Percutaneous transluminal angioplasty in renovascular hypertension

The results of percutaneous transluminal angioplasty of renal arteries (PTA) were evaluated in 43 patients followed up for 2-39 months (mean: 14 months). The benefit of PTA was higher (82%) in hypertensives with arterial fibrodysplasia (n = 11) than in atherosclerotic vascular lesions (53%, n = 19). Of 15 patients with reduced renal function before PTA, the glomerular filtration rate rose in seven. A major complication was in one patient arterial dissection and in another one loss of function of the transplanted kidney due to acute tubular necrosis. The results confirm that PTA is an important contribution to the treatment of renovascular hypertension.     

Percutaneous transluminal renal angioplasty in management of atherosclerotic renovascular hypertension: results in 100 patients

The long-term effect of percutaneous transluminal renal angioplasty (PTRA) on blood pressure and renal function was assessed in 100 consecutive patients with atherosclerotic renovascular hypertension. Technical success rates (complete plus partial) of a first PTRA averaged 76.2%, 74.1%, and 67.7% for the unilateral (n = 42), bilateral (n = 27), and solitary (n = 31) groups, respectively. Of the technical successes, 59% (43/73) experienced sustained blood pressure benefit (mostly amelioration) during a mean follow-up period of 29 months. Rates of blood pressure benefit were similar in the three groups. Ostial lesions comprised the majority of blood pressure benefit failures. Repeat angioplasty in 14 patients resulted in a 71% technical success rate and a 50% blood pressure benefit rate during a mean follow-up period of 22 months. Long-term stability of mean serum creatinine level was observed after technically successful angioplasty in all three groups. Acute renal insufficiency, which was reversible in all but one patient, complicated 26% of the procedures. Mechanical complications occurred in 14% (20/145) of the arteries acted on; surgical intervention was required in five patients. The mortality rate was 2%. These results suggest that angioplasty is effective in both the long-term management of renovascular hypertension and the preservation of renal function in a large fraction of patients with atherosclerotic renovascular hypertension.     

Percutaneous transluminal renal angioplasty in the treatment of unilateral atherosclerotic renovascular hypertension

Thirteen patients with severe, unilateral, atherosclerotic renovascular hypertension were treated with percutaneous transluminal renal angioplasty. The procedure produced wide patency of the stenosed vessel in 10 patients and partial dilatation in the remaining three. All patients exhibited a beneficial response in their hypertension; at latest follow-up, ranging from two to eighteen months, all patients were normotensive, four in the complete absence of any antihypertensive medication and the remaining nine while taking substantially less medication than before. Suppression of the differential renal-vein renin ratio was also documented.In one patient follow-up angiography, performed after seven months because of deterioration in renal function, revealed an occluded renal artery. Complications that were encountered included two small, segmental renal infarcts, three episodes of nonoliguric, presumably radiocontrast-induced, acute renal insufficiency and a soft-tissue hematoma that occurred one month after the procedure and was due to excessive anticoagulation. Percutaneous transluminal renal angioplasty may be an effective modality in the management of unilateral, atherosclerotic renovascular hypertension.     

Percutaneous transluminal renal angioplasty in hypertension

The aim of our study was assess anatomical and functional results of renal artery angioplasty with and without stenting in 25 hypertensive patients (8 female and 16 male, 42.6 and 61.6 years old respectively) with significative renal artery stenosis (RAS) (atherosclerotic: 22; fibrodysplastic: 3). Eleven patients had simple angioplasty and 13 had stenting. The rate of angioplasty success was 96%. In the stent group, the anatomical result was better: 2% of residual stenosis versus 24% in the other group (p < 0.001). Restenosis occurred in 2 patients. Immediately after revascularisation arterial blood pressure decreased from 195/105 +/- to 150/85 +/- mmHg in-group without stent (p < 0.001) and from 190/100 to 145/85 mmHg in the group (p < 0.001). The value of serum creatinine concentration in patient with renal failure didn't change after revascularization.     

