Renal sympathetic denervation
Renal sympathetic denervation (RSDN), also known as renal denervation, is an interventional procedure that uses radiofrequency ablation to destroy the nerve endings in the wall of the renal arteries. Endovascular (trans-catheter) techniques are an alternative to surgical sympathectomy.
The procedure is useful to treat refractory hypertension in post stenting patients.
- chronic renal failure
- prior renal artery interventions (e.g. stents, angioplasty)
- anomalous anatomy
- type 1 diabetes mellitus 5
The femoral artery is punctured to get vascular access. Renal artery angiography is performed, which is followed by opioid administration to reduce postprocedural abdominal pain. The guiding catheter is passed into the renal artery through which a radiofrequency catheter is passed. Circumferential ablation along both the renal arterial walls is performed for two minutes.
- femoral artery pseudoaneurysm
- renal artery dissection
- transient procedural bradycardia 4
- renal artery stenosis (long-term) 5
- reduction in systolic blood pressure of ~25 mmHg and reduction of diastolic blood pressure of ~12 mmHg 3
- long-term effectiveness beyond 24 months is still not proven 3,4
- oral antihypertensive medications are still required in most patients 5
- 1. Atas H, Durmus E, Sunbul M et-al. Successful accessory renal artery denervation in a patient with resistant hypertension. Heart Views. 2014;15 (1): 19-21. doi:10.4103/1995-705X.132142 - Free text at pubmed - Pubmed citation
- 2. Sapoval M, Azizi M, Bobrie G et-al. Endovascular renal artery denervation: why, when, and how?. Cardiovasc Intervent Radiol. 2012;35 (3): 463-71. doi:10.1007/s00270-011-0306-8 - Pubmed citation
- 3. Kannan A, Medina RI, Nagajothi N et-al. Renal sympathetic nervous system and the effects of denervation on renal arteries. World J Cardiol. 2014;6 (8): 814-23. doi:10.4330/wjc.v6.i8.814 - Free text at pubmed - Pubmed citation
- 4. Minocha J, Parvinian A, Bui JT et-al. Transcatheter renal interventions: a review of established and emerging procedures. J Clin Imaging Sci. 2015;5 (1): 5. doi:10.4103/2156-7514.150448 - Free text at pubmed - Pubmed citation
- 5. Lokhandwala A, Dhoble A. Transcatheter therapies for resistant hypertension: Clinical review. World J Cardiol. 2014;6 (8): 706-12. doi:10.4330/wjc.v6.i8.706 - Free text at pubmed - Pubmed citation