Percutaneous and open renal revascularizations have equivalent long-term functional outcomes

Area of Science:

• Cardiovascular Surgery
• Nephrology
• Vascular Medicine

Background:

• Atherosclerotic renal artery stenosis (ARAS) is a key cause of resistant hypertension and progressive kidney disease.
• Optimal treatment strategies for ARAS remain uncertain, impacting end-organ damage.
• Renovascular disease management is critical for preserving renal function and controlling blood pressure.

Purpose of the Study:

• To compare anatomic and functional outcomes of open surgical repair versus endovascular therapy for chronic, symptomatic ARAS.
• To evaluate the efficacy of different treatment modalities in patients with hypertension and renal dysfunction.
• To assess long-term patency rates and clinical outcomes following intervention for ARAS.

Main Methods:

• Retrospective analysis of 247 patients undergoing renal arterial interventions (open or endovascular) between 1984 and 2004.
• Interventions included open bypass and endovascular angioplasty with or without stenting.
• Data collected on indications for intervention, procedural details, mortality, patency, and clinical outcomes.

Main Results:

• No significant difference in 1, 3, or 5-year mortality between open and endovascular groups; 30-day mortality was higher in the open group.
• Open repair showed higher primary patency at 5 years, while endovascular repair had higher assisted primary patency.
• No significant difference in freedom from symptoms, dialysis, or renal death; endovascular repair showed better blood pressure improvement in hypertensive patients.

Conclusions:

• Open and endovascular repair of ARAS yield comparable long-term functional and anatomic results.
• Endovascular intervention may provide superior blood pressure control for patients with ARAS and hypertension.
• Treatment choice for ARAS should consider individual patient factors, including the potential for improved hypertension management.