Endovascular treatment of renal artery stenosis in Germany: a retrospective analysis of the DEGIR registry 2018–2021

Abstract

Purpose To provide an overview of endovascular treatment of renal artery stenosis (RAS) using the data of the Deutsche Gesellschaft für interventionelle Radiologie (DeGIR) quality management system.

Materials and Methods A retrospective analysis was performed. Pre-, peri- and postprocedural data, technical success rates, complication rates, and clinical success rates at dismissal were examined.

Results Between 2018 and 2021, 2134 angiography examinations of the renal arteries were performed: diagnostic angiography in 70 patients (3 %), balloon angioplasty in 795 (37 %), stent implantation in 1166 (55 %) and miscellaneous procedures in 103 (5 %). The lesion length was less than or equal to 5 mm in 1837 patients (87 %), between 5 and 10 mm in 197 (9 %), and between 10 and 20 mm in 62 (3 %). The degree of stenosis was less than 50 % in 156 patients (7 %), greater than 50 % in 239 (11 %), and greater than 70 % in 1472 (70 %). Occlusion was treated in 235 patients (11 %). Symptoms at discharge resolved in 600 patients (29 %), improved in 1012 (49 %), were unchanged in 77 (4 %), and worsened in 5 (0.2 %). Complications were reported in 51 patients (2.5 %) and the mortality rate was 0.15 %.

Conclusion A substantial number of patients with RAS and occlusions were treated by radiologists in Germany, with high technical success rates and low complication rates. The indication should be determined carefully as the current European guidelines for the treatment of RAS suggest that only carefully selected groups of patients will benefit from recanalizing treatment.

Key Points: 

• Carefully selected patient groups may benefit from endovascular treatment of renal artery stenosis.

• Analysis of the DEGIR quality management database shows that treatment of renal artery stenosis was performed by radiologists in Germany with high technical success rates and low complication rates.

• Recanalization even led to symptom improvement in a large proportion of patients with occlusions.

Zusammenfassung

Hintergrund Es soll ein Überblick über die endovaskuläre Behandlung von Nierenarterienstenosen (RAS) anhand der Daten des Qualitätsmanagementsystems der Deutschen Gesellschaft für interventionelle Radiologie (DeGIR) gegeben werden.

Material und Methoden Es wurde eine retrospektive Analyse durchgeführt. Untersucht wurden prä-, peri- und postprozedurale Daten, technische Erfolgsraten, Komplikationsraten und klinische Erfolgsraten bei Entlassung.

Ergebnisse Zwischen 2018 und 2021 wurden 2134 Angiografien der Nierenarterien durchgeführt: diagnostische Angiografie in 70 (3 %), Ballonangioplastie in 795 (37 %), Stentimplantation in 1166 (55 %) und sonstige Verfahren in 103 (5 %). Die Länge der Läsion betrug bei 1837 (87 %) weniger als oder gleich 5 mm, bei 197 (9 %) zwischen 5 und 10 mm und bei 62 (3 %) der Patienten zwischen 10 und 20 mm. Der Grad der Stenose lag bei 156 (7 %) unter 50 %, bei 239 (11 %) über 50 % und bei 1472 (70 %) Patienten über 70 %. Ein Verschluss wurde bei 235 (11 %) der Patienten behandelt. Bei der Entlassung waren die Symptome bei 600 (29 %) behoben, bei 1012 (49 %) verbessert, bei 77 (4 %) unverändert und bei 5 (0,2 %) der Patienten verschlechtert. Komplikationen traten bei 51 (2,5 %) Patienten auf, und die Sterblichkeit lag bei 0,15 %.

Schlussfolgerung Eine beträchtliche Anzahl von Patienten mit RAS und Verschlüssen wurde in Deutschland von Radiologen behandelt, mit hohen technischen Erfolgsraten und niedrigen Komplikationsraten. Die Indikation sollte sorgfältig gestellt werden, da die aktuellen europäischen Leitlinien für die Behandlung von RAS nahelegen, dass nur sorgfältig ausgewählte Patientengruppen von einer rekanalisierenden Behandlung profitieren werden.

Kernaussagen: 

• Sorgfältig ausgewählte Patientengruppen können von einer endovaskulären Behandlung einer Nierenarterienstenose profitieren.

• Die Behandlung von Nierenarterienstenosen in Deutschland wurde von Radiologen mit hohen technischen Erfolgsraten und niedrigen Komplikationsraten durchgeführt.

• Die Rekanalisation führte sogar bei einem großen Teil der Patienten mit Verschlüssen zu Symptombesserungen.

Zitierweise

• Feyen L, Artzner C, Paprottka P et al. Endovascular treatment of renal artery stenosis in Germany: a retrospective analysis of the DEGIR registry 2018–2021. Fortschr Röntgenstr 2024; 196: 283 – 291

Key words

renal arteries - quality management - renal angiography - stents - renal artery occlusion - interventional procedures

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