There was a fourfold increase in endovascular interventions for renal artery disease in the United States between 1996 and 2005. Many assume that endovascular treatment of renal artery stenotic disease is a simple procedure requiring minimal skill. That is not the case. In fact, the appropriateness of the commonplace endovascular treatment of renal artery disease has been questioned. A detailed review of the CORAL, ASTRAL, STAR, DRASTIC, Newcastle Renal Artery Stenosis Group, Hospital Broussais, and RAOOD clinical trials∗ underscores this concern. These studies compared endovascular renal artery intervention to medical management (five trials) or surgery (one trial). In none of these trials were clear advantages ascribed to endovascular therapy. Complication rates accompanying endovascular treatments ranged from 10% to 40%, and the mortality rate was not zero. The design and conduct of these trials had many flaws, yet their influence on clinical practice has persisted. Clearly, a more rigorous set of indications and contraindications for endovascular and open surgical renal artery interventions are needed.
Selection of Patients for Open Surgical or Endovascular Treatment of Renal Artery Arteriosclerotic Disease