A Study on the Outcome of Percutaneous Transluminal Renal Angioplasty in Patients with Renal Failure

Abstract

Background: The indications for percutaneous transluminal renal angioplasty (PTRA) in renovascular disease, as well as its benefits, remain a matter of debate. The aim of this study was to evaluate the outcome of angioplasty and to identify risk factors associated with less successful outcomes in patients with atheromatous renal artery stenosis and renal failure of varying degrees. Methods: The results of PTRA were analyzed retrospectively in 144 patients with serum creatinine levels of >130 µmol/l. Patients were divided into 5 groups according to their indication for angioplasty: (1) deteriorating renal function; (2) accelerating hypertension; (3) a combination of 1 and 2; (4) peripheral vascular disease, and (5) miscellaneous conditions. Results: The baseline mean (± SD) systolic and diastolic blood pressures of the entire group were lowered from 180 ± 32 and 95 ± 16 mm Hg to 162 ± 23 and 86 ± 12 mm Hg, respectively (p < 0.0005), 12 months after angioplasty. The blood pressure level was unaffected by angioplasty in patients with claudication. The mean number of antihypertensive drugs was reduced in the group with accelerating hypertension from 2.9 ± 0.8 to 2.4 ± 1.2 (p = 0.019), and in the group with unilateral renal artery stenosis and two kidneys from 2.4 ± 1.0 to 1.8 ± 1.1 (p = 0.002), 12 months after PTRA. Glomerular filtration rate at 3-month follow-up had increased from 23 ± 11 to 27 ± 14 ml/min/1.73 m² (p = 0.021) in group 1, from 25 ± 11 to 28 ± 14 ml/min/1.73 m² (p = 0.031) in the combined group of patients consisting of groups 1 and 3, and from 32 ± 13 to 35 ± 14 ml/min/1.73 m² (p = 0.019) in the group with unilateral renal artery stenosis. No statistically significant difference was found in any of these 3 groups 1 year after angioplasty. The first patient group had an increased prevalence of cardiovascular disease, aortic aneurysm, carotid occlusive disease, and peripheral vascular disease compared to the other patient groups (p < 0.05). Patients with baseline creatinine levels of >300 µmol/l had a lower survival rate at 12, 60, and 120 months after PTRA than patients with serum creatinine levels of <300 µmol/l (p < 0.005). Survival was also lower in patients with bilateral renal artery stenosis and those with a single kidney, compared to patients with a unilateral stenosis at both 5 and 10 years after PTRA (p < 0.05). Regression analysis of predictor variables of mortality rate showed that the relative risk (RR) associated with increased serum creatinine was 4.7 (CI 2.0–11.0; p < 0.0005). The RR for older patients was 1.1 (CI 1.0–1.2; p = 0.008), and the RR for former smokers was 6.0 (CI 1.6–24.0; p = 0.009). Conclusion: The results of the present study indicate that glomerular filtration can be improved in patients who primarily undergo angioplasty to rescue renal function. Renal function with creatinine levels of >300 µmol/l was associated with a lower survival rate. It is, therefore, possible that patients selected after a thorough evaluation of their renal funct...

Atherosclerotic Renal Artery Stenosis: Association with Emerging Vascular Risk Factors

“…Other studies have similarly demonstrated that serum creatinine values can be used to predict improvement in renal function following PTRA [124, 125]. Furthermore, ARAS patients undergoing PTRA with creatinine values >300 µmol/l (3.9 mg/dl) have almost 5-fold higher mortality rates compared with patients with creatinine values <300 µmol/l (relative risk = 4.7, 95% CI = 2.0–11.0, p < 0.0005) [126]. …”

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

“…A favorable outcome was correlated with a lower creatinine level (P = 0.0137) and a more rapid prior loss of renal function (r = 0.49, P = 0.020) at entry. Roussos et al [33] showed that patients with ARAS who were referred for angioplasty because of deteriorating renal function (mean serum creatinine: 3.66 ± 1.89 mg/dL) had a small increase in glomerular filtration rate at 3-month follow-up (from 23 ± 11 to 27 ± 14 mL/ min/1.73 m 2 ; P = 0.021). Analysis with patients who had both renal function deterioration and accelerated hypertension showed improvement of glomerular filtration rate (from 25 ± 11 to 28 ± 14 mL/min/1.73 m 2 ; P = 0.031) 3 months after intervention.…”

Renal artery pseudoaneurysm caused by a complete stent fracture: A case report

“…1,2 During follow-up, most stent-related complications are restenosis. Only a few cases of renal stent fractures have been reported in the relevant literature.…”