Technological advances in the design of catheters and devices used in renal artery interventions: impact on complications.
OBJECTIVE
To analyze the impact of technical improvements in stent devices and guiding catheters (e.g., reduced device diameter, increased flexibility) on the complication rates associated with percutaneous renal artery interventions.


METHODS
During a 5-year period (1997-2001), 268 consecutive patients (178 men; mean age 67+/-9 years) had 370 atherosclerotic renal artery stenoses (RAS) > or =70% treated with angioplasty/stenting in 320 procedures. The guiding catheter technique was used routinely until 2000; in 2001, a guiding sheath was used in 29% of cases. From 1997 to 2000, sealing devices were frequently used for sheath removal; during the last year, the sheaths were removed using the Femostop device.


RESULTS
In 320 interventions, 32 (10%) complications occurred, with a decreasing frequency during the last 2 years (1996/97: 13% [7/53]; 1998: 16% [9/57]; 1999: 15% [11/74]; 2000: 4% [3/70]; 2001: 3% [2/66]). There were 21 (6.6%) local complications, including 4 cases requiring permanent hemodialysis after the intervention and 11 (3.4%) access site complications. No procedure-related death occurred. During the study period, the average sheath diameter was reduced from 8.15+/-0.76 F to 6.15+/-0.63 F (p<0.05). Mean procedural time was reduced from 42+/-13 minutes to 23+/-11 minutes (p<0.05). The initial heparin dose was reduced from 10,000 to 5000 units.


CONCLUSIONS
In parallel with the use of more flexible catheters and premounted stents of lower profile, the complication rate of renal angioplasty/stenting of atherosclerotic RAS has been reduced significantly during a 5-year period.
Zeller
Thomas
T
Department of Angiology, Herz-Zentrum Bad Krozingen, Germany. thomas.zeller@herzzentrum.de
Frank
Ulrich
U
Müller
Christian
C
Bürgelin
Karlheinz
K
Schwarzwälder
Uwe
U
Sinn
Lutz
L
Horn
Barbara
B
Roskamm
Helmut
H
Neumann
Franz-Josef
FJ
D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects*; D001161:Arteriosclerosis / Q000628:therapy*; D002404:Catheterization / Q000009:adverse effects*; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012078:Renal Artery Obstruction / Q000628:therapy*; D015607:Stents / Q000009:adverse effects*