Excerpt

This report is an update to a Comparative Effectiveness Review on management strategies for renal artery stenosis (RAS) from October 2006. The systematic review included all studies of patients with atherosclerotic RAS (ARAS) that compared two or more interventions. It also reviewed recent prospective cohort (single arm) studies of angioplasty with stent placement, prospective cohort studies of medical interventions, cohort studies of RAS natural history, and prospective or large retrospective studies of surgical bypass. This update evaluated the same questions and used the same eligibility criteria, updating the literature search through April 23, 2007. This report does not address the management of fibromuscular dysplasia, renal transplant recipients, or patients who have a previous failed revascularization.

Contents

• Preface
• Executive Summary
• 1. Introduction
  • Background
  • Scope and Key Questions
  • Analytic Framework
• 2. Methods
  • Data Sources and Selection
  • Assessing the Quality, Applicability, and Relevance of the Evidence
• 3. Results
  • Key Question 1: Clinical Effects of Interventions
  • Key Question 2: Predictors of Outcomes
  • Key Question 3: Treatment Variables as Predictors of Outcomes After Angioplasty
• 4. Discussion
• References
• Abbreviations
• Appendixes
  • Appendix A Search Strategy
  • Appendix B Excluded Studies
  • Appendix C Peer Reviewers
  • Appendix D Supplemental Tables and Figure

The investigators of the original report also included: Mei Chung, MPH, Stanley Ip, MD, Athina Tatsioni, MD, Alvaro Alonso, MD, Bruce Kupelnick, BA, Priscilla Chew, MPH, Deirdre DeVine, MLitt, Scott Gilbert, MD, Joseph Lau, MD

AHRQ Contacts: Beth A Collins-Sharp, PhD, RN, Director, Evidence-based Practice Center Program, Agency for Healthcare Research and Quality, Rockville, MD; Elise Berliner, PhD, Task Order Officer, Evidence-based Practice Center Program, Agency for Healthcare Research and Quality, Rockville, MD.

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.¹ Contract No. 290-02-0022. Prepared by: Tufts-New England Medical Center Evidence-based Practice Center.

Suggested citation:

Balk EM, Raman G. Comparative Effectiveness of Management Strategies for Renal Artery Stenosis: 2007 Update. Comparative Effectiveness Review No. 5 Update. (Prepared by Tufts-New England Medical Center under Contract No. 290-02-0022.) Rockville, MD: Agency for Healthcare Research and Quality. November 2007. Available at: www.effectivehealthcare.ahrq.gov/reports/final.cfm.

None of the investigators has any affiliations or financial involvement that conflicts with the material presented in this report.

This report is based on research conducted by the Tufts-New England Medical Center Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-02-0022). The findings and conclusions in this document are those of the author(s), who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.

This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

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