Renovascular Disease Treatment

Renal vascular disease, also known as renovascular disease, refers to several medical conditions that affect the arteries and veins found in the kidneys. It is a type of vascular disease.

Because the kidneys are responsible for critical functions — including filtering wastes from the bloodstream and regulating blood pressure — any damage or disease that affects blood flow through the kidneys can have profound long-term effects, ranging from severe hypertension to kidney failure.

That’s why it’s important for someone with symptoms of kidney disease, including uncontrolled high blood pressure, to seek care from a physician trained to manage renal vascular disorders. With early detection, problems affecting the renal veins and arteries can be treated.

Scripps vascular surgeons have experience caring for the full range of disorders that affect the veins and arteries in the kidney, including:

• Renal artery stenosis, is a condition that occurs when the arteries that carry blood to the kidneys become narrowed or blocked, often due to plaque build-up.
• Renal artery thrombosis occurs when a blood clot forms and blocks blood flow in one of the renal arteries. If not treated, renal artery thrombosis can cause kidney failure.
• Renal vein thrombosis means there is a blood clot blocking one of the veins that carries blood away from your kidneys. While blood clots in the renal veins don’t always impact the kidney, they can travel through your bloodstream and block one of the arteries that carries blood to your lungs, a condition known as pulmonary embolism.
• Renal artery aneurysm refers to a weak, bulging area in a renal artery wall. The larger the aneurysm, the increased risk that it will eventually burst.
• Renal hypertension, also known as renovascular hypertension, refers to high blood pressure caused by narrowed arteries in the kidneys.
• Fibromuscular dysplasia is a rare condition caused by abnormal cell growth in an artery wall. While fibromuscular dysplasia can occur anywhere in the body, it often presents in the renal arteries, causing renal hypertension and poor kidney function.
• End-stage renal kidney disease (ESRD), or kidney failure, is a permanent condition that occurs when the kidneys can no longer function on their own, requiring either life-long dialysis or kidney transplant. ESRD may result from untreated renal vascular disease, including renal artery stenosis or renal artery aneurysm, or it may be caused by other forms of kidney disease. No matter the cause, people with kidney failure must undergo either hemodialysis or peritoneal dialysis in order to survive.

While vascular surgeons do not manage long-term care for people on dialysis, they often collaborate with nephrologists to surgically create “dialysis access” for patients who are about to begin dialysis treatments.

People with renal artery disease typically do not experience symptoms until their condition has become advanced, because plaque slowly builds up in the arteries over many years. However, people who smoke or who have diabetes may experience symptoms at a younger age.

Often, the first sign of renal vascular disease is high blood pressure, especially when it does not get better or becomes worse even with medication. Other symptoms include:

• Sudden and significant increase in blood pressure
• Blood in the urine
• Reduced kidney function
• Unexplained kidney failure

Risk factors for renal vascular disease can include:

• Age (50 or older)
• Smoking
• Diabetes
• High cholesterol
• High blood pressure
• Female gender, primarily because renal vascular disease is often present in women who have a vascular condition called fibromuscular dysplasia

Scripps doctors can detect renal vascular disease using one or more of the following tests:

• Doppler ultrasound, an imaging study that allows doctors to assess how blood is flowing through a blood vessel
• Conventional angiography, a procedure to open narrowed or blocked blood vessels that supply blood to the heart
• Magnetic resonance angiography (MRA), a type of MRI that is used to look at blood vessels and the way blood is flowing through them
• Computed tomography angiography (CTA), a procedure where contrast dye is placed intravenously (IV) and then used by the CT scanner to create the images of blood vessels
• Computed tomography (CT) scan, a painless, noninvasive way to see inside the body using X-ray imaging

Scripps is proud to offer the full spectrum of care for people with kidney disease, including top of the line treatment for complex and rare renal vascular conditions. Our vascular surgeons perform the following traditional vascular surgery and endovascular surgery (minimally invasive procedures) to repair renal veins and arteries and minimize damage to the kidneys:

• Renal angioplasty and stenting is an endovascular procedure that uses a balloon-tipped catheter to first inflate a narrowed renal artery or vein, and then place a tiny mesh cylinder called a stent to keep the blood vessel permanently propped open.
• Renal endarterectomy is when a vascular surgeon removes the inner layer of the renal artery, which contains the plaque that is restricting blood flow. Once the plaque is removed, the artery is once again smooth and unobstructed.
• Arterial bypass surgery is when a vascular surgeon creates a detour around the narrowed or blocked portion of a renal artery. This “bypass,” made from one of your own veins or from synthetic material, allows blood to reroute around the blockage and flow into the kidneys.
• Thrombolysis is used to dissolve a blood clot by injecting clot-busting medication directly into the blocked renal vein.
• Dialysis access is a procedure reserved for people with kidney failure who depend on dialysis to survive. Scripps vascular surgeons have experience placing peritoneal dialysis catheters, as well as creating both kinds of long-term hemodialysis access, called arteriovenous (AV) fistula and arteriovenous (AV) graft. They also manage short-term hemodialysis access via central venous catheter placement, for patients who need to start hemodialysis quickly and need temporary access before their AV fistula or graft has been created.

Scripps Health offers comprehensive endovascular and vascular treatment in San Diego at the following locations:

• Scripps Clinic Carmel Valley
• Scripps Clinic John R. Anderson V Medical Pavilion
• Prebys Cardiovascular Institute
• Scripps Green Hospital
• Scripps Memorial Hospital Encinitas
• Scripps Memorial Hospital La Jolla
• Scripps Mercy Hospital San Diego