Management of renal artery stenosis: effects of a shift from surgical to percutaneous therapy on indications and outcomes.
The treatment of choice for renal artery occlusive disease has shifted from open repair to percutaneous angioplasty and stenting in many institutions. Whether this change in treatment modality will lead to altered and, perhaps, relaxed indications for intervention is unclear. We reviewed our experience to determine if a shift from open surgery to percutaneous management of renal occlusive disease was associated with changes in either indications for intervention or patient outcomes. Over an 8-year period, 165 patients had intervention for renal artery stenosis by our vascular surgery teaching service. Over the period there was a dramatic increase in interventions per year (4 patients 1994 to 57 patients 2001). There was also a shift from open to endovascular management. Patient demographics and indications for intervention showed no difference between open and endovascular groups. Outcome analysis revealed similar technical success rates between groups but a significantly higher morbidity and mortality rate in the surgical group. A shift from open to percutaneous treatment of renal artery occlusive disease led to a significant increase in patient volume. This increase occurred without a change in patient demographics or indications for therapy, and appeared to reflect an increase in patient referrals.
Mackrell
Peter J
PJ
Department of Surgical Education, Greenville Hospital System, Greenville, SC 29605, USA.
Langan
Eugene M
EM
Sullivan
Timothy M
TM
Gray
Bruce H
BH
Taylor
Spence M
SM
Cull
David L
DL
Snyder
Bruce A
BA
Youkey
Jerry R
JR
Carsten
Christopher G
CG
D000368:Aged; D000800:Angioplasty, Balloon; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012078:Renal Artery Obstruction / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies; D015607:Stents; D018616:Ultrasonography, Doppler, Duplex