Proceedings from the society of interventional radiology foundation research consensus panel on renal sympathetic denervation

摘要

In 1948, Smithwick and others (1,2) reported on operative thoracolumbar sympathectomy to treat hypertension (HTN). In a study of patients with uncontrolled HTN who underwent thoracolumbar sympathectomy, 45% of 1,266 patients maintained significant improvement in blood pressure (BP) 5 years later (3). However, this procedure was also associated with significant morbidity and orthostatic hypotension and was abandoned in the 1960s with the widespread advancements in, and availability of, effective pharmacologic therapy. In the 1970s, operative ligation of the sympathetic fibers in the perirenal space was considered a contributor to the benefits of renal artery surgery for treatment of renovascular HTN or chronic kidney disease (4). More recently, convincing evidence has emerged that chronic elevation of sympathetic nervous system activity is a major contributor to the complex pathophysiology of essential HTN and in particular resistant HTN (5,6).