Percutaneous transluminal angioplasty in the treatment of renovascular hypertension

In this study we report our experience in 74 patients with hypertension and renal artery stenosis (42 with atherosclerotic stenosis, 32 with fibromuscular dysplasia) who were followed-up for a mean observation period of 21.7 months after percutaneous transluminal angioplasty (PTA). Stenosis was unilateral in 45 cases, bilateral in 16 and located in the renal artery of a solitary functioning kidney in 13 cases. Ostial involvement was observed in 26 cases. A total of 24 patients showed impaired renal function before PTA. Overall results for BP control were 8 cures (13%), 29 improvements (48%) and 24 (39%) who remained unchanged. Five of the 24 patients (21%) with impaired renal function showed improvement with a decrease in serum creatinine levels of more than 30%. Complications of PTA were rare, being limited to two haematomas at the puncture site which resolved spontaneously. These results emphasize that PTA, an easily repeatable procedure of relatively low risk, short hospital stay and low cost, is a first choice technique in the management of renovascular hypertension.     

Percutaneous transluminal angioplasty in atheromatous stenosis of the renal artery. Late results

The purpose of the study was to analyse the effects on stenosis and blood pressure of percutaneous transluminal renal angioplasty in renovascular hypertension due to atheroma. Angioplasty was successfully performed in ten hypertensive patients (seven men and three women) with unilateral (seven patients) or bilateral (three patients) renal artery stenoses: dilation without complication, anatomic technical success in each case, and reduction in mean pick systolic-pressure across the stenosis. Recurrent stenoses were demonstrated in three men during the first year. After three years (mean follow-up), six patients were improved (normotensive under treatment), but all patients received an antihypertensive drug. Four failures were observed, due to recurrent stenosis in three cases. In patients with unilateral, non ostial and non completely occluded stenosis, improvement due to successful angioplasty was generally observed, incidence of recurrent stenosis was about 20 per cent. In contrast, neither cure nor improvement can be expected in patients with advanced bilateral atheromatous renal artery stenoses. A randomised trail appears necessary to demonstrate the potential improvement of renal function after angioplasty. Our results suggest that percutaneous transluminal renal angioplasty is effective for long-term control of renovascular hypertension (75 per cent) in patients with unilateral, non ostial, atheromatous artery stenosis.     

Reversible renin-dependent renovascular hypertension successfully treated with percutaneous transluminal renal angioplasty and stenting

A 37-year old woman was suspected of having renovascular hypertension because of recent onset severe hypertension (blood pressure 220/135 mmHg; compared to 132/65 mmHg two years earlier) and an abdominal bruit. A captopril renal scan indicated the presence of right renal artery stenosis. Additionally, a captopril plasma renin activity (PRA) provocation test showed a positive result for renovascular hypertension (baseline PRA = 291 microU/mL; 1 hour post-captopril PRA = 1444 microU/mL). Selective renal angiography demonstrated a severe critical stenotic lesion at the distal portion of the right renal artery. Blood pressure (BP) decreased to 136/80 mmHg one day after successful percutaneous transluminal renal angioplasty and stenting. Repeat renal angiography six months after the procedure revealed no evidence of in-stent restenosis. Blood pressure (BP = 137/76 mmHg) and plasma renin profile (baseline PRA = 23.8 microU/mL; 1 hour post-captopril PRA=22.3 microu/mL) also were normal six months following initial revascularization. Moreover, blood pressure (137/84 mmHg) and renin profile remained normal 2.5 years after the procedure (baseline PRA = 24.3 microU/mL; 1 hour post-captopril = 25.6 microU/mL). The results of this study have thus demonstrated a case of renin-dependent renovascular hypertension in which both the blood pressure and plasma renin activity profile normalized following successful percutaneous transluminal angioplasty and stenting.     

Early results of percutaneous renal artery angioplasty in patients with renovascular hypertension

The authors report early results of percutaneous transluminal angioplasty of renal arteries in 28 patients. This method of treatment of renovascular hypertension is applicable in certain cases, mostly in patients with fibromuscular hyperplasia and in arteriosclerotic renal artery disease. Early good and very good hypotensive results were obtained in 27 cases (96.4%).     

Percutaneous transluminal angioplasty of transplant renal artery stenosis

Renal artery stenosis after renal transplant is a dreaded complication. We report two cases of post-renal transplant stenosis in internal iliac artery used for end-to-end anastomosis with the graft renal artery. Both patients were successfully treated by percutaneous transluminal angioplasty with stenting of the internal iliac artery.     

