PATIENT SELECTION Renal angiography (x-ray of the arteries supplying blood to the kidneys) is performed for patients with elevated blood pressure or impaired kidney function suspected of being due to blockage of the arteries supplying the kidneys. Patients with elevated blood pressure due to blockage of the arteries are candidates for angioplasty (repair of the artery using a balloon) if they are on 3 or more blood pressure medications or have intolerable side effects of fewer medications. In addition all patients with impaired renal function and blockage of both renal arteries are candidates for angioplasty.
PRE-PROCEDURE WORKUP Patients who are candidates for renal angiography/angioplasty are generally evaluated in our clinic by an interventional radiologist prior to the procedure. If there are no contraindications, we obtain MR angiograms on all patients prior to conventional angiography. This allows us to know the exact anatomy prior to conventional angiography which aids in minimizing iodine contrast dose. If indicated and not already completed, additional diagnostic tests may be recommended prior to angiography.
Renal MR Angiogram
POTENTIAL RISKS We discuss in detail with the patient potential risks and alternatives to the procedure. Risks include (but are not limited to) serious bleeding, infection, kidney failure, stroke and heart attack. The incidence of serious complications secondary to angioplasty is approximately 1%. If diagnostic angiography alone is performed without angioplasty the risk is approximately 0.1%. 2/3rds of patients gain some improvement in blood pressure control and can decrease the total amount of blood pressure medication. 1/3rd do not improve. Most patients treated with angioplasty for renal failure stabilize their renal function but some go on to total renal failure and require dialysis.
POST-PROCEDURE If angioplasty was performed then the patient is watched closely overnight in the intermediate care unit or intensive care unit. A catheter is placed in the bladder to carefully monitor urine output and blood thinners are given intravenously. The patient is kept in bed while the blood thinners are running to minimize the chance of bleeding at the groin puncture site. Most patients can be dismissed from the hospital the following day. If angiography alone is performed the patient can be dismissed the same day. Activity is limited to no heavy lifting or strenuous activities for 7 days post-angioplasty. Patients may go up and down stairs. They may drive the day following the procedure. Follow-up is by phone, clinic visit or follow-up with the referring physician depending on circumstances. The chance of recurrent blockage is 20% at 5 years.