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.