The management of renovascular disease: ASTRAL and beyond.
OBJECTIVE
This review concentrates on the new findings published in the atheromatous renovascular disease (ARVD) literature since the beginning of 2009, a period in which the results of two randomized control trials have been released.


RESULTS
The key advances have arisen with respect to the epidemiology of ARVD, the effects of revascularization as demonstrated by the results of randomized controlled trials, an understanding of the pathophysiology of the ischaemic kidney, and also there have been further insights regarding the selection of patients for revascularization utilizing structural and functional imaging.


CONCLUSIONS
Optimal medical management (and not revascularization therapy) is the established cornerstone for all patients with ARVD. Future studies should be directed to identifying individuals who will significantly benefit from renal revascularization.
Renal Department, Salford Royal Hospital, Stott Lane, Salford, Greater Manchester, UK.
Ching M
CM
Cheung
Constantina
C
Chrysochou
Philip A
PA
Kalra
D017130:Angioplasty; D006333:Heart Failure / Q000628:therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D058226:Plaque, Atherosclerotic / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D012078:Renal Artery Obstruction / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D015607:Stents; D042461:Vascular Endothelial Growth Factor A / Q000502:physiology
D042461:Vascular Endothelial Growth Factor A