MetroHealth Heart & Vascular Center
Renal Artery Angioplasty and Stenting
What are renovascular
• Renovascular conditions affect the blood vessels of your kidneys.
• When the blood flow is normal through your kidneys, your kidneys rid
your body of wastes. The kidneys filter these wastes into your bladder, and they
exit your body through your urine.
• When your kidney blood vessels narrow or have a clot, your kidney is
less able to do its work.
• Your physician may diagnose you with renal artery stenosis or renal
• Renal artery stenosis is the narrowing of kidney arteries. This
condition causes high blood pressure and may eventually lead to kidney failure.
• Renal vein thrombosis means that you have a blood clot blocking a vein
in your kidney. Blood clots in renal veins are uncommon and rarely affect the
kidney, but they can sometimes travel to and lodge in arteries supplying your
lungs, causing a dangerous condition called a pulmonary embolism.
What are the symptoms?
• You may not notice any symptoms. Renovascular conditions develop
slowly and worsen over time.
• If you have high blood pressure, the first sign that you may have
renal artery stenosis is that your high blood pressure may become worse or the
medications that you take to control your high blood pressure may not be
• Other signs of renal artery stenosis are a whooshing sound in your
abdomen that your physician hears through a stethoscope, decreased kidney
function, and congestive heart failure.
• In renal vein thrombosis, a clot in your vein may
break free and block a healthy blood vessel. If this happens, symptoms may
• Pain in the sides of your abdomen, legs, or
• Blood in your urine
in your urine
• A enlarged kidney that your physician can
• Fever, nausea, or vomiting
• Sudden, severe swelling in your
• Difficulty breathing
What causes renovascular conditions?
• Hardening of the arteries causes renal artery stenosis.
• Your arteries are normally smooth and unobstructed on the inside but,
as you age, a sticky substance called plaque can build up in the walls of your
arteries. Cholesterol, calcium, and fibrous tissue make up this plaque. As more
plaque builds up, your arteries narrow and stiffen.
• This is the process of atherosclerosis, or hardening of the arteries.
Eventually, enough plaque builds up to interfere with blood flow in your renal
• Smoking, obesity, advanced age, high cholesterol, diabetes, and a
family history of cardiovascular disease are factors that increase your chances
for developing atherosclerosis.
• Nephrotic syndrome is the most common cause of a clot in the renal
vein (renal vein thrombosis). Nephrotic syndrome is a condition in which large
amounts of a protein called albumin leak into your urine.
• Other causes of renal vein thrombosis include injury to the vein,
infection, and a tumor.
What tests will I need?
Your physician will recommend the following tests to help determine if you
have renal artery stenosis:
• Ultrasound: allows your physician to see your blood vessels and organs
using high-frequency sound waves. With ultrasound, your physician can locate
clots inside your arteries and determine the size of your kidney
• Angiography: locates a narrowing or blockage, measures blood
flow, and removes blood for testing. In this test, your physician injects a
contrast dye into your vessels and then takes x-rays. The structure inside of
your vessels appears on the x-ray because x-rays cannot pass through the dye.
This test finds the location and pattern of blockages in your kidney blood
• Spiral computed tomography (CT) scan: creates detailed
three-dimensional images from x-rays of slices of your body
• Magnetic resonance angiography (MRA: uses magnetic fields and radio
waves to produce three-dimensional images of your arteries
• Radionuclide scanning:uses a radioactive substance and a special
camera to analyze the blood flow through your kidney
How are renovascular conditions treated?
• If your physician diagnoses renal artery stenosis, he or she may
prescribe blood pressure medications.
Some medications may
enzyme (ACE) inhibitors
• Calcium channel blockers
• If you experience sudden blockage in your renal artery, your physician
may recommend a procedure called thrombolysis.
• In thrombolysis, a vascular physician injects a clot-dissolving
medication directly to a clot through a long, thin tube called a catheter.
• If your physician diagnoses renal vein
thrombosis, he or she may give you anticoagulants. These medications decrease
your blood's ability to clot. In critical cases of renal vein thrombosis, your
physician may perform thrombolysis.
Angioplasty and stenting
• If your renal artery is partially or completely blocked, your
physician may recommend a procedure called angioplasty and stenting.
• To perform this procedure, your physician inserts a catheter through
a small incision and guides it through your blood vessels to your renal artery.
• The catheter carries a tiny balloon that inflates
and deflates, flattening the
plaque against the walls of your artery.
• Next, your physician may insert a tiny metal-mesh tube called a stent
in the artery to hold it open.
