Renal artery angioplasty versus surgery: a hypertensionologist's dilemma

Percutaneous transluminal angioplasty for renovascular hypertension offers the potential for simple, safe, and relatively inexpensive therapy in certain categories of patients. The technique should be performed only under these conditions: (1) in centers with experience in angiography and angioplasty of peripheral vascular lesions; (2) with an experienced vascular surgical team standing by in case of surgical complications; (3) on lesions anatomically amenable to catheter dilation; and (4) on patients with prior proof of increased renin production on the affected side. Angioplasty is limited by the anatomy of the stenoses. Complications are similar to those of percutaneous angiography and occur with an estimated frequency of 5%-10%. Short-term patency is considered 70%-80%, somewhat lower than the surgical repair result. In all but certain cases where angioplasty offers a relative advantage, randomized controlled studies will be required to determine whether angioplasty or surgery should be the preferred method of therapy.