Revascularisation of renal artery stenosis caused by fibromuscular dysplasia: effects on blood pressure during 7-year follow-up are influenced by duration of hypertension and branch artery stenosis.
Fibromuscular dysplasia (FMD) mainly affects renal arteries. Percutaneous transluminal renal angioplasty (PTRA) and surgery are effective treatments, but long-time follow-up is lacking. Retrospective follow-up for 7.0+/-4.7 years of 69 consecutive patients (age 44+/-13 years) treated for hypertension due to FMD, 59 patients underwent PTRA and eight patients surgery. In two patients no PTRA was performed. Technical success was achieved in 56 (95%) patients undergoing PTRA and all eight undergoing surgery. After successful PTRA, both systolic and diastolic blood pressures (SBP and DBP) had decreased at discharge (from 174+/-33/100+/-13 to 138+/-19/80+/-15 mmHg; P<0.0001), and remained lower at 1 month, 1 year, and last follow-up after 7.0+/-4.7 years (140+/-25/83+/-12 mmHg; P<0.0001). Serum-creatinine had decreased both at 1 year (from 84+/-28 to 75+/-13 micromol/l; P=0.0030) and last follow-up (75+/-16 micromol/l; P=0.0017). The number of antihypertensive drugs decreased (from 2.3+/-1.2 before PTRA to 1.4+/-1.3 at discharge and at 1 month; P<0.0001, and 1.6+/-1.5 at last follow-up; P=0.0011). SBP decreased more after PTRA among patients with FMD only in the main renal artery than in those with branch artery involvement (43+/-29 vs 20+/-41 mmHg; P=0.0198). Beneficial effects on BP, creatinine and antihypertensive drugs also occurred after surgery. Patients on antihypertensive drugs at last follow-up had longer hypertension duration before PTRA than those without (5.9+/-7.7 vs 1.8+/-4.1 years; P=0.0349). Cure was achieved in 16 (24%), improvement in another 26(39%), and benefit in 42(63%). In conclusion, renal artery FMD, PTRA and surgery have beneficial long-term effects, negatively affected by hypertension duration and branch artery involvement.
Alhadad
A
A
Department of Vascular Diseases and Endovascular Reconstructions, University of Lund, University Hospital, Malmö, Sweden. alaa.alhadad@skane.se
Mattiasson
I
I
Ivancev
K
K
Gottsäter
A
A
Lindblad
B
B
D000328:Adult; D000800:Angioplasty, Balloon / Q000009:adverse effects; D001794:Blood Pressure; D005260:Female; D005352:Fibromuscular Dysplasia / Q000150:complications*; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012078:Renal Artery Obstruction / Q000209:etiology / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D019233:Retreatment; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000009:adverse effects