Journal of Vascular Surgery

1993

DOI: 10.1016/0741-5214(93)90340-r

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Percutaneous transluminal renal angioplasty versus surgical reconstruction of atherosclerotic renal artery stenosis: A prospective randomized study

Henrik Weibull¹,

David Bergqvist²,

Sven‐Erik Bergentz³

et al.

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Discussion1

Ptra: Effects On Blood Pressure1

Assessing the Patient: Risks And Options1

Revascularization1

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1997

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Cited by 247 publications

(83 citation statements)

References 30 publications

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“…[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.…”

mentioning

confidence: 99%

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

¹

,

²

,

³

et al. 1998

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Background-Stent revascularization is perceived as superior to balloon angioplasty and surgical revascularization, but the paucity of stent publications precludes even historical comparison with surgical data. Methods and Results-Palmaz-Schatz stent revascularization of renal artery stenosis was successfully performed on 163 consecutive patients for poorly controlled hypertension or preservation of renal function. Of these, 145 were eligible for Ն6-month clinical follow-up of the effect of the procedure on renal function, blood pressure control, number of antihypertensive medications, and survival. At 4 years, systolic and diastolic blood pressures significantly decreased (from 166Ϯ26 to 148Ϯ22 mm Hg and from 86Ϯ14 to 80Ϯ11 mm Hg, respectively; PϽ0.05), and blood pressure control was more facile in approximately half of the patients. Creatinine decreased or remained stable in approximately two thirds of the patients. The cumulative probability of survival was 74Ϯ4% at 3 years, with few deaths related to end-stage renal disease. Survival was good in patients with normal (92Ϯ4%) baseline renal function, fair (74Ϯ7%) in those with mildly impaired renal function, and poor (52Ϯ7%) in patients with elevated baseline creatinine levels (Ն2.0 mg/dL). The combination of impaired renal function and bilateral disease adversely affected survival. Conclusions-Renal artery stent revascularization in the presence of normal or mildly impaired renal function had a beneficial effect on blood pressure control and a nondeleterious effect on renal function. Survival was adversely affected by renal dysfunction despite adequate revascularization. Early diagnosis and adequate revascularization before the onset of renal dysfunction could beneficially affect blood pressure control, preserve or prevent deterioration of renal function, and improve patient survival. (Circulation. 1998;98:642-647.)

“…[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.…”

mentioning

confidence: 99%

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

¹

,

²

,

³

et al. 1998

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Background-Stent revascularization is perceived as superior to balloon angioplasty and surgical revascularization, but the paucity of stent publications precludes even historical comparison with surgical data. Methods and Results-Palmaz-Schatz stent revascularization of renal artery stenosis was successfully performed on 163 consecutive patients for poorly controlled hypertension or preservation of renal function. Of these, 145 were eligible for Ն6-month clinical follow-up of the effect of the procedure on renal function, blood pressure control, number of antihypertensive medications, and survival. At 4 years, systolic and diastolic blood pressures significantly decreased (from 166Ϯ26 to 148Ϯ22 mm Hg and from 86Ϯ14 to 80Ϯ11 mm Hg, respectively; PϽ0.05), and blood pressure control was more facile in approximately half of the patients. Creatinine decreased or remained stable in approximately two thirds of the patients. The cumulative probability of survival was 74Ϯ4% at 3 years, with few deaths related to end-stage renal disease. Survival was good in patients with normal (92Ϯ4%) baseline renal function, fair (74Ϯ7%) in those with mildly impaired renal function, and poor (52Ϯ7%) in patients with elevated baseline creatinine levels (Ն2.0 mg/dL). The combination of impaired renal function and bilateral disease adversely affected survival. Conclusions-Renal artery stent revascularization in the presence of normal or mildly impaired renal function had a beneficial effect on blood pressure control and a nondeleterious effect on renal function. Survival was adversely affected by renal dysfunction despite adequate revascularization. Early diagnosis and adequate revascularization before the onset of renal dysfunction could beneficially affect blood pressure control, preserve or prevent deterioration of renal function, and improve patient survival. (Circulation. 1998;98:642-647.)

“…5 While multiple trials have been completed on percutaneous renal artery intervention, there is only one study comparing percutaneous renal intervention with surgical revascularization. 34 Weibull et al compared percutaneous transluminal renal angioplasty with surgical reconstruction of atherosclerotic RAS in a prospective randomized study in 1993. 34 At that time, primary patency following angioplasty was 75% at two years compared to 96% for bypass in a group of 58 patients, with 17% of patients who underwent angioplasty requiring surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

Renal artery stenting may not be appropriate for patients with atherosclerotic renal artery stenosis

¹

,

³

et al. 2015

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Introduction: This study compared aortorenal bypass to renal artery stenting to determine the most efficacious and financially sound method for treating patients with atherosclerotic renal artery stenosis (RAS). Methods: A decision analysis using direct and indirect costs, and value of statistical life (VSL) was completed. Direct costs were obtained using the Nationwide Inpatient Sample (NIS), indirect costs from the National Institute of Diabetes and Digestive and Kidney Diseases, and VSL from the Department of Transportation. A variance-based sensitivity analysis was completed to assess the accuracy of the decision analysis. Results: Aortorenal bypass has a 95% five-year patency, a 98% 30-day survival, a 26% rate of overall complications, and a 70% five-year dialysis-free survival. Renal artery stenting has a 56% five-year patency, a 99% 30-day survival, a 40% rate of complications, and a 65% five-year dialysis-free survival. Renal artery stenting has an overall cost of $305,370 and aortorenal bypass has an overall cost of $103,453 per patient. After accounting for VSL, renal artery stenting has a negative value of À$182,270 and aortorenal bypass has a value of $415,881. Conclusions: Lower five-year patency and higher rate of complications from renal artery stenting that ultimately lead to significantly lower five-year dialysis-free survival.

“…PTRA is currently the first choice because it is less invasive. Randomized data in patients with ostial ARAS showed that PTRA is as effective as surgical reconstruction, and moreover, a simpler procedure [23]. A recent meta-analysis of randomized controlled trials addressed the antihypertensive effect of balloon angioplasty versus standard medical therapy in ARAS [24].…”

Section: Ptra: Effects On Blood Pressurementioning

confidence: 99%

Atherosclerotic renovascular disease and renal impairment: Can we predict the effect of intervention?

Mui¹,

³

2007

Current Science Inc

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Atherosclerotic renal artery stenosis (ARAS) is associated with hypertension, ischemic nephropathy, and high cardiovascular risk. We review the data on revascularization of the renal artery by percutaneous transluminal renal angioplasty (PTRA) and pharmacological therapy. In patients with severe ARAS and poorly controlled hypertension, PTRA can improve blood pressure control. In patients with rapid renal function loss and severe ARAS, PTRA can improve short-term renal function, but there is no evidence for long-term renoprotection. Recent evidence indicates that ARAS, and incidental renal artery stenosis, considerably increases cardiovascular risk, independent of blood pressure, renal function, and prevalent risk factors. This suggests that revascularization might potentially improve overall prognosis, but no data are available currently. The high cardiovascular risk warrants aggressive pharmacological treatment to prevent progression of the generalized vascular disorder. Ongoing trials will show whether revascularization has added, long-term effects on blood pressure, renal function, and cardiovascular prognosis.

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