Contemporary management of atherosclerotic renovascular disease: Before and after ASTRAL

Abstract

Atheromatous renovascular disease is an increasingly common diagnosis in our ageing population. Although there is a wide spread of experience in its treatment, the evidence base is heterogeneous and inconclusive. The Angioplasty and Stenting for Renal Artery Lesions trial has provided some, but not all, answers regarding the place of renal revascularization therapy and has also raised more questions and generated further debate. We present a brief review of the significance of atheromatous renovascular disease, discussion of historical treatments, a short analysis of Angioplasty and Stenting for Renal Artery Lesions, and an exploration of where future research lies. This paper provides a literature review of the prevalence and diagnostic criteria of atherosclerotic renovascular disease (ARVD), imaging for ARVD and prognostic implications of ARVD (including renal and cardiovascular implications). A discussion of the literature on therapeutic aspects follows, essentially before and after the large Angioplasty and Stenting for Renal Artery Lesions trial. Other therapies are discussed such as statin therapy and antiplatelet agents. Limitations and questions arising from Angioplasty and Stenting for Renal Artery Lesions are raised and future directions of the management of AVRD are considered. © 2011 Asian Pacific Society of Nephrology.