肾动脉纤维肌性发育不良的介入治疗

目的 :探讨肾动脉纤维肌性发育不良(FMD)所致肾血管性高血压的临床特点、介入治疗及预后情况。方法:纳入2009—2013年我科收治的FMD所致肾血管性高血压患者共22例,均进行了经皮肾动脉介入治疗,回顾分析患者的临床特点,评价并随访其介入治疗的疗效及预后。结果:22例患者平均年龄(25±5)岁,其中女性16例(72.7%)。介入治疗采用单纯球囊扩张术18例(81.8%),行肾动脉支架植入术4例(18.2%)。患者平均诊室血压由术前(163±22)/(101±15)mm Hg(1 mm Hg=0.133 k Pa)下降至(122±15)/(80±10)mm Hg。其中12例(54.5%)治愈,10例(45.5%)血压得到改善,降压有效率为100%。术前患者血清肌酐水平为(75±25)μmol/L,术后为(74±21)μmol/L,无统计学差异(P=0.69);其中有8例患者行核素99m锝肾小球滤过率(99m Tc-GFR)随访,显示患侧肾脏99m Tc-GFR由术前(25.2±4.8)m L/min上升至(39.4±8.2)m L/min,术后有明显改善(P=0.001)。随访发现2例(9.1%)患者出现了再狭窄,并再次施行了球囊扩张术,术后血压得到了改善。结论:FMD患者经皮肾动脉成型术降压安全、有效,并能改善患侧肾功能,可作为临床首选治疗方法。     

Long-term results of transluminal angioplasty in the treatment of stenosis of the renal artery

MATERIALS AND METHODS. A multicenter study was undertaken to determine the long-term results of renal angioplasty. Five teams with considerable experience in the procedure replied to a computerized questionnaire concerning transluminal angioplasty (TLA) performed with immediate success from 1979 to 1985 and followed up regularly (minimum of four years). The main purpose of the study was to assess the long-term results, both anatomical results and clinical, of renal TLA. Consideration was given to anatomical of average quality and their possible correlation with long-term results, in an attempt to foresee and even prevent restenosis. The main points of the study are given in figure 1. Two hundred and forty-seven renal TLA performed in 210 patients were included (insofar as clinical and radiologic follow-up was adequate, with a minimum of one control angiography beyond six months). Patients who had immediate failure (dilatation not possible or ineffective dilatation) were excluded from the analysis of long-term results. Likewise, TLA of the renal artery of grafted kidneys were not included in this study. The histogram of patients ages shows a clear predominance of subjects 60 to 65 years of age, with extremes ranging from 10 to 80 years (mean 53 years). TLA were done mainly by the femoral route according to a technique using a balloon catheter positioned on a previously inserted guide at the level of the stenosis. The examination was performed under local anesthesia. Balloon size was determined according to the diameter of the renal artery upstream from the stenosis and that of the contralateral renal artery. A balloon of the same or slightly larger caliber was used. The indication of angioplasty was determined after multidisciplinary discussion according to two main criteria: First, treatment of hypertension presumed to be in relation with a stenosis of the renal artery (renovascular hypertension). Secondly, conservation of the nephrotic capacities of a patient with a renal stenosis possibly associated with arterial hypertension, in relation with a bilateral stenosis of the renal arteries or with a unilateral stenosis affecting a functionally or anatomically single kidney. In this latter case, the purpose of TLA was to avoid development toward thrombosis of the renal artery and worsening of renal insufficiency. RESULTS. Two hundred and forty-seven TLA in 210 patients were included in the study. Nineteen patients (9%) had bilateral TLA. The lesions treated are indicated in figure 3. These were most often simple atheromatous and truncal lesions of the renal artery (73%) which were significant (greater than 50%) in 99% of cases. TLA was indicated in 77% of cases for treatment of arterial hypertension presumed to be renovascular. In 23% of cases, treatment of the stenosis was intended to conserve, especially, kidney vascularization, i.e., an indication of nephrotic protection. There were 9.7% immediate failures...