Hypertension remains the leading cause of cardiovascular morbidity and mortality in spite of current medical therapies. It has been estimated that 50% of Western civilization has hypertension and approximately 20% of patients have resistant hypertension. Renal denervation (RDN) is a minimally invasive, endovascular catheter based procedure using radiofrequency ablation aimed at treating resistant hypertension. Early studies show a high degree of effectiveness in renal denervation to treat hypertension. This book examines renal pathophysiology and the rationale for renal denervation, as well as possible long term benefits and risks of this new therapy. The myriad of devices involved in the evolution of this therapy are discussed and the book concludes with analyses of the cost effectiveness and future applications.

The kidney is innervated with efferent sympathetic nerve fibers reaching the renal vasculature, the tubules, the juxtaglomerular granular cells, and the renal pelvic wall. The renal sensory nerves are mainly found in the renal pelvic wall. Increases in efferent renal sympathetic nerve activity reduce renal blood flow and urinary sodium excretion by activation of α1-adrenoceptors and increase renin secretion rate by activation of β1-adrenoceptors. In response to normal physiological stimulation, changes in efferent renal sympathetic nerve activity contribute importantly to homeostatic regulation of sodium and water balance. The renal mechanosensory nerves are activated by stretch of the renal pelvic tissue produced by increases in renal pelvic tissue of a magnitude that may occur during increased urine flow rate. Activation of the sensory nerves elicits an inhibitory renorenal reflex response consisting of decreases in efferent renal sympathetic nerve activity leading to natriuresis. Increasing efferent sympathetic nerve activity increases afferent renal nerve activity which, in turn, decreases efferent renal sympathetic nerve activity by activation of the renorenal reflexes. Thus, activation of the afferent renal nerves buffers changes in efferent renal sympathetic nerve activity in the overall goal of maintaining sodium balance. In pathological conditions of sodium retention, impairment of the inhibitory renorenal reflexes contributes to an inappropriately increased efferent renal sympathetic nerve activity in the presence of sodium retention. In states of renal disease or injury, there is a shift from inhibitory to excitatory reflexes originating in the kidney. Studies in essential hypertensive patients have shown that renal denervation results in long-term reduction in arterial pressure, suggesting an important role for the efferent and afferent renal nerves in hypertension. Table of Contents: Part I: Efferent Renal Sympathetic Nerves / Introduction / Neuroanatomy / Neural Control of Renal Hemodynamics / Neural Control of Renal Tubular Function / Neural Control of Renin Secretion Rate / Part II: Afferent Renal Sensory Nerves / Introduction / Neuroanatomy / Renorenal Reflexes / Mechanisms Involved in the Activation of Afferent Renal Sensory Nerves / Part III: Pathophysiological States / Efferent Renal Sympathetic Nerves / Afferent Renal Sensory Nerves / Conclusions / References

This Renal Denervation handbook is a practical “all you need to know” guide to treating patients with hypertension. Renal Denervation is a revolutionary, minimally invasive trans-catheter intervention that has emerged as a safe and effective therapeutic companion for the limited number of patients with resistant hypertension and the huge population of those who “resist” to take their prescribed medications. Written by the world’s most recognized experts in the field, the handbook provides a review of the scientific bases of the therapy, reveals practical instructions on how to select the right patients and perform the procedure, and analyzes clinical results in a direct, easy to understand style. This guide is the resource for all healthcare providers interested in the modern management of hypertension and successfully managing the number one risk factor for stroke, myocardial infarction, and heart failure worldwide.

Hypertension remains the leading cause of cardiovascular morbidity and mortality in spite of current medical therapies. It has been estimated that 50% of Western civilization has hypertension and approximately 20% of patients have resistant hypertension. Renal denervation (RDN) is a minimally invasive, endovascular catheter based procedure using radiofrequency ablation aimed at treating resistant hypertension. Early studies show a high degree of effectiveness in renal denervation to treat hypertension. This book examines renal pathophysiology and the rationale for renal denervation, as well as possible long term benefits and risks of this new therapy. The myriad of devices involved in the evolution of this therapy are discussed and the book concludes with analyses of the cost effectiveness and future applications.

This extensively revised edition examines renal pathophysiology and the rationale for renal denervation for the management of hypertension, as well as possible long-term benefits and risks of this therapy. Renal denervation is a minimally invasive, endovascular catheter-based procedure that makes use of radiofrequency ablation to treat resistant hypertension, with studies showing a high degree of effectiveness. The devices involved in the continued evolution of this therapy are discussed and the book incorporates analyses of the development of the technique while evaluating its cost effectiveness and future applications. Renal Denervation: A New Approach to Treatment of Resistant Hypertension describes the technique in detail, its advances and its pitfalls. While it has been estimated that 50% of Western civilization has hypertension and approximately 20% of patients have resistant hypertension, hypertension remains the leading cause of cardiovascular morbidity and mortality thus strengthening arguments to consider a wider range of potential solutions to manage these patients.

