Outcomes of Hypertensive Patients with Renal Fibromuscular Dysplasia Compared with Patients with Concomitant Atherosclerotic Renal Artery Stenosis following Endovascular Therapy.
OBJECTIVE
To examine if the outcomes after endovascular treatment in hypertensive patients with renal artery fibromuscular dysplasia (FMD) and incidental atherosclerotic renal artery stenosis (ARAS) differ from the outcomes in patients with FMD alone.


METHODS
All cases of patients with renal artery FMD undergoing percutaneous transluminal angioplasty during the period 2002-2012 were reviewed. The patients with complete data before and after the procedure were identified (N = 84). Based on the procedural reports, these patients were separated into two cohorts: patients with isolated FMD (n = 59) and patients with concomitant atherosclerotic renal artery stenosis and FMD (ARAS-FMD) (n = 25). The medical record of each patient was reviewed for baseline blood pressure, antihypertensive medication use, and renal function data and the same data after the procedure. Procedural details including the angiographic findings, the number of stents placed, the average number of revascularization procedures, and the number of patients requiring more than one revascularization procedure were noted.


RESULTS
The study population included 68 patients (FMD, n = 46; ARAS-FMD, n = 22). Patients in the FMD and ARAS-FMD cohorts experienced comparable significant decreases in systolic and mean arterial pressures after endovascular intervention. There was no change in the number of antihypertensive medications after the procedure within or between groups. Patients in the ARAS-FMD cohort had lower baseline estimated glomerular filtration rates (P = .007); however, renal function stabilized in both groups after endovascular therapy.


CONCLUSIONS
Patients with ARAS-FMD respond to endovascular therapy with outcomes similar to patients with isolated renal artery FMD.
University of Virginia School of Medicine, PO Box 800170, Charlottesville, VA 22908.
Thomas L
TL
Jenkins
University of Virginia School of Medicine, PO Box 800170, Charlottesville, VA 22908.
Mary Grace
MG
Baker
Department of Radiology and Medical Imaging, PO Box 800170, Charlottesville, VA 22908.
Aparna R
AR
Baheti
Department of Medicine, PO Box 800170, Charlottesville, VA 22908.
Aditya M
AM
Sharma
Department of Public Health Sciences, PO Box 800170, Charlottesville, VA 22908.
James T
JT
Patrie
Department of Radiology and Medical Imaging, PO Box 800170, Charlottesville, VA 22908. Electronic address: jfa3h@hscmail.mcc.virginia.edu.
J Fritz
JF
Angle
Department of Radiology and Medical Imaging, PO Box 800170, Charlottesville, VA 22908.
Alan H
AH
Matsumoto
D000368:Aged; D000792:Angiography; D017130:Angioplasty; D000959:Antihypertensive Agents / Q000008:administration & dosage; D001161:Arteriosclerosis / Q000150:complications*; D001794:Blood Pressure; D005260:Female; D005352:Fibromuscular Dysplasia / Q000601:surgery*; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D006977:Hypertension, Renal / Q000150:complications*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D012077:Renal Artery / Q000000981:diagnostic imaging; D012078:Renal Artery Obstruction / Q000150:complications*; D012086:Reoperation; D015607:Stents; D016896:Treatment Outcome
D000959:Antihypertensive Agents