• Two surgical procedures that your physician may use to treat renal
artery stenosis are endarterectomy and surgical bypass.
• In a renal endarterectomy, a vascular surgeon removes the inner lining
of your renal artery, which contains the plaque. This removes the plaque and
leaves a smooth, wide-open artery.
• Bypass surgery creates a detour around the narrowed or blocked
sections of your renal artery.
• To create this bypass, a vascular surgeon connects one of your veins
or a tube made from man-made materials above and below the area that is blocked.
This creates a new path for your blood to flow to your kidneys.
• The choice of the procedure that is best for your situation depends
upon the extent and location of the blockages.
What can I expect?
Your vascular surgeon will discuss the treatment options with you and decide
on the treatment that is right for you.
Angioplasty and stenting
• Prior to your procedure, tests may be scheduled such as blood work,
electrocardiogram (ECG), and chest x-ray. These may be done at a separate
appointment, or the day of the procedure
• Angioplasty or stenting is commonly done as an outpatient procedure,
although some patients are hospitalized (inpatients)
• You can wear whatever you like to the hospital. You will wear a
hospital gown during the procedure.
• If you normally wear dentures, glasses or a hearing assist device,
plan to wear them during the procedure to assist with communication.
• Your doctor or nurse will give you specific instructions about what
you can and cannot eat or drink before the procedure.
• Ask your doctor what medications should be taken on the day of your
test. You may be told to stop certain medications, such as Coumadin (warfarin, a
• If you have diabetes, ask your physician how to adjust your
medications the day of your test.
• Tell your doctor and/or nurses if you are allergic to anything,
especially iodine, shellfish, x-ray dye, penicillin-type medications, latex or
rubber products (such as rubber gloves or balloons).
• You may or may not return home the day of your procedure. When you are
able to return home, arrange for a companion to bring you home.
• Please bring a list of your medications (including over-the-counter)
and dosages. When you arrive for your appointment, please tell your nurse if you
are taking Coumadin (warfarin), Plavix (clopidogrel), diuretics (water pill) or
• You will be given a hospital gown to wear. A nurse will start an
intravenous (IV) line in your arm so that medications and fluids can be
administered during the procedure.
• You will lie on a special table and you will be able to watch your
procedure on the monitors.
• The nurse will clean your skin at the site where the catheter (narrow
plastic tube) will be inserted (arm or groin). The catheter insertion site may
• Sterile drapes are used to cover the site and help prevent infection.
It is important that you keep your arms and hands down at your sides, under the
• Electrodes (small, flat, sticky patches) will be placed on your chest.
The electrodes are attached to an electrocardiograph monitor (ECG), which
monitors your heart rate and rhythm.
• You will be given a mild sedative to relax you, but you will be awake
and conscious during the entire procedure.
• In some cases, a catheter may be placed into your bladder during the
• The doctor will use a local anesthetic to numb the site. A plastic
introducer sheath (a short, hollow tube through which the catheter is placed) is
inserted in a blood vessel in your arm or groin. A catheter will be inserted
through the sheath and threaded to the arteries of your heart. You may feel
pressure as the introducer sheath or catheter are inserted, but you should not
feel pain. Tell the nurse or doctor if you feel any pain.
Angiography is usually performed again at the beginning of the angioplasty
procedure or sometimes the angioplasty procedure is performed at the time of the
Please tell the doctor or nurses if you feel:
• itching, tightness in the throat (allergic
• chest discomfort
• any other
After the procedure:
• The catheters and sheath are removed.
• The incision will be closed with applied pressure, suture device or a
"plug." A "plug" is a material which works with your body's natural healing
processes to form a clot in the artery. You will need to lie flat and keep the
leg straight for two to six hours to prevent bleeding (less time if a plug was
used). Your head cannot be raised more than 30 degrees (2 pillows high). Do not
try to sit or stand.
• A sterile dressing will be placed on the angio site to protect it from
infection. The nurse will check your bandage regularly, but call your nurse if
you think you are bleeding (have a wet, warm sensation) or if your toes begin to
tingle or feel numb.
• You will need to drink plenty of liquids to clear the contrast
material from your body. You may feel the need to urinate more frequently. This
is normal. If you are on bed rest, you will need to use a bedpan or urinal.
• Your doctor will tell you if you are able to return home or will need
to stay overnight. In either case, you will be monitored for several hours after
• Treatment, including medications, diet and future procedures, will be
discussed with you prior to going home. Care of the wound site, activity and
follow-up care will also be discussed.