Complications. Serious or potentially serious complications (ie, bleeding, renal artery injury, need for hemodialysis) were seen in 13% to 25% of patients who underwent angioplasty.2,5,7 Combining 3 studies (n=632), there were 5 procedurerelated deaths.5,7,10
Worsened patient survival correlated with Cr >1.7 mg/dL or age >70 (OR=9.96, P<.0001 and OR=3.4, P=.001, respectively). Worsened renal survival was present in the same subgroups (OR=7.8, P<.001 and OR=2.7, P<.01, respectively).7
Recommendations from others
The American Heart Association lists 3 clinical criteria for revascularization: 1) hypertension (accelerated, refractory, or malignant), 2) renal salvage, 3) cardiac disturbance syndromes (recurrent “flash” pulmonary edema or unstable angina with significant RAS).11 JNC 7 does not recommend looking for RAS unless hypertension is uncontrollable.12
The Society of Nuclear Medicine recommends that only moderate- to high-risk individuals be screened for RAS. This guideline clarifies that RAS does not equal renovascular hypertension and that the future “gold standard” diagnosis of renovascular hypertension should be the response to successful revascularization.13
