Leitlinie zur chirurgischen Therapie bei Erkrankungen der Nierenarterien

Background

These guidelines are the current publication of the German guidelines for surgical revascularization of renal artery disease, focusing on atherosclerotic renal artery stenosis. These guidelines update a previous version: Allenberg JR (1998) Guidelines for renovascular disease. In: German College of Vascular Surgery (DGG) Guidelines for diagnostic and therapy in vascular surgery. Deutscher Ärzteverlag, Köln

Purpose

The aim was to evaluate the effect of surgical revascularization on clinical outcomes in adults with atherosclerotic renal artery stenosis in comparison to endovascular therapy or best medical treatment.

Data Sources

The appropriate criteria were reviewed by a literature search (MEDLINE database) and updated in order to evaluate the results of previous studies and obtain new and highly significant scientific evidence on the surgical therapy of renovascular diseases.

Data interpretation

Using the evidence-based criteria there were only two randomized trials with an evidence level type Ib, one comparing surgical revascularization with best medical treatment and another comparing surgical revascularization with percutaneous transluminal angioplasty (PTA). In both studies there were no significant differences in the outcome. However, the statistical power of these trials with a total of 110 randomized patients was poor. Many trials with evidence level II and III have been carried out. Available evidence is not sufficient to predict which intervention would result in better outcomes. There have been no randomized prospective trials comparing the three therapeutic options, surgical revascularization, PTA/stent and best medical treatment.

Conclusion

An advantage for a specific type of therapy has not yet been demonstrated. The decision for any kind of treatment approach depends on the individual renal artery lesion, the therapeutic options, skills and the necessary interdisciplinary infrastructure of the treating medical unit.