Outcome and cost comparison of percutaneous transluminal renal angioplasty, renal arterial stent placement, and renal arterial bypass grafting

PURPOSE: To compare the outcomes and costs of percutaneous transluminal ren al angioplasty (PTRA), percutaneous transluminal stent placement (PTSP) of renal arteries, and renal arterial bypass grafting (RABG) in treatment of r enovascular hypertension. MATERIALS AND METHODS: Medical records and angiograms of 130 patients who u nderwent PTRA, PTSP, or RABG were retrospectively studied to determine succ ess and complication rates, angiographic stenoses, blood pressures, antihyp ertensive medications, and serum creatinine levels. Actual costs were analy zed in detail. RESULTS: Technical success rates for PTRA, PTSP, and RABG were 91%, 98%, an d 92%, respectively, Complication rates were 13%, 16%, and 38%, respectivel y. The :mean arterial pressure was initially lowered by 29.2 mm Hg, 30.3 mm Hg, and 27.3 mm Hg, respectively, and maintained at 21.0 mm Hg, 19.8 mm Hg , and 20.2 mm Hg below baseline at 12 months. The number of antihypertensiv e medications was initially reduced on average by 0.63, 0.75 and 0.58, resp ectively, but returned to baseline in all patients by 12 months. The serum creatinine level did not change substantially with any treatment, initial t reatment costs were $1,402, $2,573, and $15,393, respectively. CONCLUSION: PTRA, PTSP, and RABG were equally efficacious for control of re novascular hypertension,The initial treatment. cost for bypass grafting was substantially higher than that for PTRA and PTSP of renal arteries.