Revascularization as the treatment of choice in atherosclerotic renal artery stenosis

The prevalence of renal artery stenosis (RAS) is more common than previously thought. It is the most common secondary cause of hypertension and is associated with progressive renal failure. RAS is an independent risk factor for cardiovascular mortality. Non invasive testing for RAS including renal artery duplex, magnetic resonance imaging, and computed tomography angiography are widely available. Percutaneous transluminal renal angioplasty and stenting (PTRAS) is the contemporary treatment of choice for atherosclerotic RAS and has been shown to improve the control of hypertension and preserve renal function in appropriately selected patients. Surveillance duplexes should be performed to assess in-stent restenosis. This article provides a contemporary review of the epidemiology, laboratory and imaging techniques, appropriate selection of patients with RAS who may benefit from PTRAS and associated complications.