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Docs May Be Overdoing Some Invasive Procedures

Posted on 10/16/2009, 12:00
By -- Robert Preidt

For certain patients with renal artery stenosis, medication may be enough, researchers say

FRIDAY, Oct. 16 (HealthDay News) -- A new study calls into question the increasing use of invasive procedures as first-line treatment for patients with renal artery stenosis, a narrowing of blood vessels in and around the kidneys.

New medical technology has made renal artery stenosis easier to detect, which has led to increased use of surgical bypass or minimally invasive procedures, such as angioplasty and stenting, to treat the condition.

However, U.S. researchers analyzed data on hundreds of patients and concluded that renal artery stenosis progresses to dangerous blockage in only a small percentage of cases and doesn't always require surgery, angioplasty or stenting.

"We think these interventions are beneficial for a group of patients," study co-author Dr. Ross P. Davis, a vascular surgery fellow in the department of vascular and endovascular surgery at Wake Forest University Baptist Medical Center in Winston-Salem, N.C., said in a news release.

"But as physicians, we need to be careful about reserving those interventions for specific indications, not just for all patients whose ultrasound reports confirm the presence of artery narrowing. There need to be other indicators of progressive renovascular disease present to consider subjecting patients to the risks and costs of these procedures," Davis said.

The study was published in the September issue of the Journal of Vascular Surgery.

In recent years, the use of surgery, angioplasty and stenting to treat renal artery stenosis has increased so much that the U.S. Centers for Medicare and Medicaid Services is questioning whether such procedures are necessary for all patients with the condition and whether public health insurance should pay for them.

"You can identify that the patient has stenosis, but not necessarily that it is causing, or is going to cause, a problem for that patient," Davis said. "The fact that you have stenosis doesn't necessarily mean you have to have something done about it."

In certain cases, medications may be the best therapy, he said.

More information

The U.S. Agency for Healthcare Research and Quality has more about renal artery stenosis.

SOURCE: Wake Forest University Baptist Medical Center, news release, Oct. 13, 2009

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