Surgery and percutaneous angioplasty in the management of renovascular hypertension.
Unfortunately, no randomized trials have compared PTRA for renovascular hypertension with surgical or medical treatment. PTRA appears to be a safe and relatively simple procedure with complication rates lower than those of operation. The outcome of renal angioplasty depends on the type of stenosis. In all published series, the cure rates for fibromuscular disease are significantly higher than for atherosclerotic disease, and PTRA appears to be the procedure of choice in the treatment of hypertension in patients with fibromuscular disease. The role of renal angioplasty in patients with renovascular hypertension due to atherosclerotic diseases is uncertain. Most large published series describing the success of angioplasty in patients with atherosclerotic lesions have been highly selective, primarily including patients with focal stenotic lesions. Despite this selectivity, the cure rate has been only 19%. In completely unselected patients, atherosclerotic lesions are associated with a very high rate of technical failure, possibly as high as 60%. From the data available, focal isolated stenotic lesions of the renal artery due to atherosclerotic disease can be treated with a reasonable rate of success. The success rate in patients with bilateral disease, osteal stenosis, or total occlusion of the renal arteries appears to be very limited. In these patients, angioplasty should be attempted only when a surgical contraindication exists.
Libertino
J A
JA
Department of Urology, Lahey Clinic, Burlington, Massachusetts.
Beckmann
C F
CF
D000800:Angioplasty, Balloon; D006801:Humans; D006978:Hypertension, Renovascular / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D008722:Methods; D011859:Radiography; D012077:Renal Artery / Q000000981:diagnostic imaging