PERCUTANEOUS TRANSLUMINAL RENAL ANGIOPLASTY VERSUS SURGICAL RECONSTRUCTION OF ATHEROSCLEROTIC RENAL-ARTERY STENOSIS - A PROSPECTIVE RANDOMIZED STUDY

Purpose: The purpose of this prospective randomized study was to compa re percutaneous transluminal renal angioplasty (PTRA) and operation as initial therapy with regard to technical results, primary and seconda ry patency, and effects on blood pressure and renal function in patien ts with atherosclerotic unilateral renal artery stenosis. Methods: Fif ty-eight patients who did not have diabetes, who were less than 70 yea rs of age, and who had severe hypertension and significant stenosis we re randomized to receive PTRA or operation. Angiography was performed 10 days, 1 year, and 2 years after treatment to verify patency, and bl ood pressure and renal functions were simultaneously evaluated. Result s: Technically, PTRA was successful in 83% and operation in 97% of pat ients. The primary patency rate after 24 months was 75% in the PTRA gr oup and 96% in the operative group in technically successful cases. Th e secondary patency rate in the PTRA group was 90% and in the surgical group 97%. To achieve these results four patients in the PTRA group r equired operation, and one patient in the surgical group required PTRA . Hypertension was cured or improved after additional treatment in 90% of the patients after PTRA and 86% after operation. The corresponding figures for improved or unchanged renal function were 83% and 72%, re spectively. After additional treatment, effects on blood pressure and renal function did not differ. Seventeen percent of the patients treat ed with PTRA required surgical intervention. Conclusions: PTRA is reco mmended as first choice of therapy for atherosclerotic renal artery st enosis causing renovascular hypertension if combined with intensive fo llow-up and aggressive reintervention.