Percutaneous transluminal renal angioplasty: initial and long-term results.

Abstract

Renal artery stenosis in 201 patients with hypertension was treated with percutaneous transluminal renal angioplasty (PTRA). A total of 213 procedures were performed as treatment of 262 separate stenosis. The stenosis was caused by atherosclerosis in 134 cases and by fibromuscular dysplasia (FMD) in 52 cases; the cause was indeterminate in 27 cases. Of the 213 procedures, 172 were successful or resulted in improvement, for a technical success rate of 80.8%. The initial clinical results could be evaluated in 210 cases; cure or improvement was achieved in 80%. There were 23 cases in which neither technical nor clinical success was achieved. Data on the remaining 187 cases were the basis of this long-term follow-up study. The cumulative patency rate at 5 years was 80% in the atherosclerosis group, 89% in the FMD group, and 74% in the indeterminate group. The mortality was less than 1%. Because spasm occurred in 33 cases, causing an infarction in ten instances, antispasmodic medication seems warranted. These long-term results indicate that PTRA is the treatment of choice in patients with renovascular hypertension.

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.…”

Quantitative Residual Cortical Activity Measurement: Appropriate Test for Diagnosis of Renal Artery Stenosis?

“…tion of patients in the diagnostic criteria and the use of both glomerular filtration agents and tubular agents. There is a sensitivity and specificity for both unilateral and bilateral RAS of around 85 and 75% (range 42-100%), respectively, when hippuran is used as a marker [14][15][16][17], and around 85 and 90% (range 60-100%), respectively, for 99m Tc DTPA renography [5,[18][19][20][21]. The preliminary results for MAG3 fall in the same range [1,22,23].…”

Stenting of a renal artery bifurcation stenosis

“…The lesion lacks the ''string-of-beads'' appearance typical of fibromuscular dysplasia [25,26]. The poor response to balloon angioplasty despite the kissing balloon technique is also atypical for fibromuscular dysplasia [27,28]. On the other hand, the patient's relatively young age, lack of any atherosclerotic risk factors, and the midartery location of the lesion suggest fibromuscular dysplasia to be the cause [26,29].…”