Outpatient percutaneous transluminal renal artery angioplasty: A Canadian experience

PURPOSE: The authors performed a retrospective study of their experience an d complication rate while performing outpatient percutaneous transluminal r enal artery angioplasty (PTRA) during a 5-year period. MATERIALS AND METHODS: From July 1992 to July 1997, 87 PTRAs were performed . Of these, 62 PTRA procedures were performed on 53 outpatients. In total, 66 arteries were dilated in 62 PTRA sessions using standard, established te chniques. During the same period, only 25 PTRAs were performed on inpatient s. Angioplasties were performed on those patients with demonstrated renal a rtery stenosis and poorly controlled hypertension and/or renal failure. Pat ients chosen for PTRA were picked by a team that included a vascular surgeo n, a nephrologist, and a radiologist. Patients who were deemed suitable for an outpatient procedure were recommended by a nephrologist. Radiological i nput was sought at that time. Specific guidelines were used to select these patients who were otherwise healthy, well-orientated, and able to respond to an emergency situation. None of the subjects had significant risk factor s. All were accompanied by an adult for the first 24 hours and all lived no more than an hour's travel time from a hospital. All were stable on discha rge and were seen within 24 hours by a nephrologist. RESULTS: The technical success rate, defined as a residual stenosis on imag ing of less than 30% and/or by a pressure gradient of less than 10 mm Hg ac ross the stenosis, was 85%. The early complication rate was 5.6%, including two patients who developed a localized hematoma. In all, four patients wer e admitted to the hospital rather than being discharged to home after an av erage of 4.2 hours of observation. The late complication rate was 3% and in volved two patients. One patient, who reported pain after balloon deflation , was readmitted 6 hours after discharge with hypotension, and a diagnosis of renal artery rupture was confirmed with computed tomography. Another pat ient developed peripheral athero-emboli 20 days after the procedure. CONCLUSION: Outpatient PTRA can be performed on selected patients. In this study, late complications occurred in only 3% of patients. Early complicati ons were readily recognized in 5.6% of patients, and these patients were ad mitted for observation after the procedure.