Angioplasty does not affect subsequent operative renal artery revascularization

Background. Although increased application of percutaneous renal artery ang ioplasty and stenting has facilitated nonoperative renal revascularization, patient outcomes after failed angioplasty are not established. Methods. Renal artery revascularization was performed in 31 patients (38 ar teries) from 1993 to 1999. Twenty patients underwent primary surgical repai r, and II patients underwent secondary reconstruction after angioplasty (n = 7) or angioplasty and stenting (n = 4). Before operation, all patients ha d severe hypertension (blood pressure 166 +/- 5.2/92 +/- 2.7 mm Hg) that re quired an average of 3.0 +/- 0.2 medications for control. In addition, 22 p atients (primary 45% vs secondary 27%; P = NS) had evidence of renal insuff iciency (creatinine greater than or equal to 1.7 mg/dL). Results. There was no difference between primary and secondary procedures i n the length of hospital stay (12 +/- 1.4 vs 22 +/- 3.2 days; P = NS), majo r morbidity (10% vs 18%; P = NS) or perioperative mortality (overall mortal ity 2 of 31; primary 5% vs secondary 9%; P = NS). The majority of patients demonstrated improvement or cure of hypertension (primary 94 % vs secondary 90 %; P = NS) and stable or decreased creatinine (primary 74% vs secondary 82 %; P = not significant). Overall survival (mean follow-up 22 +/- 3.5 mo nths) was 89 % +/- 5.7 %. Conclusions. Although this surgical series does not address the true outcom es of renal artery angioplasty, the results suggest that renal artery angio plasty does not prejudice subsequent surgical outcomes in patients who are carefully followed after angioplasty.