Invited review
Atherosclerotic renovascular disease: detection and therapeutic intervention

Although the real prevalence of atherosclerotic renovascular disease (ARVD) as a cause of end-stage renal disease is unknown, its incidence has been increasing in the last years. The diagnosis of this pathology requires carrying out a number of functional and anatomical tests. The first approach should be to perform duplex Doppler ultrasonography, which, besides providing stenosis size and extent, allows calculation of the intrarenal resistive index as the pattern of renal parenchyma injury and the expected progression if revascularized. The most frequently used morphological techniques are magnetic resonance angiography (MRA) and computer tomography angiography (CTA). Anyway, it is necessary to perform renal arteriography regardless of the inherent risks due to contrast toxicity or atheroembolism. Different therapeutic options are reviewed, highlighting percutaneous transluminal renal angiography plus stent (PTRAS) as the first indication. Even though preliminary results were contradictory, several meta-analyses have concluded that better blood pressure control and renal function improvement are achieved with PTRAS as compared to conventional medical therapy. Surgical revascularization is preferable in patients with severe aorto-iliac pathology and renal artery ostium complete thrombosis. Every patient must be individualized and risks and benefits must be evaluated.