Treatment of renovascular hypertension: One year results of renal angioplasty

Abstract

During the ten year period from 1981 to 1991, percutaneous transluminal renal angioplasty (PTRA) was performed in 180 renal arteries in 137 patients, where the underlying renovascular disease was fibromuscular dysplasia (FMD) in 30 patients (22%) and arteriosclerotic vascular disease (AVD) in 107 (78%). A preinterventional work-up and a re-evaluation of the patients after one year was designed for the assessment of the clinical, functional and technical outcome. Successful technical dilatation was achieved in 97% of procedures with FMD patients and in 82% of procedures with AVD patients. A beneficial effect on the blood pressure and the renal function was registered in both groups. The overall cure and improvement rate for hypertension was 86% in the FMD group and 64% in the AVD group after one year's follow-up. A significant gain in the total renal function was registered in both groups, the average increase in glomerular filtration rate being 13% (P < 0.001) for the FMD group and 11% (P < 0.001) for the AVD group one year after PTRA. Renal function was improved or unchanged in 89% of FMD patients and 74% of AVD patients. The improvement in renal function was made by the revascularized kidney. Renal vein renin investigation predicted the clinical outcome with an excellent diagnostic accuracy as no renin negative patient became normotensive, and renin positive patients, who did not turn normotensive, were in almost 90% of the cases affected by technical failure or restenosis/contralateral stenosis. Thus, the sensitivity of renal vein renin investigation was 95% and the specificity 75%. The outcome for patients with hypertension and renal insufficiency was considerably poorer than for the whole group of patients, with only a 20% success rate for hypertension, but 50% in this group had increased or unchanged GFR after intervention. The angiographic one-year follow-up revealed a recurrence rate of 6.7% for FMD and 15.1% for AVD. For the entire series of patients, the incidence of major complications was 5.4%, including one indirect fatality, while the incidence of minor complications was 5%. In conclusion, PTRA will cure or improve blood pressure in most patients with renovascular hypertension, and it preserves and even improves renal function in these patients. Complications and recurrence are in fact not very common and PTRA appears be the best first approach in all but ostial lesions for treatment of renovascular hypertension.

Renovascular disease in patients with hypertension: detection with duplex ultrasound

“…[1][2][3] Conventional X-ray angiography is still the most accurate method to assess the presence and severity of renal artery stenosis. However, its invasive nature and high costs make this procedure unsuitable as a screening modality in a population of patients with a low prevalence of renal artery stenosis.…”

Hypertension and renovascular disease: follow-up on 100 renal vein renin samplings

“…1 Our rate of cure and improvement are of the same magnitude as reported in several other studies 2,7,9,20 but much lower than reported from the centres with the highest success. 5,6,21 Several factors might explain this difference, but especially the clinical selection for the first renography seems important. It has been calculated that the probability of renovascular hypertension should be higher than 30% to obtain reasonable cost benefit of the diagnostic programme.…”

“…2,3 Furthermore, the prevalence of renovascular hypertension is now estimated to be less than 0.5% 4 of the hypertensive population, in contrast to earlier estimates up to 5-10%. 2 The therapeutic changes combined with the conflicting reports on the clinical usefulness of renal vein renin sampling (RVRS) and on the long term effects of PTRA on hypertension, [5][6][7][8][9][10] recently addressed by van Jaarsveld and colleagues, 11 prompted us to evaluate our strategy in diagnosing and predicting the outcome of interventional treatment of renovascular hypertension.…”

Renal artery stenosis and abdominal aorta aneurysm in patients with pseudoexfoliation syndrome

“…36 In addition, improvement of renal function occurs in 79% of patients in whom RAS is associated with deteriorating renal function. 37 RAS is accounted for up to 15% of the patients with chronic renal failure.…”