RESUMO
UNLABELLED: Renal sympathetic denervation (RDN) is an emerging technique in the treatment of resistant hypertension, most commonly performed using an endovascular approach. Clinical and anatomical criteria for RDN are well established and imaging plays an integral role in selecting patients with suitable anatomy, procedural planning and device selection. Nevertheless, the current body of literature surrounding imaging related to RDN remains limited. The purpose of this article is to illustrate the expectations and limitations of various imaging techniques, including Doppler ultrasound, CT angiography, MR angiography and newer techniques such as non-contrast MR angiography, in the context of RDN. KEY POINTS: ⢠To understand the role of imaging in renal denervation ⢠To understand strengths and weaknesses of current imaging techniques ⢠To understand the relevant imaging findings in the context of renal denervation.
Assuntos
Diagnóstico por Imagem/métodos , Hipertensão Renal/diagnóstico , Hipertensão Renal/cirurgia , Rim/inervação , Cirurgia Assistida por Computador/métodos , Simpatectomia , Angiografia , Humanos , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler em CoresRESUMO
Insufficient renal artery length for renal sympathetic denervation (RDN) is defined as having a main renal artery shorter than 20 mm in length. Such an anatomy is considered a contraindication for most of the currently available endovascular RDN devices. The concern stems from the need to distribute the ablation points to effect circumferential ablation causing sympathetic denervation, without the risk of injuring the renal artery. We postulate that if the requisite ablation points could be distributed between large caliber renal branches and the short main renal artery, RDN is likely feasible and safe. We demonstrate this with 2 cases using 2 different RDN devices and detail the technical feasibility.