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Debris Released During Procedure May Harm Kidney Function
Researchers measure particles during angioplasty and stenting of kidney arteries
CHICAGO (June 29, 2007) —
Investigators from the Wake Forest University (WFU) School of Medicine in Winston-Salem N.C. and University of California at San Francisco report that debris liberated during angioplasty and stenting of the kidney arteries may harm kidney function. Details of this research has been published in the July Journal of Vascular Surgery.
Matthew Edwards, MD, lead researcher and vascular and endovascular surgeon at WFU School of Medicine, said blood was collected from kidney arteries immediately after the performance of an angioplasty and stent procedure in 28 patients. The procedures were performed with distal embolic protection using a commercially available temporary balloon occlusion and aspiration catheter system.
“Blood analysis revealed thousands of particles (average of more than 2,000 per procedure) which were large enough to block the small blood vessels in the kidney,” said Dr. Edwards. “These increasing amounts of debris collected were directly related to worse kidney function following the procedures.”
Angiograms, demographics and laboratory data were reviewed and the filtration rate was estimated before each procedure as well as four to eight weeks post-operative. Significant associations were observed between procedural and anatomic factors, and the amount of captured debris, including renal stent size, preoperative aspirin use, predilation and the ratio of renal artery stent diameter to artery diameter.
“Blockages of the kidney arteries affect up to 3.5 million Americans age 65 years and older and are an increasingly recognized cause of severe high blood pressure and kidney failure,” added Dr. Edwards. “Treating blockages with surgery, or angioplasty and stenting, to try and improve blood pressure control and kidney function as well as subsequent survival while reducing debris particles is essential, so the patient can be free from heart attacks, strokes and dialysis.”
Dr. Edwards added that further investigation is warranted to establish relationships between atheroembolism, end organ functional impairment and clinical responses. “Our results provide unique insight into the complications of renal artery stenting and guidance so we may move forward with important research designed to improve treatments for this increasingly common disease. Embolic protection devices now exist that may prevent the passage of this debris into the kidney and lead to better patient outcomes. We are currently performing a clinical trial to get this answer.”
Matthew Edwards, MD, lead researcher and vascular and endovascular surgeon at WFU School of Medicine, said blood was collected from kidney arteries immediately after the performance of an angioplasty and stent procedure in 28 patients. The procedures were performed with distal embolic protection using a commercially available temporary balloon occlusion and aspiration catheter system.
“Blood analysis revealed thousands of particles (average of more than 2,000 per procedure) which were large enough to block the small blood vessels in the kidney,” said Dr. Edwards. “These increasing amounts of debris collected were directly related to worse kidney function following the procedures.”
Angiograms, demographics and laboratory data were reviewed and the filtration rate was estimated before each procedure as well as four to eight weeks post-operative. Significant associations were observed between procedural and anatomic factors, and the amount of captured debris, including renal stent size, preoperative aspirin use, predilation and the ratio of renal artery stent diameter to artery diameter.
“Blockages of the kidney arteries affect up to 3.5 million Americans age 65 years and older and are an increasingly recognized cause of severe high blood pressure and kidney failure,” added Dr. Edwards. “Treating blockages with surgery, or angioplasty and stenting, to try and improve blood pressure control and kidney function as well as subsequent survival while reducing debris particles is essential, so the patient can be free from heart attacks, strokes and dialysis.”
Dr. Edwards added that further investigation is warranted to establish relationships between atheroembolism, end organ functional impairment and clinical responses. “Our results provide unique insight into the complications of renal artery stenting and guidance so we may move forward with important research designed to improve treatments for this increasingly common disease. Embolic protection devices now exist that may prevent the passage of this debris into the kidney and lead to better patient outcomes. We are currently performing a clinical trial to get this answer.”
About Journal of Vascular Surgery
Journal of Vascular Surgery provides vascular, cardiothoracic and general surgeons with the most recent information in vascular surgery. Original, peer-reviewed articles cover clinical and experimental studies, noninvasive diagnostic techniques, processes and vascular substitutes, microvascular surgical techniques, angiography and endovascular management. Special issues publish papers presented at the annual meeting of the Journal's sponsoring society, the Society for Vascular Surgery. Visit the Journal Web site.
About the Society for Vascular Surgery
The Society for Vascular Surgery (SVS) is a not-for-profit medical society that seeks to advance excellence and innovation in vascular health through education, advocacy, research and public awareness. SVS is the national advocate for 2,400 vascular surgeons dedicated to the prevention and cure of vascular disease.
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© 2008 VascularWeb. All rights reserved. Use of the VascularWeb site constitutes acceptance of all of the policies, rules and regulations for the site.