Carbon Dioxide Angiography–Guided Ultrasound Renal Denervation in Refractory Hypertension With Chronic Kidney Disease

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  Figure 1. Aortograms, CO2 Angiography of the Renal Arteries, IVUS Imaging, and Pre- and Post-uRDN Imaging (A to C) Aortograms obtained using CO2 angiography revealing (A) the descending aorta and proximal sections of the bilateral renal arteries, (B) the descending aorta and proximal and mid sections of the bilateral renal arteries, and (C) the abdominal aorta and its bifurcation into the bilateral common iliac arteries. (D and E) Selective CO2 angiography of (D) the left renal artery and (E) the distal right renal artery showing distal bifurcation. (F to H) IVUS and post-uRDN imaging. IVUS images of (F) the left renal artery before uRDN therapy and (G) the right renal artery after uRDN therapy. (H) Aortogram obtained using CO2 angiography after uRDN therapy revealing the left renal artery with no aneurysmal changes or dissection. (I and J) Occlusion testing of the uRDN catheter at the (I) distal and (J) proximal left renal artery. (K and L) IVUS images of (K) the left renal artery before uRDN and (L) the right renal artery after uRDN. CO2 = carbon dioxide; IVUS = intravascular ultrasound; uRDN = ultrasound-guided renal denervation.