Percutaneous renal angioplasty

Percutaneous treatment of diseases affecting the urinary tract most often begins with accessing a collecting system and placing a nephrostomy tube. Thus, nephrostomy insertion is the basic technique upon which percutaneous surgical procedures are built. This chapter discusses nephrostomy tube insertion, ureteral stent insertion, ureteral stricture dilatation, nephrostomy tract dilatation, percutaneous removal of calculi, endopyelotomy techniques used in the treatment of UPJ strictures and percutaneous renal angioplasty for treatment of renovascular hypertension. 

The drug has a short half-life with clearance that is 20% renal and the remainder metabolic. Bivalirudin also inhibits platelet activation and has been FDA-approved for use in percutaneous coronary angioplasty. 

Bergqvist D, Johnsson K, Weibull H. Comlications after percutaneous transluminal angioplasty of peripheral and renal arteries. Radiology 1987 28 3-12. 

Booth C, Preston R, Clark G, Reidy J (2002) Management of renal vascular disease in neurofibromatosis type 1 and the role of percutaneous transluminal angioplasty. Nephrol Dial Transplant 17 1235-1240... 

Courtel V, Soto B, Niauet P et al (1998) Percutaneous transluminal angioplasty of renal artery stenosis in children. Pediatr Radiol 28 58-63... 

Lee WJ, Badlani GH, Karlin GS et al (1988) Treatment of ureteropelvic strictures with percutaneous pyeloplasty experience in 62 patients. AJR 151 515-518 LeRoy AJ, Segura JW (1986) Percutaneous removal of renal calculi. Radiol Clin North Am 24 615-622 Levy JM, Duszak RL Jr, Akins EW et al (2000) Percutaneous transluminal renal angioplasty. American College of Radiology. ACR appropriateness criteria. Radiology 215 Suppl 1015-1028... 

Tanemoto M, Abe T, Chaki T et al (2005) Cutting balloon angioplasty of resistant renal artery stenosis caused by fibromuscular dysplasia. J Vase Surg 41 898-901 Towbin RB, Wacksman J, Ball WS et al (1987) Percutaneous pyeloplasty in children experience in three patients. Radiology 163 381-384... 

Digital subtraction angiography (DSA) provides a definitive diagnosis of RAS and serves as the first step for percutaneous revascularization. It should only be performed when angioplasty has been decided. The lowest amount of iodine contrast agent must be used. When renal function is impaired, intra-arterial injection of CO2 or Gd-chelate can be proposed (Spinosa et al. 1998,2002). Rotational angiography may also be used to find the optimal incidence for RAS analysis and catheterization (Hagen etal. 2005). 

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