Percutaneous transluminal revascularization for renal artery stenosis: Veterans Affairs Puget Sound Health Care System experience

• Published in: Journal of vascular surgery Vol. 34; no. 4; pp. 685 - 693
• Main Authors: Yutan, Elaine, Glickerman, David J., Caps, Michael T., Hatsukami, Thomas, Harley, John D., Kohler, Ted R., Davies, Mark G.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-10-2001; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Algorithms; Angiography - adverse effects; Angiography - instrumentation; Angiography - methods; Arteriosclerosis - complications; Atherectomy - adverse effects; Atherectomy - instrumentation; Atherectomy - methods; Biological and medical sciences; Creatinine - blood; Disease Progression; Diseases of the cardiovascular system; Hospitals, Veterans; Humans; Hypertension - etiology; Life Tables; Medical sciences; Middle Aged; Patient Selection; Proportional Hazards Models; Radiography, Interventional - adverse effects; Radiography, Interventional - instrumentation; Radiography, Interventional - methods; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Renal Artery Obstruction - blood; Renal Artery Obstruction - diagnosis; Renal Artery Obstruction - etiology; Renal Artery Obstruction - mortality; Renal Artery Obstruction - surgery; Retrospective Studies; Risk Factors; Stents - adverse effects; Time Factors; Treatment Outcome; Ultrasonography, Doppler, Duplex; Vascular Patency; Washington - epidemiology; Washington; Prognosis; Renal artery; Cuffed tube; Stenosis; Cardiovascular disease; Stent; Arterial disease; Vascular disease; Optical microscopy; Complication; Kidney disease; Human; Hypertension; Endoprosthesis; Urinary system disease; Treatment efficiency; Mortality; Instrumentation therapy; Instrumental dilatation; Long term; Morbidity; Restenosis; Functional recovery; Treatment; Renal failure; Renal artery disease
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1067/mva.2001.117886

Purpose: The safety and efficacy of percutaneous transluminal intervention for renal artery stenosis is improving. This study evaluates the immediate and long-term anatomic and functional outcomes of percutaneous transluminal angioplasty and stenting for atherosclerotic renal artery stenosis in a Veterans Affairs population. Methods: We performed a retrospective analysis of records from patients who underwent renal artery angioplasty with or without stenting at the Veterans Affairs Puget Sound Health Care System between January 1990 and June 1999. Indications for intervention included hypertension (78%) and rising serum creatinine (78%). Seventy-six patients (74 men, average age of 67 years, range 42-83 years) underwent 88 attempted interventions. Seventy-two percent of contralateral kidneys had significant disease (47% had a >60% stenosis; 16% were nonfunctioning or absent). Results: Of the 88 planned interventions, 86 were successfully performed with placement of 46 stents (52%). Technical success (defined by <30% residual stenosis) was achieved in 78 vessels (89%). The procedure-related complication rate was 5%. Patient mortality by life table analysis was 49% at 5 years. Assisted primary patency rate at 5 years was 100%. Primary and secondary restenosis rates were 37% ± 8% and 31% ± 8% at 5 years, respectively. Sixty-eight percent of patients treated for hypertension demonstrated clinical benefit (improved or cured hypertension). This clinical benefit was maintained in 52% of the patients at 5 years, as measured by life table analysis. Serum creatinine was lowered or maintained in 88% of the patients, but this clinical benefit was only maintained in 25% of patients at 5 years. Conclusions: Transluminal intervention for clinically symptomatic atherosclerotic renal artery stenosis is technically successful and safe. There are excellent assisted-patency and low restenosis rates. There is immediate clinical benefit for most patients, as evidenced by improved control of hypertension and preservation of renal function. However, within 5 years the benefit is not maintained for either hypertension (50%) or renal function (20%). Therefore, although technically successful, functional outcomes after endoluminal intervention are not maintained in the long term. (J Vasc Surg 2001;34:685-93.)