Treatment of Renovascular Hypertension With Percutaneous Transluminal Renal Angioplasty

Abstract

A FTER THE FIRST REPORTS of catheter dilatation of renal artery stenosis in a single patient with atheromatous I and in another with fibromuscular2 disease, this new method of treatment has quickly gained wide acceptance in the last decade. Reports in the literature from 1979 to 1981 on percutaneous transluminal renal angioplasty (PTRA) in small series of patients demonstrated a considerable proportion of technically successful dilatations: improvement of the angiographic appearance, or a diminished pressure gradient over the stenosis directly after the dilatation. Moreover, no serious complications were encountered, and an antihypertensive effect was seen in a large majority of patients. 3-10 The main questions at that time were which and how frequently serious complications would occur and whether long-term benefit would be limited by frequent recurrences of artery stenosis. In other words, the benefit/risk ratio looked favorable on a short-term basis but still had to be confirmed with more patients as well as for a longer follow-up period. Supported by earlier experience with catheter dilatations of atherosclerotic lesions of iliac arteries, which showed lasting results with few complications, II many centres have expanded the number of renovascular patients treated by balloon dilatation. In the following years (1983 to 1987), results were published of larger series of more than 30 patients, some patients being followed for periods up to 5 years l2-20 (see Table 1). Results remained promising, and when compared with established treatments such as vascular surgery or medication, PTRA appeared less traumatic and more direct. These series showed a low morbidity and a minimal chance of losing a kidney, let alone a life. Therefore, many doctors and patients preferred a PTRA attempt before deciding on surgery or, in principle, life-long, medical therapy. Thus, the method became widely applied, notwithstanding uncertainty about the long-term effect on the BP. As long as the BP remained well controlled after PTRA, surgery (nephrectomy or vascular repair) was not necessary. Similarly, when PTRA was technically successful but had no effect on BP control, improvement by surgery could not be expected. 21 When PTRA was technically impossible, surgical repair could still be performed. These notions, in combination with the low morbidity and