PATENCY OF PERCUTANEOUS TRANSLUMINAL RENAL ANGIOPLASTY - A PROSPECTIVE SONOGRAPHIC STUDY

Evaluation of percutaneous transluminal renal angioplasty (PTRA) is to day based primarily on clinical criteria rather than direct investigat ion of luminal width. In this study, we examined renal blood flow by c olor-coded duplex sonography (CCD) in order to correlate blood pressur e as well as renal function with the true renovascular patency. Fifty consecutive patients suspected of suffering from renovascular disease and treated by PTRA were included for a prospective sonographic study. In all PTRA was performed on 63 renal arteries. Thirty-seven patients were diagnosed to have atherosclerosis and 13 patients to have fibrom uscular dysplasia (FMD). Examinations were performed using CCD before PTRA, and one day, three months, six months and 12 months after PTRA. If CCD showed a restenosis greater than or equal to 60%, CCD was non-c onclusive or hypertension deteriorated, angiography and, if necessary, catheter re-intervention were performed. The primary pa patency rate after 12 months was 73%, and could be improved to 94% overall when tre ated restenoses (N = 22) were included. Restenosis was more frequent i n patients with mild residual stenosis identified by CCD one day after PTRA (P = 0.002). There was neither a significant difference in the r estenosis rate in patients with atherosclerosis versus FMD, nor in pat ients with ostial versus non-ostial lesions. Hypertension was improved or cured in 70% of patients with atherosclerosis, and in 85% of those with FMD. Nevertheless, hypertension deteriorated in 12% of the patie nts without restenosis, and no deterioration was present in 14% of the patients with restenosis. A decrease in serum creatinine levels by mo re than 15% was observed in 12 of 22 patients with impaired renal func tion and patent renal artery during follow-up. These results suggest t hat optimal therapeutic efficiency can be obtained using PTRA followed by systematic CCD.