Figure 32

Angiographic examples of atherosclerotic renal artery disease (ASO-RAD). A, Aortogram demonstrating severe nonostial atherosclerotic renal artery disease of the left main renal artery. B, Intra-arterial digital subtraction aortogram showing severe proximal right renal artery stenosis (ostial lesion) and moderately severe narrowing of the left renal artery due to atherosclerosis.

Atherosclerotic renal artery disease is typically associated with atherosclerotic changes of the abdominal aorta (see panel B). ASO-RAD predominantly affects men and women in the fifth to seventh decades of life but is uncommon in women under the age of 50. Anatomically, the majority of these patients demonstrate atherosclerotic plaques located in the proximal third of the main renal artery. In the majority of cases (70% to 80%), the obstructing lesion is an aortic plaque invading the renal artery ostium (ostial lesion). Twenty to 30 percent of patients with ASO-RAD demonstrate atherosclerotic narrowing 1 to 3 cm beyond the takeoff of the renal artery (nonostial lesion). Nonostial lesions are technically more amenable to percutaneous transluminal renal angioplasty (PTRA) than ostial ASO-RAD lesions, which are technically difficult to dilate and have a high restenosis rate after PTRA. Renal artery stenting has gained wide acceptance for ostial lesions. Endovascular intervention for nonos-tial lesions includes both PTRA and stents. Surgical renal revascularization is used for both ostial and nonostial ASO-RAD lesions. (From Pohl [1]; with permission.)

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