COMPARATIVE-ANALYSIS OF PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY AND OPERATION FOR RENAL REVASCULARIZATION

Contemporary patients requiring renal revascularization often have dif fuse atherosclerosis, and increasingly undergo intervention for salvag e of renal function rather than control of hypertension alone. Risk-be nefit analyses and outcome data are difficult to obtain, since few rep orts have analyzed a modem, unselected series of consecutive patients subjected to renal revascularization by surgical as well as interventi onal techniques. We reviewed our 5-year experience with 76 consecutive renal revascularizations in 63 patients. Indications for intervention were hypertension and renal salvage, 60% (n = 38); hypertension, 24% (n = 15); renal salvage, 9.5% (n = 6); and other, 6.5% (n = 4). Ninety -four percent (n = 59) of patients had atherosclerotic occlusive disea se of the renal arteries. Percutaneous transluminal angioplasty (PTA) was initially performed on 18 renal arteries in 16 patients, of whom 5 6% (n = 9) subsequently required surgical reconstruction. Fifty-eight surgical reconstructions were performed in 56 patients and consisted o f aortorenal bypass (n = 27), aortorenal endarterectomy (n = 18), and extra-anatomic bypass (n = 13). Concomitant aortic replacement was req uired in 57% (n = 32) of patients. Preoperative risk factors and opera tive indications did not differ between the PTA and surgical reconstru ction groups, Morbidity and mortality rates associated with PTA were 3 3% and 4.8%, respectively, while for surgical treatment the morbidity rate was 7% and the mortality rate 5.3% (P = NS). Functional improveme nt was achieved in 74% of surgically treated patients compared with 22 % of PTA-treated patients (P < 0.01). Actuarial renal artery primary p atency at 48 months was 81% for the surgery group and 17% for the PTA group (P < 0.01). Aortorenal bypass, endarterectomy, and extra-anatomi c bypass were equally efficacious (P > 0.05). The results of surgical reconstruction are excellent, offering more durable patency and functi onal improvement than PTA, without increased risk. The operation shoul d be tailored to fit the individual patient's disease, since the resul ts of endarterectomy and bypass procedures are equivalent. (C) 1996 by the National Kidney Foundation, Inc.