title: Surgical and radiological management of renovascular hypertension in a developing country.
abstract: OBJECTIVE
  We determined the long-term outcome of radiological and surgical intervention in young patients with renovascular hypertension.
  
  
  METHODS
  Between 1989 and 2001, 85 patients with a mean age +/- SD of 21 +/- 10.3 years, including 59 with Takayasu's arteritis (TA) and 26 with fibromuscular dysplasia (FMD), underwent radiological (percutaneous transluminal angioplasty) or surgical treatment for renovascular hypertension due to renal artery stenosis. The technical success, complications and clinical response of each treatment were compared.
  
  
  RESULTS
  Of the patients 29 with TA and 20 with FMD underwent a total of 56 balloon angioplasties. Technical success was achieved in 94.58 renal units with a clinical response in 41 patients (83.9%). However, the re-stenosis rate was 24.13% in TA and 10% in FMD cases. A total of 41 surgical procedures were performed in the 28 and 7 patients with TA and FMD, respectively, including aortorenal bypass with vein in 12, and with a polytetrafluoroethylene graft in 4, lienorenal bypass in 4, iliorenal bypass in 2, gastroduodenal bypass in 1, autotransplantation in 1, nephrectomy in 14 and partial nephrectomy in 2. The clinical response rate to renal revascularization procedures was 94.4%, whereas it was only 50.0% for nephrectomy/partial nephrectomy during a median followup of 42 months (range 9 to 96).
  
  
  CONCLUSIONS
  Percutaneous transluminal angioplasty and renal revascularization provide comparable long-term results in the management of renal artery stenosis due to TA and FMD. Although it is technically complex, surgery for TA is safe and effective. However, the rate of re-stenosis following angioplasty for TA is higher compared with FMD.
authors.affiliation: Department of Urology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareli Road, Lucknow, India. anant@sgpgi.ac.in
authors.forename: Anant
authors.initials: A
authors.lastname: Kumar
authors.forename: Deepak
authors.initials: D
authors.lastname: Dubey
authors.forename: Pradeep
authors.initials: P
authors.lastname: Bansal
authors.forename: K V
authors.initials: KV
authors.lastname: Sanjeevan
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Gulati
authors.forename: Sunil
authors.initials: S
authors.lastname: Jain
authors.forename: raj Kumar
authors.initials: rK
authors.lastname: Sharma
mesh_terms: D000293:Adolescent; D000328:Adult; D003906:Developing Countries; D005260:Female; D005352:Fibromuscular Dysplasia / Q000150:complications; D006801:Humans; D006978:Hypertension, Renovascular / Q000209:etiology / Q000532:radiotherapy* / Q000601:surgery*; D007194:India; D008297:Male; D012008:Recurrence; D013625:Takayasu Arteritis / Q000150:complications