Percutaneous transluminal renal angioplasty: initial and long-term results

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.     

Percutaneous transluminal angioplasty of the femoropopliteal artery: initial and long-term results

Patients with dilated stenoses and recanalized occlusions were evaluated to assess the initial and long-term results of percutaneous transluminal angioplasty (PTA) in the femoropopliteal artery. The follow-up period was at least 1 year. The initial success rate was 84% (128/164). The initial results were influenced by the radiologist's experience, catheter selection, and type of lesion. The 5- and 7-year cumulative patency rates were 70% and 60%. There was no difference in long-term patency between initially successful stenoses and short (less than 3 cm) occlusions. Both the morphology and location of the stenotic lesion influenced the long-term results. Although many factors influence the initial and long-term success rate, results of this study justify PTA in the femoropopliteal artery. Patients with localized stenoses and short occlusions are best suited for this treatment.     

Percutaneous transluminal angioplasty of the ilio-femoro-popliteal arteries: initial and long-term results

Percutaneous transluminal angioplasty has been widely used for dilatation and recanalization of occluded or stenosed vessels, but clinical experience in Japan is not extensive. Follow-ups of 78 ilio-femoro-popliteal angioplasties were performed for up to 51 months to assess the initial and long-term results. The initial technical success rate was 91%. The three-year cumulative patency rate was 75%. This study demonstrates that the long-term results of PTA of ilio-femoro-popliteal arterial lesions are competitive with reconstructive surgery. PTA should be the treatment of choice in patients with atherosclerotic narrowing or occlusion of the lower extremities.     

Percutaneous transluminal angioplasty for pediatric renovascular hypertension

Five children had percutaneous transluminal angioplasty (PTA) for renal artery stenosis, involving the mid- or distal main renal artery or proximal branches in 4 and developing after saphenous vein patch angioplasty in 1. All 5 children became normotensive following the procedure, but one later became hypertensive due to recurrent renal artery stenosis. The authors recommend PTA for treatment of mid- to distal renal artery stenosis in children.     

Percutaneous transluminal angioplasty for treatment of renovascular hypertension.

Four patients with typical renovascular hypertension due to atherosclerotic stenosis (3 patients) and near occlusion (one patient) were treated with percutaneous transluminal angioplasty (PTA). Two patients had malignant hypertension by clinical standards. All had significant reduction in blood pressure following angioplasty, resulting in either a normotensive state, or management with significantly less antihypertensive medication. Patency and normal renin levels were achieved within two months in 2 patients. Clinical follow-up documented continued reduction in blood pressure. Advantages of the procedure include local anesthesia, relatively little discomfort, repeatability, and the fact that surgery is not precluded if angioplasty is unsuccessful.     

经皮肾动脉腔内成形术治疗肾血管性高血压

目的：评价经皮穿刺肾动脉腔内成形术（PTRA）对肾血管性高血压的治疗效果。方法：1983年3月至1996年12月，对21例肾血管性高血压的24支狭窄肾动脉（双侧者3例）施行了PTPA治疗。根据术中狭窄部位动脉压差改变及临床血压变化对其疗效进行了评价。结果：从21例进行了PTRA的24支狭窄肾动脉中，18支（75%）立刻获得技术成功。后经随访的12例病人中，3年疗效；治愈9例（75%），改善2例（16.7%），无效1例（8.3%）；5年疗效：治愈7例（58.3%），改善2例（16.7%），无效3例（25%）。结论：PTRA对肾血管性高血压的治疗是一种简便，安全，且有较好远期疗效的方法。     

Percutaneous transluminal angioplasty vs. surgery for renovascular hypertension

Therapeutic results in 102 hypertensive patients were evaluated after either renal artery percutaneous transluminal angioplasty (PTA) or surgical bypass procedures for renovascular hypertension. A minimum of 6 months of follow-up was accepted to evaluate therapeutic success or failure. Renal angioplasty had a beneficial result in each of 13 patients with fibromuscular dysplasia and in 10 (83%) of 12 patients with atherosclerotic lesions that did not involve the origin of the renal artery. Although surgery was also beneficial in each of six patients with fibromuscular dysplasia, it helped only five of 10 patients with atherosclerosis of the renal artery. Angioplasty results were similar to surgical results for atherosclerotic lesions that involved the origin of the renal artery. Angioplasty was unsuccessful in two cases of neurofibromatosis because of the firm nature of the lesions, where a bypass procedure was successful in one case. Major complications were more common in surgical cases than in angioplasty. PTA is recommended for all renal artery lesions; surgery should be reserved for failed PTA or recurrent renal artery stenosis after PTA.     

Percutaneous transluminal angioplasty for renovascular hypertension in arteritis: experience in China

Forty-two patients with renovascular hypertension were treated with percutaneous transluminal angioplasty. In 32, arteritis was the cause of the renovascular disease. Thirty of the 42 patients were followed for more than 6 months after angioplasty. Twenty-two of these 30 patients had arteritis; 19 of the 22 (86.4%) benefited from the angioplasty, compared with six of eight patients (75%) with atherosclerosis or fibromuscular dysplasia.     

