A recent institutional experience with renovascular hypertension

Area of Science:

• Vascular Surgery
• Nephrology
• Hypertension Management

Background:

• Renovascular hypertension (RVH) presents with diverse etiologies, including atherosclerosis, Takayasu's arteritis, and fibromuscular dysplasia.
• A significant proportion of patients (29%) exhibit bilateral renal artery disease, and (31%) have coexisting chronic renal failure.
• The management of RVH requires careful consideration of the underlying cause and disease extent.

Purpose of the Study:

• To evaluate the outcomes of different treatment modalities for renovascular hypertension.
• To assess the efficacy of surgical revascularization versus percutaneous transluminal angioplasty.
• To analyze the impact of renal revascularization on renal function in patients with chronic renal failure.

Main Methods:

• Retrospective analysis of 51 patients with renovascular hypertension over an 8-year period.
• Evaluation of etiologies, including atherosclerosis, Takayasu's arteritis, fibromuscular dysplasia, dissection, trauma, and aneurysm.
• Comparison of outcomes following percutaneous transluminal angioplasty (PTA) and surgical revascularization, including aortorenal bypass, endarterectomy, and ex-vivo reconstruction.

Main Results:

• Surgical revascularization was performed in 47 patients, with aortorenal bypass being the most common procedure (55%).
• Hypertension was cured in 57% of patients and improved in 32% post-intervention.
• In patients with chronic renal failure, 50% experienced a reduction in serum creatinine levels >10% after renal revascularization.

Conclusions:

• The etiology of renovascular hypertension is highly variable, necessitating a tailored treatment approach.
• While percutaneous transluminal angioplasty may be suitable for select cases, surgical revascularization is frequently required for optimal outcomes.
• Renal revascularization can lead to significant improvements in both blood pressure control and renal excretory function.