Renal sympathetic denervation

Renal sympathetic denervation (RSDN), also known as renal denervation, is an interventional procedure that uses radiofrequency ablation to destroy the nerve endings in the wall of the renal arteries. Endovascular (trans-catheter) techniques are an alternative to surgical sympathectomy.

Indications

The procedure is useful to treat refractory hypertension in post stenting patients.

Contraindications

• chronic renal failure
• prior renal artery interventions (e.g. stents, angioplasty)
• anomalous anatomy
• type 1 diabetes mellitus

Procedure

The femoral artery is punctured to get vascular access. Renal artery angiography is performed, which is followed by opioid administration to reduce postprocedural abdominal pain. The guiding catheter is passed into the renal artery through which a radiofrequency catheter is passed. Circumferential ablation along both the renal arterial walls is performed for two minutes.

Complications

• femoral artery pseudoaneurysm
• renal artery dissection
• transient procedural bradycardia 
• renal artery stenosis (long-term)

Outcomes

• reduction in systolic blood pressure of ~25 mmHg and reduction of diastolic blood pressure of ~12 mmHg
• long-term effectiveness beyond 24 months is still not proven
• oral antihypertensive medications are still required in most patients