Outcomes of renal artery angioplasty and stenting using low-profile systems.
OBJECTIVE
Renal artery percutaneous transluminal angioplasty (RPTA) and stenting (RAS) are accepted therapies for selected patients with renovascular hypertension and chronic renal insufficiency. We evaluated the outcomes and complications of RAS performed by vascular surgeons at our institution with modern low-profile systems.


METHODS
We retrospectively analyzed all RPTA and RAS procedures attempted with the use of low-profile systems from June 2000 to September 2003. Eighty-two patients (96 arteries) with atherosclerotic renal artery stenosis were treated. Indication for treatment was hypertension in 44 (54%) and chronic renal insufficiency in 38 (46%). Technical success, complication rates, clinical success for control of hypertension or renal insufficiency, restenosis, and survival were reviewed with a mean follow-up of 1 year.


RESULTS
Ninety-three arteries were treated with stents, three with RPTA only. Primary technical success was 95%, with 98% overall technical success. Major complications occurred in 6.1% and minor complications in 1.2%. Hypertension was improved in 81% at 1 year. Renal function was improved in 23%, stable in 53%, and worse in 24% at 1 year. Restenosis was seen by routine duplex surveillance in 25% at 1 year. Restenosis associated with clinical deterioration and confirmed by angiogram was seen in 10%. The overall 3-year survival was 83%.


CONCLUSIONS
RPTA/RAS can be performed with low-profile systems with excellent technical success, low complication rates, and clinical outcomes that compare favorably with prior reports.
Nolan
Brian W
BW
Division of Vascular Surgery, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA. Brian.Nolan@Hitchcock.org
Schermerhorn
Marc L
ML
Rowell
Erin
E
Powell
Richard J
RJ
Fillinger
Mark F
MF
Rzucidlo
Eva M
EM
Wyers
Mark C
MC
Zwolak
Robert M
RM
Walsh
Daniel B
DB
Cronenwett
Jack L
JL
D000800:Angioplasty, Balloon; D001161:Arteriosclerosis / Q000628:therapy; D005260:Female; D006801:Humans; D006978:Hypertension, Renovascular / Q000628:therapy*; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012008:Recurrence; D012077:Renal Artery / Q000601:surgery*; D012078:Renal Artery Obstruction / Q000628:therapy*; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome