Complications in Percutaneous Transluminal Dilatation of Renal Arteries

Abstract

We propose a classification of the complications in renal artery percutaneous transluminal angioplasty (PTA) according to their severity and their direct or indirect relationship to PTA. Minor complications are reversible within the normal recovery period after PTA, while major complications are irreversible or reversible but necessitate extended hospitalization or surgery. The following complications are reported in the literature as being directly related to PTA: hemorrhage at the puncture site, hemorrhage from renal or access artery perforation or rupture, occlusive or nonocclusive dissection of the renal or access arteries, renal artery thrombosis, renal artery spasm or embolism leading to segmental renal infarction, peripheral artery embolisation, and balloon rupture complications. The indirectly related complications include transient or irreversible renal insufficiency, contrast media hypersensitivity, pressure-drop-related cerebral or myocardial ischemia, and anticoagulation-related hemorrhage infections. In our own series of 105 PTA in 80 patients, complications occurred in 11% of which 4% were major, 1% indirectly related to PTA leading to death. In the reports available, the rate of major complication ranges between 3 and 10%, and the death rate around 1%.

Percutaneous transluminal renal angioplasty in management of atherosclerotic renovascular hypertension: results in 100 patients.

“…Given these considerations, reported rates of major complications have ranged from 7% to 14%.' 3 Mortality rates associated with PTRA have ranged from 0% to 3%, as recently reviewed by Mahler et al 31 How do the results of our study compare with those of other modalities in the management of atherosclerotic renovascular hypertension? Turning first to renovascular surgery, direct comparison is often hindered by several limitations of the available surgical reports.…”

Blood Pressure Outcome of Angioplasty in Atherosclerotic Renal Artery Stenosis

“…However, the cure rate is lower and the incidence of complications higher among patients with atherosclerotic RAS. 14,20 Atherosclerotic patients more frequently suffer technical failures or subsequent restenosis than those with fibromuscular RAS.…”

“…2,3,7,14,20 Retrospective series report that the usual BP outcome after angioplasty for atherosclerotic RAS is improvement, that is, a reduction in BP levels and/or in the required number of antihypertensive agents. 2,14 There are no uniform criteria for assessing improvement, however, and it may be spontaneous or a consequence of alterations in drug choice and dosage.…”

“…3,4,23 The complication rate in our group of patients undergoing angioplasty was substantial (6 of 23, or 26%) and higher than in many retrospective series. 14,20 Clinicians involved in the present trial may have used a low threshold to define the presence of a complication. However, they probably applied the same criteria to patients in both treatment groups, and angioplasty was more frequently associated with complications than diagnostic angiography alone.…”

“…Secondary end points were the treatment score and the incidence of complications. 20 The treatment score was defined as the number of antihypertensive agents administered. Treatment was also quantified in DDD units 16 at randomization and termination, using the following DDD: nifedipine 30 mg, clonidine 0.45 mg, prazosin 5 mg, furosemide 40 mg, enalapril 10 mg, and atenolol 75 mg.…”