Endovascular techniques in the diagnosis and treatment of hypertension

Abstract

We consider endovascular techniques used for the diagnosis and treatment of hypertension. Endovascular techniques can determine, for example, the level of renin not only from the peripheral blood, and each of the renal veins, which is very important in the diagnosis of renovascular hypertension. Angiography of the renal arteries is the «gold standard» for diagnosing renal artery stenotic lesion. The essential role played by the radiologists in the treatment of hypertension as secondary, and essential, and the most relevant when drug therapy is powerless. Arsenal of means of endovascular techniques used in the treatment of kidney disease is growing – it stenting renal artery embolization of renal vessels, renal denervation. However, despite the positive aspects in the use of endovascular approach requires a very strict selection of patients. As shown by the experience stenting of hemodynamically significant stenosis of the renal arteries with the existing clinic hypertension does not always lead to the normalization of the systemic blood pressure. The same situation is observed in the use of radiofrequency ablation in the treatment of hypertension. The uncontrolled use of endovascular techniques may reduce the effectiveness of interventions and increase the number of intraand postoperative complications.

Keywords

hypertension / secondary hypertension / renal artery stenosis / hypertonic disease / blood rennin level / renal artery stenting / renal artery embolization / renal denervation

References

[1] Барсуков, А.В. Артериальная гипертензия. Клиническое профилирование и выбор терапии / А.В. Барсуков, С.Б. Шустов. – СПб.: ЭЛБИ СПб, 2004. – 249 с.

[2] Гордиенко, А.B. Особенности медикаментозной терапии у больных артериальной гипертензией. Практические вопросы рациональной антигипертензивной терапии / А.B. Гордиенко [и др.] // Врач. – 2011. – № 14. – С. 41–44.

[3] Козлов, К.Л. Хирургическое лечение ишемической болезни сердца у больных пожилого и старческого возраста / К.Л. Козлов [и др.]. – М.: Изд-во РАМН. – 2007. – 354 с.

[4] Козлов, К.Л. Рентгенэндоваскулярные методы лечения при вазоренальной гипертензии: учебно-методические рекомендации / К.Л. Козлов [и др.]. – СПб., 2015. – 36 с.

[5] Шальнова, С.А. Распространенность артериальной гипертонии в России: информированность, лечение, контроль / С.А. Шальнова [и др.] // Профилактика заболеваний и укрепление здоровья. – 2001. – № 2. – С. 3–7.

[6] Alhamid, Naji. Renal Artery Embolization for Managing Uncontrolled Hypertension in a Kidney Transplant Candidate / Naji Alhamid [et al.] // Avicenna Journal of Medicine. – 2013. – Vol. 3. – P. 23–25.

[7] Bhatt, D.L. SYMPLICITY HTN-3 Investigators. A controlled trial of renal denervation for resistant hypertension / D.L. Bhatt [et al.] // N. Engl. J. Med. – 2014. – Vol. 370. – P. 1393–1401.

[8] DiBona, G.F. Translational medicine: the antihypertensive effect of renal denervation / G.F. DiBona, M. Esler // Am. J. Physiol. Regul. Integr. Comp. Physiol. – 2010. – Vol. 298. – P. 245–253.

[9] Eirin, A. Renal vein cytokine release as an index of renal parenchymal inflammation in chronic experimental renal artery stenosis / A. Eirin [et al.] // Nephrology Dialysis Transplantation. – 2014. – Vol. 29. – P. 274–282.

[10] Esler, M. The sympathetic nervous system through the ages: from Thomas Willis to resistant hypertension / M. Esler // Exp. Physiol. – 2011. – Vol. 96. – P. 611–622.

[11] Hasbak, P., Hypertension and renovascular disease: follow-up on 100 renal vein renin samplings / P. Hasbak, L.T. Jensen, H. Ibsen // Journal of Human Hypertension. – 2002. – Vol. 16. – P. 275–280.

[12] Hansen, K.J. Prevalence of renovascular desease in eldery: a populaton based study / K.J. Hansen [et al.] // J. Vasc. Surg. – 2002. Vol. 36. – P. 443–451.

[13] Hirsch, A.T. Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation / A.T. Hirsch [et al.] // Circulation. – 2006. – Vol. 113. – P. 463–654.

[14] Ginat, D.T. Transcatheter renal artery embolization: clinical applications and techniques / D.T. Ginat, W.E. Saad, U.C. Turba // Tech. Vasc. Interv. Radiol. – 2009. – Vol. 12. – P. 224–239.

[15] Ginat, D.T. Transcatheter renal artery embolization for management of renal and adrenal tumors / D.T. Ginat, W.E. Saad, U.C. Turba // Tech. Vasc. Interv. Radiol. – 2010. – Vol. 13. – P. 75–88.

[16] Gruntzig, A. Treatment of renovascular hypertension with percutaneous transluminal dilation of a renalartery stenosis / A. Gruntzig [et al.] // Lancet. – 1978. – Vol. 311. – P. 801–802.

[17] Kothary, N. Renal angiomyolipoma: long-term results after arterial embolization / N. Kothary [et al.] // J. Vasc. Interv. Radiol. – 2005. – Vol. 16. – P. 45–50.

[18] Murphy, T.P. Increase o f utilization of percutaneous renal artery interventions / T.P. Murphy, G. Soares, M. Kim // American Journal of rentgenology. – 2004. – Vol. 183. – P. 561–568.

[19] Patel, H. Renal denervation for hypertension: where are we now? / H. Patel, C. di Mario // Br. J. Cardiol. – 2013. – Vol. 20 – P. 142–147.

[20] Ramon, J. Renal angiomyolipoma: long-term results following selective arterial embolization / J. Ramon [et al.] // Eur. Urol. – 2009. – Vol. 55. – P. 1155–1161.

[21] Rees, C.R. Palmaz stent in atherosclerotic stenoses involving the ostia of the renal arteries: preliminary report of a multicenter study / C.R. Rees [et al.] // Radiology. – 1991. – Vol. 181. – P. 507–514.

[22] Safian, R.D. Renal artery stenosis / R.D. Safian, S.C. Textor // N. Engl. J. Med. – 2001. – Vol. 344. – P. 431–442.

[23] Tegtmeyer, C.J. Percutaneous transluminal angioplasty for the treatment of renovascular hypertension / C.J. Tegtmeyer [et al.] // JAMA. – 1981. – Vol. 246. – P. 2068–2070.

[24] Trnka, P. Reninoma: An Uncommon Cause of Renin-Mediated Hypertension / P. Trnka // Frontiers in Pediatrics. – 2014. – Vol. 2. – P. 89.

[25] Weber, B.R. Renal artery stenosis: epidemiology and treatment / B.R. Weber, R.S. Dieter // International Journal of Nephrology and Renovascular Disease. – 2014. – Vol. 7. – P. 169–181.

RIGHTS & PERMISSIONS

Eco-Vector