Surgical and radiological management of renovascular hypertension in a developing country

Area of Science:

• Cardiovascular Medicine
• Interventional Radiology
• Pediatric Hypertension

Background:

• Renovascular hypertension in young patients is often caused by Takayasu's arteritis (TA) or fibromuscular dysplasia (FMD).
• Long-term outcomes of interventions for renal artery stenosis in this demographic require further elucidation.

Purpose of the Study:

• To compare the long-term efficacy of radiological (percutaneous transluminal angioplasty) and surgical interventions for renovascular hypertension in young patients.
• To evaluate technical success, complications, and clinical response rates for both treatment modalities.

Main Methods:

• Retrospective analysis of 85 young patients (mean age 21 years) with renovascular hypertension due to TA (n=59) or FMD (n=26) between 1989 and 2001.
• Comparison of outcomes following percutaneous transluminal angioplasty (n=49) and surgical procedures (n=41).

Main Results:

• Technical success for angioplasty was 94.58%, with an 83.9% clinical response rate. Re-stenosis rates were 24.13% for TA and 10% for FMD.
• Surgical revascularization procedures achieved a 94.4% clinical response rate, while nephrectomy/partial nephrectomy had a 50% response rate.
• Median follow-up was 42 months, with surgery demonstrating comparable long-term results to angioplasty.

Conclusions:

• Percutaneous transluminal angioplasty and surgical revascularization yield similar long-term results for managing renal artery stenosis in TA and FMD.
• Surgery for TA is safe and effective despite technical complexity, with lower re-stenosis rates compared to angioplasty in TA.
• Angioplasty is a viable option, but higher re-stenosis rates in TA warrant consideration.