TREATMENT OF RENOVASCULAR HYPERTENSION - ONE-YEAR RESULTS OF RENAL ANGIOPLASTY

During the ten year period from 1981 to 1991, percutaneous translumina l renal angioplasty (PTRA) was performed in 180 renal arteries in 137 patients, where the underlying renovascular disease was fibromuscular dysplasia (FMD) in 30 patients (22%) and arteriosclerotic vascular dis ease (AVD) in 107 (78%). A preinterventional work-up and a re-evaluati on of the patients after one year was designed for the assessment of t he clinical, functional and technical outcome. Successful technical di latation was achieved in 97% of procedures with FMD patients and in 82 % of procedures with AVD patients. A beneficial effect on the blood pr essure and the renal function was registered in both groups. The overa ll cure and improvement rate for hypertension was 86% in the FMD group and 64% in the AVD group after one year's follow-up. A significant ga in in the total renal function was registered in both groups, the aver age increase in glomerular filtration rate being 13% (P < 0.001) for t he FMD group and 11% (P < 0.001) for the AVD group one year after PTRA . Renal function was improved or unchanged in 89% of FMD patients and 74% of AVD patients. The improvement in renal function was made by the revascularized kidney. Renal vein renin investigation predicted the c linical outcome with an excellent diagnostic accuracy as no renin nega tive patient became normotensive, and renin positive patients, who did not turn normotensive, were in almost 90% of the cases affected by te chnical failure or restenosis/contralateral stenosis. Thus, the sensit ivity of renal vein renin investigation was 95% and the specificity 75 %. The outcome for patients with hypertension and renal insufficiency was considerably poorer than for the whole group of patients, with onl y a 20% success rate for hypertension, but 50% in this group had incre ased or unchanged GFR after intervention. The angiographic one-year fo llow-up revealed a recurrence rate of 6.7% for FMD and 15.1% for AVD. For the entire series of patients, the incidence of major complication s was 5.4%, including one indirect fatality, while the incidence of mi nor complications was 5%. In conclusion, PTRA will cure or improve blo od pressure in most patients with renovascular hypertension, and it pr eserves and even improves renal function in these patients. Complicati ons and recurrence are in fact not very common and PTRA appears be the best first approach in all but ostial lesions for treatment of renova scular hypertension.