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Published on: October 26, 2020
Percutaneous transluminal dilatation: the treatment of choice for renal artery stenosis causing hypertension
Insights
Percutaneous transluminal angioplasty (PTD) is a safe and effective treatment for renal artery stenosis, even for patients who are good surgical candidates. This minimally invasive procedure should be considered the primary treatment option for significant renal artery stenosis causing hypertension.
Area of Science:
- Cardiovascular Medicine
- Interventional Radiology
Background:
- Renal artery stenosis (RAS) is a significant cause of hypertension.
- Surgical interventions like renal artery bypass have traditionally been used.
- Percutaneous transluminal angioplasty (PTD) has emerged as an alternative treatment.
Purpose of the Study:
- To evaluate the safety and effectiveness of PTD for renal artery stenosis.
- To argue for PTD as the first-line treatment for significant RAS.
- To present cumulative data and institutional experience.
Main Methods:
- Review of published data on PTD for renal artery lesions.
- Analysis of institutional experience at Indiana University.
- Consideration of patient selection criteria including functional significance and surgical candidacy.
Main Results:
- PTD has demonstrated reasonable safety and effectiveness in treating renal artery lesions from fibromuscular disease, atherosclerosis, or post-surgical cases.
- Experience suggests PTD is suitable even for patients who are good candidates for surgical bypass.
- The cumulative experience, though not from controlled trials, supports PTD as a primary treatment.
Conclusions:
- PTD should be the initial treatment of choice for patients with significant renal artery stenosis causing hypertension, particularly those with incomplete occlusion and functional significance.
- PTD offers a safe and effective alternative to surgery, especially for high-risk patients.
- Further evaluation of safety, effectiveness, cost, and availability supports the widespread adoption of PTD for RAS.
Abstract:
During the last 3 yr a large number of patients with renal artery stenosis have undergone attempted treatment of their stenosis by the technique termed percutaneous transluminal angioplasty or dilatation (PTD) using the balloon tipped catheter developed by Gruntiz. A number of publications have documented that this technique is reasonably safe and effective in renal artery lesions due to fibromuscular disease (FMD), atherosclerosis (AS), or prior surgery such as renal artery bypass or transplantation. Although initially many of the patients that were treated were felt to be poor surgical risks, many patients have now been treated who were excellent candidates for renal artery bypass. The cumulative experience argues that PTD should be the first treatment tried in any patient with significant renal artery stenosis causing hypertension. It should be noted that the cumulative experience is not based on any controlled trial and therefore may well be biased. Nevertheless, I will present this argument based on the published data and our own experience at Indiana University. This argument pertains to any patient with incomplete renal artery occlusion who has a functionally significant stenosis (determined by renal vein renin sampling) and who is a good surgical candidate. Those patients who are at high risk for major surgery will obviously be best treated by PTD or medical management. The argument has four major points: safety, effectiveness, cost analysis, and availability.
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