Hypertension (high blood pressure) is a leading cause of stroke, cardiovascular and kidney disease. In most individuals with hypertension blood pressure can be managed through lifestyle changes and with drug therapies. However, a sub-group of those with hypertension have treatment-resistant hypertension. Resistant hypertension is elevated, above target blood pressure (140/90 mmHg, 130/80 mmHg in patients with diabetes, and 150/90 mmHg for patients over 80 years of age) that persists despite lifestyle and diet modifications and optimal doses of at least three concurrent antihypertensive agents of different categories, including a diuretic. Renal denervation is a catheter-based procedure that ablates afferent and efferent nerves in the renal arteries to decrease sympathetic nervous system activity and reduce blood pressure. The review of the safety and efficacy/effectiveness of RDN included 27 studies. Based on these studies, RDN using the Symplicity system appeared to be safe and well tolerated. The cost-effectiveness (specifically, cost-utility) of RDN was addressed in two published economic analyses and four conference abstracts, all originating from two industry-supported economic models. Both models were designed to assess the lifetime costs and consequences of treatment with RDN in a hypothetical patient population with an average age of approximately 60 years.

This is a reference text covering all aspects of renal disease, including: pathology, clinical features, imaging, hypertension, atherosclerotic disease, medical and surgical treatment.

​Vascular management and care has become a truly multidisciplinary enterprise as the number of specialists involved in the treatment of patients with vascular diseases has steadily increased. While in the past, treatments were delivered by individual specialists, in the twenty-first century a team approach is without doubt the most effective strategy. In order to promote professional excellence in this dynamic and rapidly evolving field, a shared knowledge base and interdisciplinary standards need to be established. Pan Vascular Medicine, 2nd edition has been designed to offer such an interdisciplinary platform, providing vascular specialists with state-of-the art descriptive and procedural knowledge. Basic science, diagnostics, and therapy are all comprehensively covered. In a series of succinct, clearly written chapters, renowned specialists introduce and comment on the current international guidelines and present up-to-date reviews of all aspects of vascular care.

There is an enormous sense of excitement in the communities of cancer research and cancer care as we move into the middle third of the ?rst decade of the 21st century. For the ?rst time,there is a true sense of c- ?dence that the tools provided by the human genome project will enable cancer researchers to crack the code of genomic abnormalities that allow tumor cells to live within the body and provide highly speci?c, virtually non-toxic therapies for the eradication,or at least ?rm control of human cancers. There is also good reason to hope that these same lines of inquiry will yield better tests for screening, early detection, and prev- tion of progression beyond curability. While these developments provide a legitimate basis for much op- mism, many patients will continue to develop cancers and suffer from their debilitating effects, even as research moves ahead. For these in- viduals, it is imperative that the cancer ?eld make the best possible use of the tools available to provide present day cancer patients with the best chances for cure, effective palliation, or, at the very least, relief from symptoms caused by acute intercurrent complications of cancer. A modality that has emerged as a very useful approach to at least some of these goals is tumor ablation by the use of physical or physiochemical approaches.

In anticipation of the opening of the H. Lee Moffitt Cancer Center and Research lnstitut~ on the campus of the University of South Florida, an international symposium, "The First Annual H. Lee Moffitt Symposium on Cancer Biology and Therapeutics" was held in Tampa, Florida on January 20-22, 1986. In this first symposium we decided to present a broad-based series of topics dealing with the major issues in the field of cancer. These topics ranged from the biochemistry of the cancer cell to the design of antineoplastic agents, through tumor cell heterogeneity, treatment of ltuman neoplasms to immunological aspects of cancer biology and tr~atment. The speakers chosen represented individuals of international acclaim who are very active in the area of cancer research and treatment. The symposium brought together scien tists/physicians from six nations including Austria, Canada, France, Hungary, West Germany, and of course, the United States. The congeniality of the participants promoted the friendly exchange of knowledge which, it is hoped, will greatly hasten the time when successful management of human cancer will become routine. Future symposia in this series will be highly focused and will deal with a single facet of this vast field of cancer research and treatment. Joseph G. Cory, Editor Andor Szentivanyi, Editor University of South Florida, 1986 V ACKNOWLEDGMENTS This volume presents the Proceedings of the H. Lee Moffitt International Syn~osium on Cancer Biology and Therapeutics which was held in Tampa, Florida on January 20, 21, and 22, 1986.