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Renal artery revascularization: outcomes stratified by indication for intervention
Virendra I Patel1, Mark F Conrad, Christopher J Kwolek
1Department of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA 02114-3117, USA. vpatel4@partners.org
Journal of Vascular Surgery
|June 6, 2009
Summary
Open revascularization (OR) and percutaneous revascularization (PR) show similar efficacy for hypertension due to renal artery stenosis. However, OR demonstrated better outcomes for renal salvage, potentially due to patient selection for this group.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Nephrology
Background:
- Endovascular therapy has increased renal artery interventions, but its impact on hypertension and renal salvage remains unclear.
- Evaluating the influence of procedure indication on outcomes for both open (OR) and percutaneous revascularization (PR) is crucial.
Purpose of the Study:
- To assess the role of procedure indication in determining outcomes of open and percutaneous renal artery revascularization.
- To compare the efficacy of OR and PR in treating hypertension and preserving renal function.
Main Methods:
- Retrospective review of renal artery interventions between January 1, 2002, and December 31, 2006.
- Inclusion criteria for OR required independent renovascular indications for revascularization.
- Analysis compared outcomes based on procedure type (OR vs. PR) and indication (hypertension vs. renal salvage).
Main Results:
- OR patients were younger, had more comorbidities (peripheral arterial disease), and higher baseline creatinine levels.
- Survival and assisted patency rates were similar between OR and PR at three years.
- Open revascularization showed a trend towards better blood pressure control and significantly favored renal function preservation compared to percutaneous revascularization.
Conclusions:
- Both PR and OR are similarly effective for treating hypertension associated with renal artery stenosis.
- Open revascularization appears to offer superior outcomes for renal salvage, possibly due to patient selection bias.
- Further research is needed to clarify optimal patient selection for each revascularization technique.
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