Problems with blood flow to your kidneys can lead to kidney failure and high blood pressure. The Washington University and Barnes-Jewish Heart & Vascular Center offers diagnosis and treatment for renal artery stenosis and renal artery aneurysm.
Leading Care for Renal Vascular Disease
Our surgeons are committed to delivering the most promising treatment methods. At the Heart & Vascular Center, you have access to:
- Initial diagnosis and second opinions: We see many patients who are experiencing signs of kidney failure or other renal problems for the first time. We also treat people who have had diagnostic testing, or even renal stenting, at other hospitals but need further care from a specialized center.
- Full range of options: Our vascular team uses techniques that include minimally invasive approaches. You may be able to return home and recover faster.
- Collaborative care: Our physicians build lifelong relationships with their patients. You’ll receive care from vascular specialists and nephrologists (kidney specialists). We work closely together to evaluate your options and deliver the treatment that is best for your situation.
- Care for all ages: We offer one of the few holistically integrated clinics for renal vascular hypertension in children and adults. Our pediatric clinic is a cooperative effort involving vascular surgeons, pediatric cardiologists (heart specialists) and pediatric nephrologists from St. Louis Children’s Hospital.
What Is Renal Vascular Disease?
The kidneys are two bean-shaped organs in your lower back. They remove waste from your body, regulate electrolyte balance and blood pressure, and stimulate your body’s red blood cell production.
The renal artery provides blood flow to the kidneys. When this artery is blocked, it may cause kidney failure and high blood pressure. Problems with the renal artery are called renal vascular disease or renovascular disease.
Types of Renal Vascular Disease
Several conditions can affect the health of your renal blood vessels. Types of renal vascular disease include:
• renal artery stenosis, a partial blockage of the artery
• renal artery or vein thrombosis, a clot in a blood vessel to or from the kidney
• renal artery aneurysm, a bulge or weakness in the renal artery wall
• atheroembolic renal disease (AERD), when bits of plaque break off and block arteries
Causes and Risk Factors for Renal Vascular Disease
Renal vascular disease occurs more often in older people, although it can affect people of all ages. It is more common in women than in men.
People may develop renal vascular disease due to:
- atherosclerosis or “hardened arteries” resulting from a buildup of a fatty material called plaque
- fibromuscular dysplasia, a condition that weakens artery walls, mostly in young women
- pediatric renovascular disease due to genetic disorders such as Williams syndrome, neurofibromatosis type 1 (NF1) or other causes of renal artery stenosis
Other risk factors that may increase the chance of developing renal vascular disease include:
- coronary artery disease
- heavy alcohol use or substance use
- high cholesterol
- hypertension (high blood pressure)
Symptoms of Renal Vascular Disease
Symptoms of renal vascular disease include:
• sudden onset of hypertension (high blood pressure)
• hypertension that doesn’t respond to blood pressure medications
• increased urea (waste product excreted by kidneys) in blood
• unexplained kidney failure
Diagnosing Renal Vascular Disease
Tests can find the source of symptoms and check the health of the blood vessels that supply your kidneys. You may have:
- Doppler ultrasound, which uses sound waves to assess the structure and function of the kidneys and how fast blood flows through the arteries
- renal angiography, which uses X-rays and a special dye injected into the arteries to show blood flow to and from the kidneys
- magnetic resonance angiography (MRA), which uses magnetic fields and dye to visualize renal arteries
- computed tomographic angiography (CTA), which uses CT scan (X-rays and a computer) and dye to help the renal arteries show up clearly on imaging
- renography, which uses a radioactive substance injected into a vein, a special camera and a computer to evaluate kidney function and structure
Renal Vascular Disease Treatment
Not everyone needs surgery right away for renal vascular disease. Your medical team may first recommend lifestyle changes like a healthy diet and exercise. If you smoke, we help you quit. Blood pressure medications may resolve hypertension and slow kidney damage.
You may need vascular surgery if you have severely blocked renal arteries and uncontrolled hypertension despite medication. Our vascular surgeons offer procedures including:
Renal artery angioplasty and stenting
Angioplasty is an endoscopic technique (using tiny tools inside blood vessels) to clear plaque and blockages. In this minimally invasive procedure, your surgeon:
- carefully guides a catheter (flexible plastic tube) into the renal artery
- passes a guidewire through the catheter to the blockage
- inflates a small balloon, which presses plaque against the artery walls to open it and allow better blood flow to the kidney
- places a stent (wire mesh tube) across the blocked area to help keep the artery open after balloon treatment
Revascularization procedures restore blood flow. Your surgeon may use one of these procedures if you are experiencing kidney failure or if endovascular procedures do not work. Options include:
- Renal artery bypass: The vascular surgeon uses a bypass to create a detour around the narrowed or blocked segments of the renal artery. Your surgeon connects a human-made material, called a bypass graft, to the artery above and below the blocked area. The procedure creates a new path for blood to flow to the kidneys.
- Renal artery endarterectomy: In renal artery endarterectomy, your surgeon removes the inner lining of the renal artery. The inner lining of the artery contains the plaque. Removing the lining leaves a smooth, wide-open artery. The surgeon closes the artery with a patch made of vein tissue.
In severe cases where kidney damage is irreversible, you may be a candidate for a kidney transplant. Transplant surgeons replace your kidney with a donor kidney. Our center is one of the nation’s leaders in kidney transplant, performing more than 300 kidney transplants each year.
Renal artery aneurysm treatment
Treatment for a renal artery aneurysm depends on the size and location and whether or not you have symptoms. For a small aneurysm (less than 3 centimeters, or about one inch), your doctor may observe it for any changes. You may not need treatment right away.
We generally recommend surgical treatment for aneurysms that are bigger than 3 centimeters, dissecting (tearing) or causing symptoms. Surgical options for a renal artery aneurysm include:
- open repair of the aneurysm with a patch or graft
- coil embolization, when we fill the aneurysm with a wire substance to cut off its blood flow and prevent it from growing
- stent grafting to seal off the aneurysm with a tube, treating renal artery stenosis at the same time, if needed
To avoid the increased risk of rupture, we generally treat renal artery aneurysms surgically in a pregnant woman or a woman of child-bearing age.
Research and Clinical Trials for Renal Vascular Disease
We are exploring new ways to manage renal vascular disease postoperatively and instead of surgery. Research is looking into renal artery denervation, which changes some of the nerve signals going to the kidney, as a way to manage hypertension without surgery.
You may have access to investigational therapeutic options that are not ordinarily available. Other research opportunities seek to develop new knowledge to help future patients. Learn more about our innovation.
To make an appointment with a Washington University vascular specialist at Barnes-Jewish Hospital, call 314-273-7373.