Impact of the rapid-exchange versus over-the-wire technique on procedural complications of renal artery angioplasty.
OBJECTIVE
To investigate whether the use of rapid-exchange (RX) systems adds to the safety of percutaneous renal artery procedures compared to the conventional over-the-wire (OTW) technique.


METHODS
The interventional registry in our department was interrogated to identify patients who underwent plain balloon angioplasty and/or stent implantation for >60% renal artery stenosis and intractable hypertension or decreasing renal function between 1998 and 2004. In this time period, 63 consecutive patients (36 men; mean age 67 years, range 57-80) underwent 78 renal artery angioplasty procedures. The first 46 procedures were done using a transfemoral OTW technique via 7-F sheaths; the following 32 procedures were performed with an RX system via a transfemoral 6-F access. Duration of fluoroscopy, amount of contrast agent, course of serum creatinine, and complications were compared between OTW and RX approaches.


RESULTS
Duration of fluoroscopy (median 13.1 versus 11.1 minutes, p=0.099) and primary technical success (94% versus 97%, p=0.64) were not significantly different between the OTW and RX approaches, but significantly less contrast agent was needed with the RX system (median 215 versus 140 mL, p<0.001). Complications, all minor, occurred significantly more often with the OTW (11/46, 24%) compared to the RX system (2/32, 6%; p=0.040) and included misplaced stents, prolonged severe hyper/hypotension, transient renal impairment, and puncture site complications. In particular, the rates of increased serum creatinine within 24 hours were higher in the OTW patients compared to the RX group (20% versus 3%, respectively, for >25% increase [p=0.041] and 9% versus 0% for >50% increase [p=0.087]).


CONCLUSIONS
Rapid exchange systems seem to add to the safety of percutaneous renal artery interventions. This likely may be due to a variety of causes, including lower doses of contrast medium, shorter duration of fluoroscopy, and smaller device diameters.
Amighi
Jasmin
J
Department of Angiology, Medical University Vienna, Austria.
Sabeti
Schila
S
Dick
Petra
P
Schlager
Oliver
O
Ahmadi
Ramazanali
R
Minar
Erich
E
Schillinger
Martin
M
D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation*; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012078:Renal Artery Obstruction / Q000000981:diagnostic imaging / Q000628:therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015607:Stents; D016896:Treatment Outcome
D003287:Contrast Media