SHOULD PERCUTANEOUS TRANSLUMINAL RENAL-ARTERY ANGIOPLASTY BE APPLIED TO OSTIAL RENAL-ARTERY ATHEROSCLEROSIS

Purpose: The purpose of this study was to review the results of percutaneous transluminal renal artery angioplasty (PTRA) in patients with atherosclerosis to assess safety, anatomic and functional outcome, and differences in outcome between ostial and nonostial lesions. Methods: We used retrospective review of 52 consecutive patients who had undergone attempted PTRA for renal artery atherosclerosis during the calendar years 1987 to 1992. Results: Fifty-two patients had 60 renal arteries on whom PTRA. was attempted. The mean age was 68 years. Atherosclerosis was generalized in 81% of the patients. The indication for angioplasty was salvage of functioning renal parenchyma in 81% of patients. Eight patients were undergoing dialysis at the time of attempted PTRA. Five arteries (8%) could not be dilated. There were one cardiac death and two arterial complications requiring surgery within 30 days. Thirty-five percent of patients with available angiograms had an anatomic improvement above a threshold of one stenotic group (30% to 40% diameter improvement), with residual stenosis of less than 50%. Half of patients treated for hypertension had improvement in their hypertension. Overall, there was no change in creatinine levels before and after the procedure. Four of eight patients undergoing dialysis at the time of PTRA were able to discontinue dialysis during follow-up. four patients (11%) required surgical bypass and five patients (14%) required chronic dialysis during follow-up. Conclusions: Modest success at low risk can be expected from PTRA in a group of patients with severe atherosclerosis. No significant difference in results between ostial and nonostial lesions was noted.