Renal angioplasty and or stenting for renal hypertension

What is Renal Angioplasty / stent?

Renal artery angioplasty and stenting is a medical procedure used to treat renal artery stenosis, which is the narrowing of one or both renal arteries. These arteries supply blood to the kidneys, and if they become narrowed, it can lead to high blood pressure, kidney damage, and other complications.

During the procedure, a small incision is made in the groin area, and a catheter is inserted into the femoral artery. The catheter is then guided up to the renal artery using X-ray guidance. Once the catheter is in place, a small balloon is inflated to widen the narrowed artery. In some cases, a stent (a tiny mesh tube) is also placed in the artery to help keep it open.

The procedure is typically performed under local anesthesia, and patients may be able to go home the same day or stay in the hospital overnight for observation. Renal artery angioplasty and stenting can be an effective treatment for renal artery stenosis, and it may help improve kidney function and reduce the risk of complications. However, like any medical procedure, it does carry some risks, and patients should discuss the benefits and risks with their healthcare provider before undergoing the procedure.

Why is it done?

It is done if there is a blockage and narrowing of the artery. The most common obstructive disease is atherosclerosis (vascular stiffness). As much blood will go away, complaints will disappear or decrease. The procedure can be performed in the presence of hypertension, which does not respond to medical treatment due to stenosis in the renal artery,  in the presence of impaired renal function, in the presence of heart failure.

How is it done?

Angiography is performed before. The angioplasty catheter is placed in the occluded or narrowed vessel. The balloon is inflated and the clogged vessel is opened. If some complications have developed in the vessel during the expansion process, if sufficient clearance has not occurred, the stent, which keeps the vessel open continuously, is placed at the level of obstruction. First, angioplasty and then stent placement or special stents loaded on the balloon and placed by inflating the balloon are used.

Risks and Complications of Renal Angioplasty / Stent Procedure:

1- Catheter and balloon can cause vascular damage.

2-Coagulation in the artery

3- When only angioplasty is applied, the obstruction may not be opened. In this case, the stent is inserted.

4-Bleeding may occur during insertion of the catheter at the entry site.

5- When the operation is applied to the vessels going to the brain, stroke (paralysis) may occur.

6- Vascular occlusion can usually occur within 24 hours, medications, angioplasty and stent placement may need to be repeated, or emergency surgical treatment may be required.

Required Procedures Before Renal Angioplasty / Stent Procedure:

1- Before the procedure, the patient should be fasting for at least 8 hours. Fluid intake should continue until 8 hours before the procedure. After that, fluid intake will be done intravenously. This condition is not required in an emergency.

2- Before the procedure, hemostasis tests (INR, APTT, fibrinogen, platelet count) showing the coagulation properties of the blood and tests for blood-borne diseases (HBs, HIV and HCV) must be performed. If hemostasis tests are not at the desired level, anticoagulant drugs should be discontinued and appropriate treatment should be given. Patients using oral anticoagulant drugs should discontinue their medication 3-4 days before the procedure.

      BUN and creatinine tests should also be done, as the contrast agent used may cause kidney damage.

      Before the procedure, the patient should continue to take medications such as heart and blood pressure medications that he regularly uses. If the patient takes his medication in the morning, he should drink it with a small amount of water.

      Those with diabetes should not take diabetes-related blood sugar-lowering drugs because they are hungry. Patients using metformin (glucophage) as a sugar reducer should definitely inform their doctor, this drug should not be used for 48 hours before and after the procedure.

      It is necessary to shave the groin area to be entered 1 day before the procedure.

Required Actions After the Procedure

      After the procedure is finished, the bleeding will be stopped by manually pressing the entry site. After the bleeding is stopped, a sandbag will be placed on the entry site to prevent bleeding again.

      The patient will lie in bed for at least 4 hours after the procedure and lie flat without bending his leg. During this time he will not get up for his needs. Food can be eaten after the procedure unless otherwise stated. In order to avoid some side effects of the contrast agent, it will be beneficial to take plenty of fluids. The patient will be kept under observation in the hospital for a while.