Renal artery revascularization after unsuccessful percutaneous therapy: a single centre experience

This retrospective review describes the long time effect of surgical revascularization after unsuccessful early or mid-term failure of percutaneous transluminal renal angioplasty (PTRA).

From January 1995 to January 2005, 60 out of 696 patients operated due to renal artery occlusive disease (17 fibromuscular dyplasia (FMD): mean age, 33.4 years; 43 atherosclerotic disease (ASD): mean age, 62.46 years) after unsuccessful PTRA underwent surgical revascularization for renal artery stenosis at our institution. The mean duration from failed PTRA to operation was 1.74 years. Out of the 68 renal arteries, 44 were pretreated with angioplasty alone (19, FMD; 25, ASD), and 24 were treated with PTRA and stent (all ASD). Operative management, response of renal function and hypertension as well as survival were compared to the literature.

Fifty-nine per cent (n = 40) of the renal arteries were treated by transaortic thrombendarterectomy, 37% (n = 25) by bypass. Thirty-day and in-hospital mortality was 0% in all pretreated patients; after a mean of 4.16 years, it was 16.6% (only atherosclerotic). There was a significant decrease in systolic blood pressure values for all patients early after surgery as well as in follow-up. Creatinine remained stable in the patients with FMD, and there was an insignificant increase in creatinine level in the atherosclerotic patients. Hypertension was improved or healed in 32.5% of all pretreated patients, in cases with FMD in 54%, in atherosclerotic cases in 22.2%. Re-stenoses occurred in 26% of cases with FMD and in 18% of patients with atherosclerotic RAS.

Surgical renal artery revascularization after failed PTRA is feasible and safe and systolic blood pressure can be lowered. The higher rate in re-stenoses in both the literature as well as in our own experience may be explained by the alterations in the renal artery after interventional treatment.