Renal Artery Stenosis in Nice
Dr. Ilya Khantalin, Vascular Surgeon in Alpes-Maritimes
Treatment of Renal Artery Stenosis
Dr. Ilya Khantalin in Nice
Renal artery stenosis is a vascular condition characterized by the narrowing of the arteries supplying blood to the kidneys. This narrowing reduces blood flow to the kidneys, which can impair their function and lead to complications such as high blood pressure and kidney failure.
Early detection and treatment are essential in at-risk patients to prevent worsening of these complications.
Today, arterial diseases are managed using modern techniques validated by the French National Authority for Health (HAS), combining innovation with adherence to recognized surgical protocols.
Vascular diseases are classified as Long-Term Conditions (ALD), allowing 100% coverage by French Social Security.
What is renal artery stenosis?
Vascular Surgeon in Saint-Laurent-Du-Var
The renal arteries are the main blood vessels that carry blood to the kidneys, enabling them to filter toxins and regulate blood pressure.
Renal artery stenosis occurs when the walls of these arteries thicken and stiffen due to cholesterol deposits (atherosclerotic plaques) or due to fibromuscular dysplasia, a rare structural arterial abnormality that primarily affects young women.
This narrowing decreases renal blood flow, depriving the kidneys of the necessary blood supply for proper function.
The main causes of renal artery stenosis include:
- Atherosclerosis: The leading cause in patients over 50 years old, often associated with risk factors such as hypertension, smoking, diabetes, and high cholesterol.
- Fibromuscular Dysplasia: A rare hereditary disorder affecting mostly young women and usually not linked to traditional cardiovascular risk factors.
Diagnosis and treatment of renal artery stenosis
Specialist in vascular surgery in Saint-Laurent-Du-Var
Symptoms and consequences of renal artery stenosis
Early-stage renal artery stenosis is often asymptomatic.
As narrowing progresses, clinical signs may include:
- Resistant hypertension: high blood pressure that does not respond well to conventional treatments.
- Kidney failure: impaired kidney function due to reduced blood flow.
- Edema: fluid retention, especially in the lower limbs.
In advanced cases, renal artery stenosis can cause renovascular hypertension (secondary hypertension due to reduced renal perfusion) and contribute to chronic kidney disease.
Diagnosis
Diagnosis is based on several examinations to confirm artery narrowing and assess kidney function impact. A nephrologist’s opinion is also necessary.
Examinations include:
- Doppler ultrasound of renal arteries: a non-invasive test to evaluate blood flow and detect narrowing.
- Magnetic Resonance Angiography (MRA): imaging technique to visualize renal arteries without radiation exposure.
- CT Angiography (Angioscanner): a specialized CT scan using X-rays to visualize arteries and confirm stenosis severity.
Early and accurate diagnosis is crucial to guide appropriate treatment.
Available treatments for renal artery stenosis
Medical treatment
Medical therapy is usually the first approach for moderate or asymptomatic stenosis and includes:
- Antihypertensive medications to control blood pressure.
- Statins to reduce cholesterol levels and slow atherosclerosis progression.
- Antiplatelet agents to reduce the risk of clot formation in the renal arteries.
This treatment aims to stabilize the disease and prevent progression but does not reverse the stenosis.
Angioplasty and stenting
For severe stenosis or resistant hypertension, angioplasty with stent placement may be indicated.
This procedure involves inserting a balloon catheter into the renal artery to dilate the vessel, followed by placing a stent to keep the artery open.
Angioplasty with stenting is effective in restoring blood flow to the kidney and improving blood pressure, but may not be suitable for patients with severe artery calcification.
Renal artery bypass surgery
In rare cases, surgery may be necessary. This complex procedure, called renal artery bypass, creates a new pathway for blood flow around the narrowed area. It is performed through an abdominal incision and is mainly reserved for patients who cannot undergo angioplasty.
Indications and treatment choice
Treatment decisions depend on several factors:
- Kidney function status: treatment is recommended if stenosis impairs kidney function.
- Severity of hypertension: difficult-to-control blood pressure despite medication justifies interventional treatment.
- Associated symptoms: edema or signs of heart failure may also indicate the need for treatment.
A thorough evaluation by a nephrologist is essential to determine the most appropriate therapy.
Follow-up and prognosis after treatment
Medical follow-up is crucial after treating renal artery stenosis to:
- Monitor blood pressure response and adjust medications.
- Regularly test kidney function to ensure proper renal performance.
- Perform imaging studies (ultrasound or CT angiography) to confirm the artery remains open.
In many cases, treatment significantly improves blood pressure control and kidney function. However, patients must continue managing risk factors such as smoking and cholesterol to prevent recurrence.