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

Abstract

The long-term effect of percutaneous transluminal renal angioplasty (PTRA) on blood pressure and renal function was assessed in 100 consecutive patients with atherosclerotic renovascular hypertension. Technical success rates (complete plus partial) of a first PTRA averaged 76.2%, 74.1%, and 67.7% for the unilateral (n=42), bilateral (n=27), and solitary (n=31) groups, respectively. Of the technical successes, 59% (43/73) experienced sustained blood pressure benefit (mostly amelioration) during a mean foUow-up period of 29 months. Rates of blood pressure benefit were similar in the three groups. Ostial lesions comprised the majority of blood pressure benefit failures. Repeat angioplasty in 14 patients resulted in a 71% technical success rate and a 50% blood pressure benefit rate during a mean follow-up period of 22 months. Long-term stability of mean serum creatinine level was observed after technically successful angioplasty in all three groups. Acute renal insufficiency, which was reversible in all but one patient, complicated 26% of the procedures. Mechanical complications occurred in 14% (20/145) of the arteries acted on; surgical intervention was required in five patients. The mortality rate was 2%. These results suggest that angioplasty is effective in both the long-term management of renovascular hypertension and the preservation of renal function hi a large fraction of patients with atherosclerotic renovascular hypertension. Among patients with accelerated or malignant hypertension, the prevalence of renovascular hypertension is about 30%. Moreover, it is estimated that up to 45% of patients with accelerated hypertension and renal insufficiency suffer from renovascular hypertension.

Four-Year Follow-up of Palmaz-Schatz Stent Revascularization as Treatment for Atherosclerotic Renal Artery Stenosis

“…Renal artery stent revascularization procedural results have been demonstrated to be superior to balloon angioplasty, 20,31 as assessed by hemodynamic transstenotic pressure gradient measurements, complication rates, and restenosis rates. The data presented here define its long-term benefits as manifest by significant decreases in the systolic and diastolic blood pressures, more facile blood pressure control, and a reduction in the number of antihypertensive medications.…”

“…[1][2][3][4][5][6][7][8] Although surgical revascularization has cured or improved blood pressure control, preserved or stabilized renal function, 9 -15 and reversed end-stage renal failure, 16 -18 its morbidity and mortality rates have been higher than those of stent revascularization. 19 -24 Stent revascularization has created the perception of superiority to balloon angioplasty [25][26][27][28][29][30][31] and surgical revascularization, but the paucity of stent publications precludes even historical comparison with surgical data. This article details the 4-year follow-up of 145 patients Ն6 months after their procedures who underwent PalmazSchatz stent revascularization of Ն1 stenotic renal artery, as well as its impact on renal function, blood pressure control, and survival.…”

Blood Pressure Outcome of Angioplasty in Atherosclerotic Renal Artery Stenosis

“…21 Patients with fibromuscular RAS were not included because good evidence is already available that the benefits of angioplasty outweigh the risks in such patients.…”

“…In the largest retrospective series of angioplasty for atherosclerotic RAS, mechanical complications and acute renal failure (generally reversible) occurred in 26% and 14% of procedures, respectively. 21 In a prospective randomized trial comparing angioplasty with surgery in atherosclerotic RAS, 9 there were major and minor complications in 5 and 11 of the 29 patients in the angioplasty group (17% and 48%), respectively. In the present trial, most immediate complications were mild and transient.…”

ACC/AHA 2005 Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic)

“…Percutaneous transluminal renal balloon angioplasty is the treatment of choice for symptomatic RAS caused by FMD (744,(768)(769)(770). However, in atherosclerotic RAS, balloon angioplasty alone is associated with a lower procedural success rate and a higher restenosis rate (745,(771)(772)(773)(774)(775)(776)(777). Aortoostial stenoses represent the most common atherosclerotic lesions and are prone to vascular recoil due to confluent plaque that extends from the wall of the aorta into the ostium of the renal artery.…”