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Renal vascular hypertension. Surgery vs. dilation
Insights
Renal artery stenosis treatments like surgery or angioplasty show varied success. Atherosclerotic disease often benefits, but fibrodysplastic disease carries risks, highlighting the importance of lesion etiology in blood pressure outcomes.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Vascular Surgery
Background:
- Renal artery stenosis (RAS) is a significant cause of secondary hypertension.
- Treatment options for RAS include surgical intervention and percutaneous transluminal angioplasty (PTA).
- The long-term efficacy and safety of these interventions depend on the underlying etiology of the stenosis.
Purpose of the Study:
- To evaluate the long-term blood pressure response to surgical or PTA treatment for renal artery stenosis.
- To compare the outcomes of treatments based on the etiology of renal artery stenosis (atherosclerotic vs. fibrodysplastic).
- To assess the impact of these interventions on renal function and patient survival.
Main Methods:
- A retrospective analysis of patients who underwent surgery or PTA for renal artery stenosis.
- Blood pressure was measured an average of 3 years post-intervention.
- Etiology of stenosis (atherosclerotic or fibrodysplastic) and treatment outcomes were recorded.
Main Results:
- 85% of patients with atherosclerotic renal artery stenosis showed blood pressure improvement.
- The overall cure rate for atherosclerotic RAS was low (6%), suggesting it's often a complication of essential hypertension in smokers.
- In fibrodysplastic disease, both treatments improved blood pressure, but surgery led to a 41% rate of kidney loss.
Conclusions:
- Treatment response for renal artery stenosis is strongly influenced by the lesion's etiology.
- Angioplasty and surgery can effectively manage blood pressure in atherosclerotic RAS, though rarely curative.
- While beneficial for blood pressure in fibrodysplastic RAS, surgical risks, including kidney loss, must be considered.
Abstract:
The blood pressure response to surgery or percutaneous transluminal angioplasty (PTA) was determined an average of 3 years after treatment. In atherosclerotic disease, 85% of patients benefited. Furthermore, the extremely low overall cure rate of 6% (4/67) suggests that renal artery stenosis due to atherosclerosis is rarely a sole cause of hypertension, but more likely is an atherosclerotic complication of essential hypertension that develops in patients who are cigarette smokers. In fibrodysplastic disease both treatments were likely to improve the blood pressure. However, surgery resulted in a 41% rate of loss of the operated kidney. The response to PTA or surgery is strongly influenced by the etiology of the lesion being treated.