will discuss with you any specific benefits of having renal angioplasty compared with the alternatives.

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  • The procedure What happens during renal angioplasty?

    Renal angioplasty involves inserting a plastic tube called a catheter into your renal artery (the main blood vessel supplying your kidney). This is normally done by passing the catheter up to your renal artery from an artery in your groin. Renal angioplasty takes between 30 and 90 minutes and is usually done in the X-ray department of a hospital.

    You will be asked to lie flat on your back on an X-ray table. Your radiologist may insert a cannula (fine tube) into a vein in your arm so that you can have a sedative or painkillers if you need them.

    You’ll have an injection of local anaesthetic into your skin where the catheter is to be inserted – usually in your groin. This will completely block any feeling from this area. A nurse will usually stay with you throughout the procedure to look after you. Tell the nurse if you feel any pain or discomfort during the procedure so that your doctor can give you some painkillers.

    Your radiologist will insert a guide wire into the artery in your groin using a needle. A catheter is then inserted over the wire. Your radiologist will use the X-ray equipment to make sure that the catheter reaches the right place, just near the blockage. They will then inject a dye called contrast medium through the catheter to show up how the blood flows through your renal artery. You may have a warm feeling when the contrast medium is injected. Your radiologist will then replace the catheter with one that has a balloon on the tip, which can be inflated. It may be inflated more than once to make sure the artery is wide enough. After the procedure, your radiologist will remove the balloon and catheter.

    If your radiologist thinks that your renal artery may not stay open after the balloon is deflated, they may put in a stent. This is a tiny wire mesh tube. The collapsed stent is placed over the balloon at the end of the catheter, which is inserted into your artery. When your radiologist inflates the balloon, it opens up the stent. The stent stays permanently in place once your catheter has been removed, to keep your artery open.

    Image showing a blood vessel treated with balloon angioplasty and stent

    Your radiologist will close the hole in your artery in one of two ways. They may put a special type of plug over the hole to close it, or they may put pressure on the puncture site for about 20 minutes.

  • Aftercare What to expect afterwards

    After your renal angioplasty, you’ll be taken to the ward. You’ll be asked to lie flat in bed for several hours, and to stay in bed for up to 12 hours after your procedure. It’s important to follow your nurse’s instructions. Your nurse will regularly check the puncture site.

    You’ll usually need to stay in hospital overnight.

  • Recovery Recovering from renal angioplasty

    You’ll probably have some medicines to keep you calm and relaxed during your angioplasty. This is called sedation. Sedation affects your coordination and reasoning skills for a while, so don’t drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your doctor’s advice.

    You may have some discomfort in your groin where the catheter was inserted for about a week afterwards. You may also have a bruise there.

    You may be given some medicine to take to prevent blood clots forming in your arteries.

    You can get back to your usual activities when you get home, although it’s a good idea not to do any strenuous exercise for 24 hours.

  • Risks What are the risks?

    As with any medical procedure, there are certain risks that may come with having a renal angioplasty. Ask your doctor to explain how these risks apply to you.

    Side-effects

    Side-effects are the unwanted, but mostly temporary effects you might get after having a renal angioplasty. You may have some bruising and discomfort around the area where the catheter was inserted. The bruise might be sore for a few days but it should disappear in a few weeks.

    Complications

    Complications are when problems occur during or after your angioplasty. Most people who have a renal angioplasty make a full recovery without any complications.

    Possible complications include the following.

    •  You may have some blood collecting underneath your skin where the catheter was inserted (this is called a haematoma). If the hole in your artery doesn’t close properly, this is sometimes known as a ‘false aneurysm’. About five in 100 people develop a haematoma or false aneurysm after a renal angioplasty.
    • You may get an infection in the wound in your groin. This usually isn’t serious and can be treated with antibiotics.
    • It’s possible, though unlikely, that your renal artery may become completely blocked or damaged as a result of the procedure. If this happens, you may need to have a stent to restore the blood flow to your kidney.
    • It’s possible that the catheter used in this procedure could disturb fatty deposits in the wall of your artery and cause them to break away. This may cause a blood clot in a blood vessel somewhere else in your body. This happens in about to one to two in 100 people who have the procedure.
    • You might have an allergic reaction to the contrast medium used in the procedure. Your radiologist will aim to use the lowest possible dose of contrast medium to reduce your risk of getting a reaction.

