SUMMARY Sixteen consecutive patients with renovascular hypertension were treated by transluminal dilatation and observed during 6-39 months (mean 21.8 months). Poststenotic renal artery pressure increased (p < 0.001) and the renal arteries were patent on angiograms taken immediately after dilatation. In 13 patients, angiography was repeated 2-9 months later; at that time the selective renal vein renin ratio had decreased (p < 0.001). At the end of the follow-up, blood pressure was improved or normal in 14 cases. One of the eight patients with atherosclerosis was normotensive without treatment, compared with five of six patients with fibromuscular dysplasia (p < 0.05). The results in two cases with vasculitis are uncertain. The four patients with relapses, one after intimal catheter dissection, were treated successfully by redilatation. Thus, renovascular hypertension can be improved by transluminal dilatation in patients with atherosclerosis and in patients with fibromuscular dysplasia with lasting success and a low morbidity rate.THE APPLICATION of percutaneous transluminal dilatation in patients with renovascular hypertension is the most recent use for this method, which was initially used in peripheral and then in coronary arteries.'-" Although the initial results and the data from short-term follow-up studies are encouraging,2 3, 6-15 the beneficial effects should be shown to be persistent before propagating the method further. We report our experience in 16 consecutive cases, including patients with atherosclerosis, fibromuscular dysplasia (FMD) and vasculitis, observed for 6-39 months.
Patients and Methods
Patient EvaluationNineteen stenosed renal arteries were treated by transluminal dilatation in a group of 16 consecutive patients (table 1). Eight patients had renal artery stenosis regarded by radiologic criteria"6' 17 as due to atherosclerosis; in one (patient 7), this was found in three renal arteries. Six other patients showed angiographic signs of FMD, in one case the intimal and in five the medial type of FMD. Systemic vasculitis was suspected in two patients: in one man because of multilocular vascular lesions, including bilateral renal artery stenoses, the histologic aspect of a popliteal artery biopsy and a high erythrocyte sedimentation rate, and in one woman because of progressive bilateral renal artery stenosis, associated with lupus erythematosus discoides. Only case 15, who had vasculitis, was treated systemically (prednisone 30 mg/day). In all patients, renal vein renin was determined by radioimmunoassay.18 Selective renal vein blood samples were taken before and after dilatation after renin stimulation by daily ingestion of furosemide (120 mg) given 3 days before the examination. Betablocking drugs were discontinued for at least 2 weeks. Ischemic/contralateral kidney renin ratios ranged from 1.56-3.35 before dilatation. The patients were examined before and immediately after dilatation and every 3 months thereafter. In 13 patients, renal arteriography and selective renal vein renin determi...
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