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Reader Remarks on:

Revascularization Is Ineffective for Atherosclerotic Renal Artery Stenosis

• Renin
• Fibromuscular dysplasia of renal artery
• renal revascularization
• complications
• Rx RAS

Renin

Joe Reynolds, 13 Nov 2009 7:41 AM EST

Competing interests: None declared

I was wondering if the Renin levels pre and post op were measured

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Fibromuscular dysplasia of renal artery

Barbara A McFee, 12 Nov 2009 6:26 PM EST

Competing interests: None declared

Have studies been done of patients with FMD and if so are the results published?

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renal revascularization

Darol Joseff MD, 13 Nov 2009 10:59 AM EST

Competing interests: None declared

The real conclusion seems to be that renal revascularization doesn't help in those cases where the treating physician is 'uncertain' it would help. Unfortunately, the authors did not include the data from patients who were thought to 'require' revascularization. So, it seems that the study design limited the possible conclusions, and the authors rightly acknowledge this. Thus, the title 'Revascularization Is Ineffective for Atherosclerotic Renal Artery Stenosis' is not actually supported by the evidence presented. It'll take a clever editor to create an accurate title for this paper.

Since 25% of persons in the US over age 65 have some detectable renal artery stenosis, it's obvious that most don't require revascularization. However, if they do have 'renovascular hypertension' (RVH, by the way, is defined as a retrospective diagnosis) or, perhaps more accurately, 'renoprival disease', they may benefit from renal revascularization. Unfortunately, the 'sound bite' view of this article, even the title, may be improperly used by insurers to deny coverage for even those carefully selected patients who may actually benefit from revascularization.

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complications

d t, usa, 15 Nov 2009 2:26 PM EST

Competing interests: None declared

ten percent major complications!! what are they doing... possibly learning angioplasty in us we do it for less than 1 % or better

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Rx RAS

Newell Falkinburg, 19 Nov 2009 3:32 PM EST

Competing interests: None declared

Were they studying unilateral RAS or Bilat RAS or both.

Looks like sloppy reporting to me .

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