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[Renovascular hypertension. Changes and prognosis of the surgical treatment]
Insights
Percutaneous transluminal angioplasty (PTA) is now the preferred treatment for renovascular hypertension. Surgical interventions are reserved for complex cases where PTA is ineffective, offering varying long-term blood pressure control.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Nephrology
Context:
- Retrospective analysis of 663 patients with renovascular hypertension treated surgically in Japan (1963-1988).
- Investigated causes including fibromuscular dysplasia (FMD), atherosclerosis (SC), and aortitis syndrome (AO).
- Surgical procedures included nephrectomy, aortorenal bypass, and autotransplantation.
Purpose:
- To evaluate the long-term outcomes of surgical treatment for renovascular hypertension.
- To compare the efficacy of different surgical approaches based on the underlying cause.
- To assess the evolving role of surgery in the context of emerging endovascular techniques like PTA.
Summary:
- Fibromuscular dysplasia (FMD) patients were younger (mean 27 years) compared to atherosclerosis (SC) (52 years) and aortitis syndrome (AO) (29 years).
- Surgical success rates (normal blood pressure) varied: 77% for FMD, 59% for SC, and 50% for AO at 10 years.
- PTA has reduced surgical case numbers, particularly for FMD, shifting surgical focus to complex and refractory cases.
Impact:
- Highlights the shift towards PTA as the primary treatment for renovascular hypertension.
- Demonstrates the continued, albeit diminished, role of surgery for complex vascular lesions.
- Provides long-term prognosis data for surgical management of different renovascular hypertension etiologies.
Abstract:
We investigated 663 patients with renovascular hypertension (349 males and 314 females), who were surgically treated at 73 institutions of Urology or Surgery in Japan from 1963 to 1988. There were 294 cases with fibromuscular dysplasia (FMD), 178 with atherosclerosis (SC), 104 with aortitis syndrome (AO) and 87 with other causes. The mean age was 27 years old for FMD, 52 years for SC and 29 years for AO. Thirteen % of FMD, 19% of SC and 38% of AO had stenoses in both renal arteries. Since percutaneous transluminal angioplasty (PTA) has begun in early 1980's, the number of operative cases has been decreased, especially in the case of FMD due to a good result by PTA. Nephrectomy was done in 38% of 704 operations. Aortorenal bypass and autotransplantation were performed in 49% and 26% of the rest, respectively. Recently, autotransplantation has increasingly been applied for complicated vascular lesions. As regards prognosis of the surgical treatment, 77% of FMD, 59% of SC and 50% of AO presented normal blood pressure with or without antihypertensive drugs at least for 10 years after an operation. However, among the patients with normal blood pressure who were observed for more than 5 years, 30% of FMD, 56% of SC and 44% of AO had taken antihypertensive drugs. Eleven patients (1.7% of all) died within one month after the operation, 5 patient of whom had bilateral stenoses. In conclusion, PTA is the first choice for renovascular hypertension and surgery has been done for more difficult and complicated cases in which PTA is ineffective.(ABSTRACT TRUNCATED AT 250 WORDS)