Page 9 - Carotid and peripheral vascular interventions textbook

CHAPTER 10 • RENAL ARTERY INTERVENTION

Table 10-3. ACC/AHA/SCAI/SIR/SVM 2018 Appropriate Use Criteria (AUC) for Treatment of ARAS-.
(Modif ed from Bailey SR, Beckman JA, Dao TD, et al. ACC/AHA/SCAI/SIR/SVM 2018 Appropriate
use criteria for peripheral artery intervention: A report of the American College of Cardiology Appropriate Use
Criteria Task Force, American Heart Association, Society for Cardiovascular Angiography and Interventions.
J Am Coll Cardiol. 2019;73:214-237, with permission from Elsevier).

Indications AUC Score

Renal Stent Placement
Continue or Intensify (Primary Stenting) –
Medical Therapy Atherosclerotic Lesions

Hemodynamically Significant RAS (With a Severe [70-99%] RAS or 50-69% RAS with hemodynamic Significance)
Chronic Kidney Disease*
1. • Bilateral RAS or a solitary viable† kidney with RAS Appropriate
• Accelerating decline in renal function (Class IIa, LOE B)
2 • Unilateral RAS May Be Appropriate
• Accelerating decline in renal function Appropriate (Class IIb, LOE C)
(Class I, LOE A)
3 • Unilateral smaller kidney (<7cm pole to pole) Rarely Appropriate

Hypertension
4 • Failure to control BP on 3 maximally tolerated May Be Appropriate
medications, 1 of which is a diuretic (Class IIa, LOE B)

5 • Uncontrolled on <3 antihypertensive medications
Appropriate
(Class I, LOE A) Rarely Appropriate
6 • Well-controlled BP on ≥2 antihypertensive medications
7 • New onset
• No medical management
Cardiac Destabilization
257
8 • Sudden-onset f ash pulmonary edema Appropriate
(Class I, LOE B)
9 • Recurrent ADHF requiring hospitalization May Be Appropriate
• Uncontrolled on maximal medical therapy (Class I, LOE B)
10 • Uncontrolled unstable angina despite maximal medical May Be Appropriate
therapy (Class IIa, LOE B)

Incidentally Discovered RAS
11 • Bilateral RAS or a solitary viable† kidney with RAS Appropriate
(Class I, LOE A) Rarely Appropriate
12 • Unilateral RAS

Borderline (50-69 %) RAS Without Hemodynamic Confirmation of Severity
13 • Unilateral RAS, bilateral RAS, or a solitary viable† Appropriate
kidney with RAS (Class I, LOE A) Rarely Appropriate

*Chronic kidney disease was def ned as a decrease in estimated GFR rate <60mL/min/1.73 m or serum creatinine >1.5mg/dl that persisted
2
for at least 3 months.
†Viable is pole to pole kidney length ≥7cm.
ADHF, acute decompensated heart failure; BP, blood pressure; RAS, renal artery stenosis