Percutaneous transluminal coronary angioplasty: short- and long-term results

We reviewed the results of percutaneous transluminal coronary angioplasty (PTCA) in 200 consecutive patients from January 1988 to January 1989. The mean age was 55.8 years. Twenty-two per cent had unstable angina, 66% had stable angina and the other 12% had atypical chest pain or were asymptomatic after a myocardial infarction. Five percent had left ventricular function less than 45%. The angioplasty procedure was angiographically successful in 184 patients (92%). There was no significant difference in success rate in the different vessels or indications. Coronary bypass surgery was required in 3% of patients as an emergency procedure; myocardial infarction occurred in 2% less than 24 hours after the procedure. There has been no in-hospital death. The recurrence rate of ischemic symptoms was 26.5%. Considering lesions treatment, the procedure was successful in 71% of the 200 patients over a long-term follow-up period.     

Percutaneous excimer-laser and excimer-laser-assisted angioplasty of the lower extremities: results of initial clinical trial

Percutaneous peripheral excimer-laser angioplasty at 308 nm was used for treatment of 30 patients with peripheral vascular disease. Twenty-eight patients underwent laser-assisted balloon angioplasty, and two patients underwent laser angioplasty alone. Acute angiographic and clinical success was achieved in 24 of 31 (77%) femoropopliteal stenoses and occlusions. Seven of nine (78%) stenoses, six of seven (86%) short (0-5 cm) occlusions, seven of eight (88%) medium-length (6-10 cm) occlusions, three of four (75%) long (11-15 cm) occlusions, and one of three (33%) extreme (greater than 15 cm) occlusions were successfully treated. Inability to treat total occlusions was in each case related to a failure to maintain coaxial position and subintimal passage of the fiber. These cases demonstrate the feasibility of safely performing percutaneous peripheral excimer-laser or excimer-laser-assisted angioplasty. The overall frequency of restenosis after a mean follow-up period of 9.1 months was 29%. The data suggest that these procedures may be useful for the treatment of peripheral vascular disease in selected patients.     

Percutaneous transluminal renal angioplasty: indication for renovascular hypertension associated with renal atrophy

The results of clinical studies indicate that percutaneous transluminal renal angioplasty (PTRA) is an effective means for treating renovascular hypertension resulting from renal artery stenosis. However, the indications for the patients with renal failure or renal atrophy are not established on a firm ground. We attempted PTRAs of ten kidneys in nine patients with hypertension associated with renal atrophy. They were followed for an average of 8 months by the methods including blood pressure, angiography or DSA, blood chemistry, and RI-renogram. We also evaluated enlargement of the renal size on an angiogram or on a plain film at DSA. Angiographic follow-up showed persistent relief of the stenosis in all cases. After PTRA, blood pressure reduced to normal or improved in two thirds of the patients for the follow-up period. In the study of three patients with excellent results for blood pressure, two patients showed the renal length to be increased by 1.0 cm or more, and one patient by 0.5 cm. In the same group, RI-renogram also showed good response. These data indicate that PTRA could improve total perfusion on the affected kidneys. On the other hand, in three patients with no change in blood pressure, there was poor response in both the renal size and the data of RI-renograms. We suggest that the irreversible changes might have occurred in these kidneys. It was difficult to predict cure group from no change group before PTRA.     

Percutaneous transluminal angioplasty: the treatment of choice for renovascular hypertension due to fibromuscular dysplasia

Twenty-three renal artery stenoses in 21 hypertensive patients, caused by fibromuscular dysplasia, were treated with percutaneous transluminal angioplasty (PTA). Follow-up over a period of 1 to 30 months, including angiography, renal vein renin assay, and radionuclide flow studies, was performed in 8 patients, each with one stenosis. Dilatation was initially successful in all cases and was successfully repeated in 1 case. The mean systolic pressure decreased by 61.81 mm Hg and the mean diastolic pressure by 36.28 mm Hg in response to treatment. Thirteen patients were cured, 8 were felt to have better control of blood pressure on medication, and there was no failures. This study demonstrates that PTA is a clinically effective method of treating renovascular hypertension due to fibromuscular dysplasia.     

Percutaneous transluminal renal angioplasty: Initial results and long-term follow-up in 202 patients

Percutaneous transluminal renal angioplasty was performed in 202 patients with 250 stenoses. The procedure was successful in 201 of 250 (83%). Results were better for postostial atherosclerotic lesions (94%), fibromuscular lesions (83%), and transplant kidneys (71%) than for ostial atherosclerotic lesions (29%). Of all the patients, 61% had reduced blood pressures following the procedure, with cure (diastolic blood pressure ≤90 mm Hg) in 31% of the patients. Cure rate with a mean follow-up of 25.8±19.4 months was 21% in bilateral atheromatous lesions, 30% in unilateral atheromatosis, 65% in unilateral fibromuscular disease, and 40% in bilateral fibromuscular dysplasia. Of the transplanted patients, 60% were cured. Complications occurred in 23 (11%) of the patients. Recurrence of stenoses occurred in 16 lesions (8%). 80% within the first year after the procedure.     

