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Improved results with surgical treatment of renovascular hypertension: an individualized approach
S T Bartlett1, W E Dugoni, R E Ward
1Department of Surgery, University of California, Davis.
Insights
Treating renal artery occlusive lesions effectively manages renovascular hypertension. Surgical and endovascular interventions significantly improve blood pressure and kidney function, reducing medication needs.
Area of Science:
- Cardiovascular Surgery
- Nephrology
- Vascular Medicine
Background:
- Renovascular hypertension, caused by renal artery occlusive lesions, poses a significant clinical challenge.
- Effective management is crucial for preventing end-organ damage and improving patient outcomes.
Purpose of the Study:
- To evaluate the efficacy of various treatment modalities for renal artery occlusive lesions causing renovascular hypertension.
- To assess the impact of these treatments on blood pressure control, medication requirements, and renal function.
Main Methods:
- Retrospective analysis of 20 patients treated for renal artery occlusive lesions over one year.
- Diagnostic methods included angiography, isotopic renography, and renal vein renin levels.
- Treatment options encompassed saphenous aortorenal bypass, endarterectomy, percutaneous angioplasty, and nephrectomy.
Main Results:
- No operative mortality was observed across all treatment groups.
- Eighty-five percent of patients experienced improvement or cure of hypertension.
- Average antihypertensive medication use decreased from 3.1 to 1.6, and mean serum creatinine improved from 3.6 to 2.2 mg/dl.
Conclusions:
- An individualized therapeutic approach is essential for successful renovascular hypertension treatment.
- Surgical and endovascular interventions offer significant benefits in managing renal artery occlusive disease.
- Nephrectomy is a viable option for high-risk patients with compromised renal function.
Abstract:
During a one-year period, 20 patients were treated for renal artery occlusive lesions causing renovascular hypertension. Diagnosis depended on angiography, isotopic renography, and selective renal vein renin determinations in certain patients. Treatment included saphenous aortorenal bypass, 9 patients; endarterectomy, 3 patients; percutaneous angioplasty, 5 patients; and nephrectomy in 3 patients. There was no operative mortality. Eighty-five percent of the patients were improved or cured of hypertension, and the average number of antihypertensive medications required decreased from 3.1 to 1.6. The mean serum creatinine of all patients decreased from 3.6 mg/dl to 2.2 mg/dl. In one subset of patients expanding suprarenal aneurysms caused renal artery stenosis or occlusion. Aortic replacement with renal artery endarterectomy or bypass is the only treatment option for these patients. High risk patients with normal renal function and a glomerular filtration rate less than 15% in the affected kidney can be treated with nephrectomy. Our results demonstrate that an individualized approach to therapy and attention to operative detail is mandatory for successful treatment of renovascular hypertension.