Some invasive procedures that are becoming increasingly common as a first line of treatment for patients diagnosed with narrowed arteries in and around the kidneys may not be necessary, according to a new study by researchers at Wake Forest University Baptist Medical Center. The study shows that the condition, known as renal artery stenosis, only progresses to a dangerous blockage in a very small percentage of cases and does not always necessitate a surgical or even minimally-invasive procedure, such as angioplasty and stenting, both of which are becoming more and more common as technology makes the narrowing easier to detect. The finding is especially timely because the number of these procedures has risen so dramatically in recent years that the federal Centers for Medicare and Medicaid Services has questioned whether such procedures are, in fact, necessary for all patients with renal artery stenosis – and whether the government should pay for them. Renal artery stenosis is the narrowing of blood vessels in and around the kidneys that can lead to declining kidney function or hypertension that is difficult to control. There is an ongoing debate about how best to treat patients with this condition. Current management options include treatment with medicine, surgical bypass of the stenosis, or approaches such as angioplasty and stenting, where a wire mesh tube is placed over a balloon and threaded through the blood vessels via a needle puncture of the skin to the area of narrowing. When the balloon is inflated, the stent expands, locks in place and forms a scaffold, permanently holding the artery open to increase blood flow. "We think these interventions are beneficial for a group of patients," said study co-author, Ross P. Davis, M.D., a vascular surgery fellow in the Department of Vascular and Endovascular Surgery. "But as physicians, we need to be careful about reserving those interventions for specific indications, not just for all patients whose ultrasound reports confirm the presence of artery narrowing. There need to be other indicators of progressive renovascular disease present to consider subjecting patients to the risks and costs of these procedures."
Link