Endovacular Therapy for Atherosclerotic renal artery stenosis: Present and Future

ENDOVASCULAR THERAPY FOR ATHEROSCLEROTIC RENAL ARTERY STENOSIS: PRESENT AND FUTURE. Edited by Michael R. Jaff. Volume 2 of Endovascular Intervention: Today and Tomorrow. Series Editor: Frank J. Criado. 144 pp. Illust. Futura Publishing Company, Inc., Armonk, NY. 2001. US$75. ISBN 087993-470-0

For those interested in the current status of nonoperative therapy for renal artery stenosis, this text provides both a broad perspective and an intelligent approach to the topic. As a vascular surgeon involved in the operations for this disease and collaborating in the decision for angioplasty with or without stenting, it is immediately relevant to my practice. However, I think this review provides an equally valuable perspective for family practitioners and others involved in front-line therapy for patients with renal artery stenosis.

The book is organized into a logical sequence of chapter topics authored by experts in their respective fields. The first chapter details the prevalence, diagnosis and natural history of renal artery stenosis and its management by surgical revascularization. The emphasis on the relative under-appreciation of this disease as well as the potential adverse natural history serve as cogent reminders to all involved in treating this condition. This appears to be a relatively underdiagnosed disease in which the insidious consequences are potentially the end results of poor blood pressure control and subsequent cardiovascular events and dialysis. These areas provide essential background to allow the reader to put into perspective the current role of endovascular stenting.

The role of surgical therapy is well reviewed by Wong, Oskin and Hansen whose group has published extensively on the results of the surgical management of renal artery stenosis. Rosenfeld and Fishman detail the techniques of stenting, although their chapter may be of less interest to nonspecialists. Subsequent and specific controversial issues in the role of renal artery stenting are then expanded in the remaining chapters. The role of stenting in flash pulmonary edema, renal artery stenting versus surgery, preservation of renal function as well as long-term (4-year) follow-up of renal artery stenting are well presented and focus the reader on the real issues regarding this treatment. However, the reader is not left with a definitive impression of the primary role of this treatment after contrasting the surgical and interventionalist conclusions in their respective chapters.

I would readily recommend this book, not only for the content but also for its approach to management intervention. For the specialist, surgical, medical or interventionalist, it provides a reasoned overview from authorities in their fields. For family practitioners and others involved in front-line therapy of patients with this disease, this book provides a current perspective regarding "back-line" specialist treatment. Overall, this review provides some of the background data and focuses the main issues regarding the role of endovascular stenting in the treatment of renal artery stenosis. Ultimately the decision to use these interventions not only involves patient circumstances, local renal artery conditions and understanding of the background literature but also the availability of local expertise and resources.

[Author Affiliation]

Randy Gunman, MD Assistant Professor Vascular Surgery Program Director University of Manitoba Winnipeg, Man.