Lasting improvement of renovascular hypertension by transluminal dilatation of atherosclerotic and nonatherosclerotic renal artery stenoses. A follow-up study.

Abstract

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...

Indications for Renal Artery Surgery: A Review

“…The complication rate for the procedure has been reported to be between 5 and 10% (Grim 1981, Mahler et al 1982, the most common complication being the necessity to redilate the artery to achieve a radiographically satisfactory result. PTA has been reported as having a successful outcome in 70-80% of patients with fibromuscular hyperplasia (Mahler et al 1982, Grim 1981, Saddekni et al 1980), but the follow-up period for most of the patients was less than 24 months.…”

Technical Aspects of Percutaneous Transluminal Angioplasty in Renovascular Disease

“…These catheters had a smaller shaft diameter and were much more flexible and maneuverable than Doner's equipment and therefore dilation of visceral and coronary arteries became possible. Since the late 1970s, several authors have reported successful initial dilation of renal artery disease due to atherosclerosis and fibromuscular dyspla sia [3][4][5][6][7][8][9], There are also a few papers with long-term follow-up results of renal angioplasty [10][11][12]. In this paper we wish to review the pathophysiology of the dilation process and the relationship of the response of the vessel wall to the dilating forces to the long-term results of the technique in the renal artery.…”

The hypotensive mechanism of percutaneous transluminal dilatation(PTD) in renovascular hypertension due to bilateral renal artery stenosis.

“…It is conceivable that the depressor effect of PTD is caused by an attenuation of some pressor mechanisms or by an activation of some depressor mechanisms. It has been reported that a depressor effect occurred within a few hours after PTD in most cases with RVH (Mahler et al 1982 ;Millan et al 1985). However, there has been no report on the detailed time course study on BP changes immediately after the PTD.…”

“…Since the hypotension was accompanied by a transient decrease in heart rate immediately after PTD, the hypotension may be induced either by a decrease in sympathetic tone or by an increase in vagal tone at least just after PTD. It is hypothesized that these changes in autonomic nervous activity are mediated centrally through the renal afferent mechanism in response to rapid changes in renal hemodynamics induced by PTD.percutaneous transluminal dilatation ; reninagniotensin system ; autonomic nervous system ; renovascular hypertension It has been repeatedly confirmed that the percutaneous transluminal dilatation (PTD) is effective in the treatment of renal artery stenosis (Grim et al 1981;Mahler et al 1982;Kuhlmann et al 1985 ;Millan et al 1985). Recently PTD is recommended as a treatment of the first choice for all patients with renovascular…”

“…percutaneous transluminal dilatation ; reninagniotensin system ; autonomic nervous system ; renovascular hypertension It has been repeatedly confirmed that the percutaneous transluminal dilatation (PTD) is effective in the treatment of renal artery stenosis (Grim et al 1981;Mahler et al 1982;Kuhlmann et al 1985 ;Millan et al 1985). Recently PTD is recommended as a treatment of the first choice for all patients with renovascular…”