Hypertension is a major risk factor for stroke, coronary heart disease, heart failure, vascular disease, and chronic renal failure. There is growing evidence that activation of renal sympathetic afferent and efferent fibers promotes the development and progression of hypertension. If performed early in the disease, renal sympathetic nerve ablation or minimally invasive renal sympathetic nerve disruption may delay or even prevent the development of target organ damage and damage to the cardiovascular system from hypertension. Approximately 8-15% of hypertensive patients have refractory hypertension, for which current antihypertensive drugs have limited efficacy and require lifelong medication, and for which patients have poor compliance. Intractable hypertension seriously affects human health and imposes a great burden on society, therefore, there is an urgent need to find an effective treatment strategy. As early as 1955, Smithwich used surgical renal sympathectomy to treat refractory hypertension, and performed visceral neurectomy in 1506 patients with malignant hypertension, after which half of the patients had ideal blood pressure control and significantly improved the survival rate of patients with malignant hypertension (death rate of nearly 100% within 5 years). The procedure has faded from clinical practice due to the high technical requirements, the number of surgical complications and the subsequent development of antihypertensive drugs. In recent years, the emergence of renal sympathetic nerve ablation, a safe interventional procedure with significant and long-lasting results, has brought new hope for the treatment of refractory hypertension, promising a once-and-for-all treatment option for patients. However, this treatment has more contraindications and carries a greater risk for patients with renal impairment and the elderly due to the use of nephrotoxic angiographic agents. Contraindications to renal sympathetic ablation: 1) inappropriate renal artery anatomy (diameter < 4 mm; length < 20 mm; dysplastic muscle fibers; significant stenosis). Normal vascular variants such as collateral renal arteries and multiple renal arteries are relative contraindications. (2) Renal impairment: dGFR < 45 ml/min/1.73 m2. (The creatinine level may be within the normal range at this time.) "Minimally invasive renal sympathetic nerve dissection" for refractory hypertension In order to avoid the comorbidities caused by renal sympathetic nerve ablation for refractory hypertension and the nephrotoxicity of the contrast medium, the urology team has developed a new method of renal sympathetic nerve ablation for refractory hypertension. In order to avoid the comorbidities and nephrotoxicity of the contrast agent caused by the damage to the intima of the renal artery, the urology team has used a combination of highly selective peri-renal artery sympathectomy and renal artery sympathetic nerve destruction under laparoscopy to destroy the renal sympathetic nerve for the purpose of treating "refractory hypertension". Because of the minimally invasive laparoscopic technique, this method does not use contrast agents, which makes up for the shortcomings of renal sympathetic nerve ablation and avoids the risk of renal failure caused by the use of contrast agents; it also avoids the serious complications caused by the original open surgery to remove the sympathetic nerve to treat severe hypertension, and greatly reduces the risk of surgery and the possibility of serious complications. It is especially suitable for the treatment of refractory hypertension with "contraindications to renal sympathetic nerve ablation".
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