The Implications of Acute Anatomic Injury After Percutaneous Renal Intervention

Abstract

Purpose: Percutaneous renal artery revascularization for hypertension and renal dysfunction remains common. The frequency, cause, and outcomes of anatomic injury associated with renal intervention are poorly delineated. This study aims to determine the frequency of acute anatomic renal injury after renal artery interventions, identify factors associated with anatomic renal injury, and determine whether anatomic renal injury related to renal intervention is associated with late adverse clinical events. Methods: A retrospective analysis of patients undergoing renal artery interventions for atherosclerotic renal artery disease between 2002 and 2022 was performed. Acute anatomic renal injury encompassed renal artery dissection, renal artery perforation, acute occlusion, renal parenchymal infarction, and renal parenchymal perforation. Freedom from renal-related morbidity (increase in persistent creatinine >20% of baseline, progression to hemodialysis, death from renal-related causes) and patient survival were measured. Results: A total of 968 patients underwent 1309 renal artery interventions: 47% for hypertension, 25% for hypertension associated with chronic renal dysfunction, and 28% for chronic renal dysfunction. An acute anatomic renal injury occurred in 5.9% of the patients. The occurrence of an anatomic injury was associated with a significant decrement in freedom from renal-related morbidity (79±2% vs 55±8%, no-injury vs injury group, mean±standard error of the mean; p=0.003) and markedly decreased survival at 5 year follow-up (78±3% vs 48±8%; p=0.002). No factor was identified that predicted anatomic injury. In those patients with anatomic injury, perforation was associated with decreased survival, while estimated glomerular filtration rate <60, resistive index >0.8, and dissection were associated with a lack of retained renal benefit. Conclusion: Acute anatomic renal injury occurs in approximately 6% of patients undergoing percutaneous renal artery intervention and is a negative predictor of survival and is associated with subsequent renal failure, need for dialysis, and death from renal-related causes. Clinical Impact Acute anatomic renal injury occurs in approximately 5% of patients undergoing percutaneous renal artery intervention. Modern endovascular interventions allow for the control and remediation of injuries in the majority of cases with an overall low mortality and morbidity. There is a significant early occlusion of renal arteries following the injury within 1 month. In the long term, the occurrence of injury is a negative predictor of survival and is associated with subsequent renal failure, the need for dialysis, and death from renal-related causes.