PERCUTANEOUS TRANSLUMINAL RENAL, ARTERY ANGIOPLASTY USING THE COAXIALTECHNIQUE

Purpose: To evaluate the angiographic and clinical results of all perc utaneous transluminal renal angioplasties (PTRAs) performed at one cen tre in Norway since the introduction of the method. Most of the PTRAs were performed with the coaxial technique (guiding-catheter-assisted a ngioplasty). Material and Methods: In 419 patients, 595 PTRAs of 552 s tenoses were performed from 1982 to 1993. The cases included 295 patie nts with arteriosclerotic vascular disease (AVD), 49 with fibromuscula r dysplasia (FMD), and 74 transplantation patients (TX). Angiographic and clinical follow-up were undertaken. Results: Initial angiographic success was obtained in 92% of the patients and another 3% improved. T he rates of immediate success were 92%, 98% and 84% for AVD, FMD and T X respectively. The corresponding rates for primary patency were 57%, 67% and 54%, and for secondary patency (after 1 to 6 angioplasties) 77 %, 93% and 64%. Lower long-term results were obtained for: recanalized vessels; long lesions; bifurcation stenoses; stenoses in patients wit h abdominal aortic aneurysm; smaller vessels; and segmental branches i n native and TX kidneys. Of 252 patients with hypertension, 8% were cu red and another 58% improved. Of 215 patients with reduced renal funct ion, 38% were normalized or improved and 42% unchanged. Major complica tions including 2 deaths were seen in 2.9% of the procedures and other complications in 4.7%. Conclusion: PTRA with a guiding catheter can b e performed in most patients with a high success rate and a low compli cation rate. This study points to two major problems with PTRA: the hi gh restenosis rate and the low response to treatment of hypertension. The careful selection of patients for PTRA is important for increasing the success rate, and follow-up to detect restenosis is mandatory.