ABSTRACT
Renovascular disease (RVD) is a generalized term referring to lesions of the main renal artery, including stenoses, aneurysms, and occlusions. RVD has emerged as an important comorbidity impacting the care of patients with coronary artery disease (CAD). RVD is the most common cause of secondary hypertension and the second leading cause of renal insufficiency after diabetic nephropathy.1 An increased awareness coupled with the availability of new diagnostic techniques has led to a rising number of patients identified with RVD.The risk factors and pathophysiology leading to RVD appear to be similar to those for CAD. The vast majority of patients with RVD have renal artery stenosis (RAS), traditionally defined as a critical narrowing in the lumen of the main renal artery,2 although branch vessel and accessory vessel disease may coexist. Rarely aneurysms of the renal vasculature may also be encountered. Moreover, RVD has been identified as an independent predictor of increased adverse coronary events.3 The severity of RAS has been shown to correlate with mortality in a long-term population study.4 In fact current data suggest survival is worse in patients with renovascular hypertension compared to those with essential hypertension.2,5,6 Because of its prevalence among patients with coronary artery disease in the cardiac catheterization suites and its relationship to hypertension, renal insufficiency, volume overload, and poor outcomes, it is important for the cardiovascular specialist to have a complete understanding of this disease. Furthermore, physicians performing diagnostic and interventional cardiology catheterization procedures need to have a low threshold for performing renal angiography (selective and non-selective) to better identify patients with RAS.
