Percutaneous transluminal angioplasty of the renal artery. Results and long-term follow-up.

Abstract

Percutaneous transluminal angioplasty (PTA) was used to treat 109 patients with 141 renal artery stenoses, including 58 patients in whom medical management was unsuccessful. The initial success rate was 94%. Fifty-five patients had severe diffuse atherosclerosis and 40 had renal insufficiency. Thus far, 36 patients (50 stenoses) have undergone a total of 52 follow-up angiographic studies. Clinical data, including blood pressure response, were obtained in all cases. Only 7 of the 98 hypertensive patients failed to respond to PTA. Of the 11 patients treated primarily for renal insufficiency, 5 improved. Of the 29 hypertensive patients who also had elevated BUN and creatinine, renal function improved in 13. Altogether, 96 patients (88%) benefited from the procedure. Analysis of long-term results suggests that PTA should be the treatment of choice for fibromuscular dysplasia and short, segmental atherosclerotic lesions and could also prove helpful in improving renal insufficiency.

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

“…1719 - 20 For example, in the report on 51 patients with atherosclerotic renovascular hyperten- 17 which also provided an analysis of the technical result of PTRA according to the anatomy of the lesion, the combined rates of complete plus partial success averaged 67% for the unilateral as well as the bilateral groups. As shown in Figure 1, our technical success rates averaged 76%, 74%, and 68% for the unilateral, bilateral, and solitary groups, respectively.…”

Successful Treatment of Renovascular Hypertension due to Fibromuscular Dysplasia by Intravascular Ultrasound-Guided Atherectomy

“…The assessment of renal artery structure at PTRA is also important. Initial and long-term results of PTRA show that cure rates are mainly dependent on the histological characteristics of the lesion [10]. Medial fibroplasia is more responsive to balloon angioplasty than intimal or periarterial fibroplasia [10].…”

“…Initial and long-term results of PTRA show that cure rates are mainly dependent on the histological characteristics of the lesion [10]. Medial fibroplasia is more responsive to balloon angioplasty than intimal or periarterial fibroplasia [10]. Furthermore, elastic recoil or dissection in the lesion affected the occurrence of acute occlusion and chronic restenosis after angioplasty [11].…”

Treatment of Renovascular Hypertension

“…The balloon should be inflated for at least three separate periods of 60 s each and if possible until the hour-glass shape of the stenosis has disappeared. The diameter of the balloon is chosen to achieve 10-20% over dilation of the estimated normal artery lumen [67][68][69], Immediate angiographic control of the morphological re sult should be performed after angioplasty.…”