title: Renal denervation for refractory hypertension - technical aspects, complications and radiation exposure.
abstract: OBJECTIVE
  To analyze procedural details, complications and radiation exposure in renal denervation (RDN) using the Medtronic Symplicity® device in the treatment of refractory hypertension.
  
  
  METHODS
  Fifty three consecutive patients underwent RDN. The number of ablations per artery, peri-procedural complications, procedure time (PT), fluoroscopy time (FT), dose-area product (DAP) and procedure-related complications were documented. Additionally, the radiation dose was compared between obese (body mass index ≥ 30 kg/m(2)) and non-obese patients.
  
  
  RESULTS
  Bilateral RDN was performed in 50/53 (94 %) cases and with a minimum of 4 ablations per artery in 33/50 (66 %), the mean count being 5.4 (range R: 2 - 13) on the right and 4.3 (R: 1 - 10) on the left. The FT and DAP decreased significantly over the first 12 procedures, reaching a steady state with a median FT of 11.2 min (R: 7.5 - 27) and a median DAP of 4796 cGy × cm(2) (R: 1076 - 21 371), resulting in an effective dose of 15.7 mSv. The median PT was 57 min (R: 40 - 70). Obese patients had a 3.3-fold higher radiation dose (p < 0.001). We observed one severe spasm and one imminent respiratory depression, both resolved without sequelae.
  
  
  CONCLUSIONS
  For an experienced interventionalist, RDN has a short learning curve with a low risk profile. The radiation dose does not exceed that of other renal artery interventions, but is explicitly higher in obese patients, who account for a large portion of patients with refractory hypertension.
authors.affiliation: Radiologie, Charité Universitätsmedizin Berlin, Berlin Germany. Christian.Scheurig@charite.de
authors.forename: C
authors.initials: C
authors.lastname: Scheurig-Muenkler
authors.forename: W
authors.initials: W
authors.lastname: Weiss
authors.forename: E
authors.initials: E
authors.lastname: Foert
authors.forename: M
authors.initials: M
authors.lastname: Toelle
authors.forename: M
authors.initials: M
authors.lastname: van der Giet
authors.forename: T J
authors.initials: TJ
authors.lastname: Kröncke
authors.forename: W
authors.initials: W
authors.lastname: Zidek
authors.forename: M-J
authors.initials: MJ
authors.lastname: Powerski
mesh_terms: D000328:Adult; D000368:Aged; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation*; D002908:Chronic Disease; D003714:Denervation / Q000009:adverse effects / Q000295:instrumentation*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000601:surgery*; D007668:Kidney / Q000000981:diagnostic imaging / Q000294:innervation* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016896:Treatment Outcome