Percutaneous transluminal revascularization for renal artery stenosis: Veterans Affairs Puget Sound Health Care System experience.
OBJECTIVE
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.
Yutan
E
E
Section of Vascular Surgery and Interventional Radiology, Seattle Division of the Veterans Affairs Puget Sound Health Care System, Washington, USA.
Glickerman
D J
DJ
Caps
M T
MT
Hatsukami
T
T
Harley
J D
JD
Kohler
T R
TR
Davies
M G
MG
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000792:Angiography / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D001161:Arteriosclerosis / Q000150:complications*; D017073:Atherectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D003404:Creatinine / Q000097:blood; D018450:Disease Progression; D006787:Hospitals, Veterans; D006801:Humans; D006973:Hypertension / Q000209:etiology; D015993:Life Tables; D008875:Middle Aged; D018579:Patient Selection; D016016:Proportional Hazards Models; D015641:Radiography, Interventional / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D012078:Renal Artery Obstruction / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency; D014861:Washington / Q000453:epidemiology
D003404:Creatinine