title: Outcome after endovascular revascularization of atherosclerotic renal artery stenosis.
abstract: BACKGROUND
  With an aging population, more patients might be treated for atherosclerotic renal artery stenosis (ARAS). The goal of this treatment is to achieve a dialysis-free life or a well-controlled blood pressure with reduced risks of cardiovascular complications.
  
  
  OBJECTIVE
  To analyze the clinical outcome of percutaneous transluminal renal artery angioplasty without stenting (PTRA) or with stenting (PTRS) for ARAS at one center.
  
  
  METHODS
  The study group comprised 152 patients who underwent 203 PTRA/PTRS. All had hypertension, and 45% had azotemia. A retrospective collection of baseline and postprocedural number of antihypertensive drugs, blood pressure, and serum creatinine were analyzed during a follow-up of 3-18 months.
  
  
  RESULTS
  Technical success rate was 95%, and clinical benefit was seen in 63% of patients. Complications included a 30-day mortality rate of 1.5%, a total complication rate of 35%, and major adverse events in 13%. The major adverse events were highly related to azotemia. Major adverse events within 30 days, with permanent disability, were seen in 5% and almost exclusively in patients with moderate or severe renal impairment. A subgroup analysis of 28 patients with renal duplex resistive index (RI) pre-PTRA/S and 6 months' follow-up showed a benefit of PTRA/PTRS in 17 (68%) of the 25 patients with RI <80 and in all three (100%) of the patients with RI >or=80.
  
  
  CONCLUSIONS
  Endovascular treatment of ARAS has an excellent technical success rate, with a clinical improvement rate of >60%. However, it is associated with a considerable complication rate. Serious complications are seen mainly in azotemic patients. Predictors of clinical response could not be identified. Renal duplex RI is questioned as a predictor of clinical outcome.
authors.affiliation: Department of Radiology, Uppsala University Hospital, Uppsala, Sweden. hampus.eklof@radiol.uu.se
authors.forename: H
authors.initials: H
authors.lastname: Eklöf
authors.forename: D
authors.initials: D
authors.lastname: Bergqvist
authors.forename: A
authors.initials: A
authors.lastname: Hägg
authors.forename: R
authors.initials: R
authors.lastname: Nyman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D000800:Angioplasty, Balloon / Q000379:methods*; D050197:Atherosclerosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D053099:Azotemia / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D001794:Blood Pressure / Q000502:physiology; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006978:Hypertension, Renovascular / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D012078:Renal Artery Obstruction / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D015607:Stents; D015996:Survival Rate
chemical_list: D003404:Creatinine