Endovaskuläre renale Sympathektomie – eine neue Methode zur Therapie der medikamentenresistenten arteriellen Hypertonie

Abstract

The endovascular renal sympathectomy is a new therapeutic strategy for the treatment of severe hypertension. Such severe hypertension has to be refractory to medical treatment with at least three antihypertensive drugs reliably applied in full dose. Moreover, secondary hypertension has to be ruled out. The procedure of renovascular sympathectomy is performed with a specifically developed ablation catheter which delivers 10 – 12 W at a resistance of 280 – 320 Ω. The procedure requires an angiography laboratory, a sterile environment and an intensive care unit nearby.

During the procedure the success of renal ablation cannot be estimated which is a great disadvantage. The achieved reduction of blood pressure becomes obviously in the following weeks and reaches up to 30 mmHg for the systolic pressure and 10 – 15 mmHg for the diastolic blood pressure. In about 10 % of patients this method fails to decrease blood pressure at all. An additional positive effect on diabetes and sleepapnoe syndrome has been observed in single cases. Further randomized studies are being performed for the establishment of the procedure as standard treatment strategy.

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