Percutaneous transluminal revascularization for renal artery stenosis: Veterans Affairs Puget Sound Health Care System experience

Purpose: The safety and efficacy of percutaneous transluminal intervention for renal artery stenosis is improving. This study evaluates the immediate and long-term anatomic and functional outcomes of percutaneous transluminal angioplasty and stenting for atherosclerotic renal artery stenosis in a Ve terans Affairs population. Methods. We performed a retrospective analysis of records from patients who underwent renal artery angioplasty with or without stenting at the Veteran s Affairs Puget Sound Health Care System between January 1990 and June 1999 . Indications for intervention included hypertension (78%) and rising serum creatinine (78%). Seventy-six patients (74 men, average age of 67 years, r ange 42-83 years) underwent 88 attempted interventions. Seventy-two percent of contralateral kidneys had significant disease (47% had a >60% stenosis; 16% were nonfunctioning or absent). Results. Of the 88 planned interventions, 86 were successfully performed wi th placement of 46 stents (52%). Technical success (defined by <30% residua l stenosis) was achieved in 78 vessels (89%). The procedure-related complic ation rate was 5%. Patient mortality by life table analysis was 49% at 5 ye ars. Assisted primary patency rate at 5 years was 100%. Primary and seconda ry restenosis rates were 37%<plus/minus>8% and 31%+/-8% at 5 years, respect ively. Sixty-eight percent of patients treated for hypertension demonstrate d clinical benefit (improved or cured hypertension). This clinical benefit was maintained in 52% of the patients at 5 years, as measured by life table analysis. Serum creatinine was lowered or maintained in 88% of the patient s, but this clinical benefit was only maintained in 25% of patients at 5 ye ars. Conclusions. Transluminal intervention for clinically symptomatic atheroscl erotic renal artery stenosis is technically successful and safe. There are excellent assisted-patency and low restenosis rates. There is immediate cli nical benefit for most patients, as evidenced by improved control of hypert ension and preservation of renal function. However, within 5 years the bene fit is not maintained for either hypertension (50%) or renal function (20%) . Therefore, although technically successful, functional outcomes after end oluminal intervention are not maintained in the long term.