Imaging and endovascular treatment of renal artery stenosis in the diabetic patient

Although diabetes is a classical risk factor for macroangiopathy, the prevalence of renal artery stenosis (RAS) in this type of pathology has not been clearly determined. More than 50% of RAS occur in diabetic patients (almost exclusively Type 2), whereas autopsy findings and the few clinical surveys reported indicate that the percentage of RAS within the diabetic population is close to 30%. RAS occur especially in elderly subjects with Type 2 diabetes and multiple vascular involvement, and bilateral stenoses are frequent. Diagnostic imaging of RAS can cause adverse effects in the diabetic patient if iodinated contrast media are used, especially in cases of renal insufficiency. The presence of this risk factor requires that iodinated radiological explorations be performed with due caution, or that another product be substituted as a contrast agent(CO2 or gadolinium), or that an imaging technique without iodine be used (colour Doppler ultrasound, magnetic resonance angiography). The therapeutic management of RAS in the diabetic patient differs little from that employed for other atheromatous stenoses of the renal artery. Endovascular treatment of RAS is the technique of choice for most patients, whether diabetic or not. The existence of diabetes has little effect on therapeutic strategy, except in cases of renal insufficiency when the risk of iodine overload should limit the doses of contrast medium or require the partial or even total substitution of another agent (CO2, gadolinium). As in the case of other RAS, the indications depend on the lesion and the clinical presentation. Similarly, the results are both clinical and anatomical, and the existence of diabetes has a limited impact on these different parameters.