[The long-term results on arterial pressure and kidney function after the percutaneous transluminal dilatation of renal artery stenosis].
BACKGROUND
The purpose of this study was to evaluate the clinical results analyzing the cure, improvement and failure rates of percutaneous transluminal angioplasty (PTA) in patients with the diagnosis of renovascular hypertension with special reference to those with atherosclerotic vascular disease, according to their age, and their effect on blood pressure control and renal function.


METHODS
In 93 hypertensive patients with a mean age of 43.4 years 123 renal artery PTA were performed: Twenty-six patients older than 50 years and eleven with 50 years or less had atherosclerosis, 27 fibromuscular dysplasia and a mixed disease was found in one patient. Twenty-eight patients with renal transplant were diagnosed as having arterial graft stenosis.


RESULTS
After renal PTA, there was a significant decrease in blood pressure in all cases. Patients with atherosclerotic renal vascular disease showed a decrease in systolic pressure (SP) from 168 +/- 19 before PTA to 154 +/- 8 mmHg at 96 months (p < 0.001) and diastolic (DP) from 113 +/- 10 before PTA to 90 +/- 4 mmHg at 96 months (p < 0.001) respectively after the procedure. Significant differences were also observed in patients with fibromuscular dysplasia. Most patients with renal transplant arterial stenosis had less than five years of follow-up and SP and DP decreased from 162 +/- 18 and 109 +/- 8 mmHg before PTA, to 147 +/- 10 (p < 0.001) and 91 +/- 7 mmHg (p < 0.001) at 12 months after dilation respectively. Clinical improvement was achieved in 91% of patients with atherosclerosis at 96 months and fifty percent of the patients with fibromuscular dysplasia were cured after the same period from the time of PTA. Twelve months after the renal transplant artery dilation was achieved a clinical improvement in 81% and a cure rate in 6% of the patients. Ostial lesions comprised the majority of blood pressure benefit failures. There was no significant improvement in renal function immediately after renal artery dilation except in those patients with fibromuscular dysplasia. Residual stenosis greater than 75% was present in 15 patients after the first PTA. Complications were seen in 4.8% and were related to renal failure and vessel dissection.


CONCLUSIONS
Angioplasty is effective in the long-term management of high arterial blood pressure and may preserve renal function according to renal artery disease.
Rodríguez Pérez
J C
JC
Servicio de Nefrología, Hospital Nuestra Señora del Pino, Las Palmas de Gran Canaria.
Maynar Moliner
M
M
Pérez Borges
P
P
Plaza Toledano
C
C
Reyes Pérez
R
R
Pulido Duque
J M
JM
Palop Cubillo
L
L
Rodríguez Pérez
A
A
D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D001161:Arteriosclerosis / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D001794:Blood Pressure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006978:Hypertension, Renovascular / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012078:Renal Artery Obstruction / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D017211:Treatment Failure
Resultados a largo plazo sobre la presión arterial y la función renal después de la dilatación transluminal percutánea de la estenosis de la arteria renal.