    It’s also possible that your artery may not open up as much as hoped, or may close up again later.

    It’s important to note that there’s a small risk of major complications, such as heart attack and stroke, as a result of a renal angioplasty. It’s possible that these complications could be fatal. Your risk of a major complication is likely to be higher if you have other medical problems – your doctor can tell you more. Remember that most people who have a renal angioplasty make a full recovery.

  • FAQs FAQs

    How well does renal angioplasty work?

    Answer

    Experts aren’t yet sure how well renal angioplasty works and who might benefit from it. This may depend on the type of renal artery stenosis it’s used for and whether medicines have helped. Your doctor will discuss with you whether angioplasty could help in your particular circumstances.

    Explanation

    Experts don’t yet know exactly how well renal angioplasty (with or without a stent being put in) works as a treatment for renal artery stenosis. Studies have been done in people who have renal artery stenosis caused by plaques building up on the lining of their arteries (atherosclerosis). This is the most common type of renal artery stenosis. These studies show that if you’re taking medicines for your high blood pressure, then a renal angioplasty probably won’t give you extra benefits.

    On the other hand, the studies show renal angioplasty may still be helpful for certain other people with renal artery stenosis. You are more likely to be offered renal angioplasty if your blood pressure is very difficult to treat with medicines. After your renal angioplasty, you’ll probably still have to take medicines to help keep your blood pressure down.

    The situation is different if you have renal artery stenosis caused by fibromuscular dysplasia (thickening of your renal artery). Studies in people with this type of renal artery stenosis have shown that renal angiography may sometimes cure their high blood pressure. The younger you are and the less time you’ve had it, the more likely you are to be cured. Experts say that better studies are needed before we can say for sure how well renal angioplasty works in fibromuscular dysplasia.

    Your doctor will discuss with you whether renal angioplasty is likely to help in your particular circumstances.

    My doctor has suggested I have a renal angioplasty to help reduce my blood pressure. How can a procedure on my kidney improve my blood pressure?

    Answer

    Your kidneys play an important role in keeping your blood pressure healthy. If the blood supply to your kidney falls, your kidney responds as though your blood pressure has dropped. This can make your blood pressure rise too high. Renal angioplasty opens up the artery so that the blood flow to your kidney is better.

    Explanation

    You have two kidneys which normally play a vital part in keeping your blood pressure at a healthy level. If the pressure of the blood that flows through them falls too low, they react by releasing a chemical called renin. Renin helps to produce other chemicals which increase the amount of sodium and water in your blood and make your small blood vessels (arteries) contract. Together, these effects make your blood pressure rise again.

    If the arteries to your kidneys become abnormally narrowed, as in renal stenosis, less blood is able to flow through them. Your kidneys respond as though your blood pressure has dropped. They produce renin which sets off the chain of events to raise your blood pressure. This can make your blood pressure become too high.

    Renal angioplasty opens up your renal artery so that more blood flows through to your kidney again. You may be offered renal angioplasty if you have high blood pressure due to renal artery stenosis.

    What is fibromuscular dysplasia and can renal angioplasty help?

    Answer

    Fibromuscular dysplasia is a condition that causes some of your arteries to thicken and harden. It can affect your renal arteries so your kidneys don’t get enough blood. Renal angioplasty is a procedure which opens your renal arteries to let more blood through.

    Explanation

    Your renal arteries supply your kidneys with blood. In fibromuscular dysplasia, the tissues in your renal arteries can start to thicken and harden, so less blood can get to your kidneys. This may give you high blood pressure. Fibromuscular dysplasia most commonly affects young and middle-aged women. Doctors don’t fully understand why some people develop this condition.