Percutaneous laser thermal angioplasty: initial results and 1-year follow-up in 129 femoropopliteal lesions

Percutaneous peripheral laser thermal angioplasty with a laser-heated metallic-capped fiber was used as an adjunct to conventional balloon angioplasty. Initial angiographic and clinical success was achieved in 99 of 129 (77%) femoropopliteal stenoses and occlusions (21 of 22 [95%] stenoses, 17 of 17 [100%] short [1-3-cm] occlusions, 26 of 37 [70%] medium-length [4-7-cm] occlusions, and 35 of 53 [66%] long [greater than 7 cm] occlusions). There was a 4% frequency of vessel perforation without clinical sequelae and no necessity for emergency bypass surgery. The 1-year cumulative clinical patency was 77% for the 99 lesions with an initial clinical success. In the 21 stenoses and 17 short occlusions, the cumulative clinical patency rates were 95% and 93%, respectively. In the longer occlusions (4-7 cm and greater than 7 cm), the clinical patency rates were 76% and 58%, respectively. The initial angiographic and clinical success, as well as the 1-year cumulative clinical patency, for stenoses and short occlusions after laser-assisted balloon angioplasty may be greater than after conventional balloon angioplasty alone.     

Percutaneous transluminal angioplasty of the subclavian arteries: long-term results in 52 patients.

We studied the long-term results of percutaneous transluminal angioplasty of the subclavian artery in treating stenosis (43 patients) or occlusion (nine patients). In all 52 patients, the blood pressure before treatment in the arm on the involved side was at least 30 mm Hg lower than that in the opposite arm. Thirty-nine patients (75%) had symptoms of vertebrobasilar insufficiency (dizziness, blurred vision, ataxia). Angioplasty was successful in 40 (93%) of 43 patients with stenosis and in five (56%) of nine patients with occlusion. In the successfully treated patients, follow-up angiograms showed absence of narrowing greater than 30% stenosis, and the blood pressure in the treated arm equaled that in the opposite arm. The patients were followed up for 6-48 months (mean, 29 months). During this time, the blood pressure in the treated arm remained normal in 41 (91%) of 45 patients. The symptoms of vertebrobasilar insufficiency subsided in 28 (72%) of 39 patients. These results suggest that percutaneous transluminal angioplasty is useful for treating subclavian artery stenosis or occlusion.     

支架成形术治疗肾动脉狭窄

目的　分析支架成形术治疗肾动脉狭窄临床疗效。方法　本组肾血管性高血压患者 15例 ,肾动脉狭窄病变血管 15支 (13例 ,89% ) ,闭塞病变血管 2支 (11% )并肾功能衰竭。其中 ,双侧肾动脉受累 2例。狭窄病例中 ,治疗前狭窄程度为 6 0 %～ 90 %。共植入支架 16枚。术后观察患者状况及血管造影随访结果。结果　技术成功率 10 0 % ,未发生严重并发症。随访 6～ 15个月 ,显示临床治愈 4例(2 6 % ) ,改善 9例 (6 0 % ) ,无效 2例 (13% ) ,临床总有效率 86 %。收缩压由术前平均 (2 7.12± 3.0 9)kPa降至术后随访平均 (18.6 2± 3.12 )kPa ,舒张压由术前平均 (17.73± 1.92 )kPa降为术后平均 (11.12± 2 .4 3)kPa(P <0 .0 5 )。术后肾功能保持稳定者 9例 (6 0 % ) ,明显好转者 5例 (33% ) ,继续恶化者 1例 (6 % )。造影复查 1例 (6 .7% ) ,于术后 6个月出现支架内再狭窄 (约狭窄 70 % ) ,经支架内球囊扩张后 ,随访 2次血管造影其再狭窄程度稳定在 2 0 %左右。结论　内支架成形术治疗肾动脉狭窄 ,临床疗效显著 ;闭塞病例支架成形治疗的成功 ,为介入治疗此病的进一步发展开辟了广阔的前景     

Percutaneous transluminal angioplasty for occlusion of the subclavian artery: Short-and long-term results

Percutaneous transluminal angioplasty was performed in 8 symptomatic patients with proximal occlusion of the left subclavian artery. Technical and short-term clinical success was achieved in 7 cases. Nonoccluding embolization to the distal subclavian artery and stenosis of the brachial artery after a combined femoral/brachial approach occurred as complications in 2 patients. Three patients are asymptomatic with a patent subclavian artery 25, 28, and 37 months after angioplasty. Reobstructions in 4 patients occurring after 8, 12, and 16 months were retreated by angioplasty (3 patients) and stent implantation (1 patient with a second restenosis) with good technical and clinical success. Long-term patency was less than 50%, but successful retreatment is feasible. Therefore, we consider percutaneous transluminal angioplasty a reasonable therapeutic option in patients who are not surgical candidates.