Surgery for Renal Artery Stenosis

At NYU Langone, our specialists sometimes perform surgery to manage the symptoms of renal artery stenosis and prevent complications. Good candidates for surgery are people with severe narrowing—greater than 60 to 70 percent of the artery’s diameter. People without symptoms or evidence of damage to the arteries or kidneys typically don’t require surgery.

Percutaneous Balloon Angioplasty and Stenting

Angioplasty with stent placement is typically the first procedure used for people with renal artery stenosis because it’s minimally invasive and involves less recovery time than conventional surgery. Percutaneous balloon angioplasty and stenting can increase blood flow to the kidneys, lower blood pressure, and prevent complications such as kidney damage. 

During a percutaneous balloon angioplasty, an NYU Langone vascular specialist makes a small incision in the thigh. He or she guides a flexible tube called a catheter through the femoral artery and into the narrowed renal artery. The doctor then inflates a surgical balloon, which is located at the tip of the catheter, pushing plaque against the inner walls of the artery to allow for better blood flow. 

This procedure is often performed immediately after an arteriogram, which is used to diagnose renal artery stenosis.

Next, your vascular specialist typically places a stent—a wire mesh tube—in the blood vessel to act as “scaffolding.” The stent keeps the artery open, increasing blood flow to the kidneys. The stent remains in place permanently. 

During the procedure, a series of X-rays, called fluoroscopy, is used to help the doctor visualize the catheter and stent inside the artery. The procedure lasts 30 to 90 minutes, depending on the severity of the narrowing. 

Angioplasty and stenting is performed using local anesthesia and sedation. Your doctor determines how long you stay in the hospital based on your medical history and overall health. Some people are able to go home the day of the procedure. 

After returning home, you can expect to resume your usual activities within two days. Most people are placed on an antiplatelet medication, such as aspirin or clopidogrel, to prevent platelets in the blood from sticking to the stent, causing clots.

Renal Artery Bypass

In a renal artery bypass surgery, blood flow is redirected around a blockage in one or more of the renal arteries with a graft made from a synthetic tube or a healthy vein from another part of the body. 

The surgeon makes an incision, then selects and removes a healthy vein, usually from the leg, to be attached to the blocked artery. Next, the doctor uses stitches to attach one end of the vein graft to the renal artery between the blockage and the kidney. The other end is attached to the aorta, the largest artery in the body, the main leg artery, or a healthy artery in the abdomen. This bypass of the blocked renal arteries allows blood to flow freely to the kidneys. 

Most people remain in the hospital for three to seven days after renal artery bypass surgery, with a follow-up visit one or two weeks later to remove stitches from the skin. Recovery can take two to four weeks.

Renal Endarterectomy

In a renal endarterectomy, which is no longer commonly performed, your doctor removes plaque, the waxy substance blocking the renal artery and restricting blood flow to the kidneys. The procedure is performed using general anesthesia.

To perform a renal endarterectomy, the doctor makes an incision in the abdomen or on the side, opens the renal artery and the aorta, and removes plaque. Next, he or she stitches the artery and the incision in the skin closed. Sometimes, an adhesive patch is placed over the incision to close it. 

The surgery typically requires a five- to seven-day stay in the hospital. It can take three to four weeks to recover at home.

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