    If you have fibromuscular dysplasia causing high blood pressure, your doctor will offer you medicines to reduce your blood pressure. They will probably suggest you lose any extra weight, stop smoking and reduce salt in your diet. You may also be offered renal angioplasty as a way of treating your high blood pressure. Some people who have a renal angioplasty also have a stent (a tiny mesh tube) inserted to keep the artery open. But this isn’t usually needed if you have fibromuscular dysplasia.

    Whether or not you’re offered angioplasty depends on your individual circumstances. These include how long you’ve had high blood pressure and how well your medicines work to control it. Experts think renal angioplasty may be able to cure high blood pressure in some people with fibromuscular dysplasia. But there’s no strong evidence yet to say how well angioplasty works when compared with medicines to treat high blood pressure from fibromuscular dysplasia.

    If your doctor offers you renal angioplasty, ask about how this procedure may help in your own circumstances.

  • Resources Resources

    Further information

    Sources

    • Kumar P, Clark M. Clinical medicine. 8th ed. Edinburgh: Saunders; 2012
    • Renal artery stenosis. BMJ Best practice. bestpractice.bmj.com, published 8 July 2014
    • Renal artery angioplasty. Medscape. emedicine.medscape.com, published 11 September 2014
    • Renal artery stenosis. Medscape. emedicine.medscape.com, published 25 March 2013
    • Fibromuscular dysplasia. Medscape. emedicine.medscape.com, published 14 April 2014
    • Renovascular disease. PatientPlus. www.patient.co.uk/patientplus.asp, published 19 July 2012
    • Renal artery stenosis and occlusion. Merck. www.merckmanuals.com, reviewed April 2014
    • Leaper D, Whitaker I (editors). OSH Post-operative complications. 2nd Ed. Oxford: Oxford University Press; 2010
    • Nordmann A, Logan A. Balloon angioplasty versus medical therapy for hypertensive patients with renal artery obstruction. Cochrane Database of Systematic Reviews 2003, Issue 3. doi: 10.1002/14651858.CD002944
    • Renal angioplasty. Edinburgh Renal Unit. www.edren.org, published 23 April 2010
    • Angioplasty and vascular stenting. RadiologyInfo.org. www.radiologyinfo.org, reviewed 22 August 2014
    • Anesthesia. RadiologyInfo.org.  www.radiologyinfo.org, reviewed 7 October 2014
    • Cooper C, Murphy T, Cutlip D, et al. Stenting and medical therapy for atherosclerotic renal-artery stenosis. N Engl J Med 2014; 370(1):13–22
    • Weinberg M. Stenting for atherosclerotic renal artery stenosis: one poorly designed trial after another. Cleveland Clinic Journal of Medicine March 2010; 77(3);164­71. doi: 10.3949/ccjm.77a.10001
    • Renal angiogram and angioplasty. Circulation Foundation. www.circulationfoundation.org.uk, accessed 6th November 2014
    • Olin J, Gornik H, Bacharach J, et al. Fibromuscular dysplasia: state of the science and critical unanswered questions: a scientific statement from the American Heart Association. Circulation 2014; 129 (9):1048–78. doi: 10.1161/01.cir.0000442577.96802.8c 
    • Afsar B, Covic A and Kanbay M. Renal artery stenting in patients with uncontrolled hypertension: should we? And to whom? The Journal of Clinical Hypertension 2014; 16:479–81. doi: 10.1111/jch.12344
    • Trinquart L, Mounier–Vehier C, Sapoval M, et al. Efficacy of revascularization for renal artery stenosis caused by fibromuscular dysplasia: a systematic review and meta-analysis. Hypertension 2010; 56:525–32. doi: 10.1161/HYPERTENSIONAHA.110.152918
    • Chrysant G, Bates M, Sullivan T, et al. Proper patient selection yields significant and sustained reduction in systolic blood pressure following renal artery stenting in patients with uncontrolled hypertension: long-term results from the HERCULES trial. The Journal of Clinical Hypertension 2014; 16(7):497–503. doi: 10.1111/jch.12341.
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