Background: Atherosclerosis and fibromuscular dysplasia are significant causes of renal artery stenosis, which frequently leads to arterial hypertension and renal failure. Treatment may consist of surgical revascularization or percutaneous angioplasty with stent implantation. This study was designed to evaluate the response to endovascular treatment for critical stenosis of the renal arteries in patients with severe arterial hypertension and renal failure.
Material and method: From the year 2000 through 2003 percutaneous angioplasty with stenting of renal artery stenosis was performed in 25 patients. The study group comprised 8 male and 17 female patients, aged 43 to 79 years (mean age: 59.6 years). Arterial hypertension was the indication for surgery in twentyfour patients, 5 of whom also suffered from chronic renal failure. One patient was selected due to acute renal failure. Patient selection was based on the presence of critical ostial stenosis (> 70%) of the renal artery. Seven patients (28%) presented with bilateral stenosis; two others had occlusion of the contralateral renal artery with renal cirrhosis.
Results: Technically, stent implantation was 100% success. A perioperative creatnine increase (> 1.5 mg%) was observed in 11 patients (44%). Two patients required kidney dialysis; one of whom developed multiorgan failure, and subsequently myocardial infarction, which was the immediate cause of death. Following the procedure, a decline in blood pressure or a decrease in the number and dose of antihypertensive drugs was observed in 19 subjects (76%); however, the effect proved shortlasting in most of them. Significant restenosis (> 50%) was found in 2 patients (8%). Two others (8%) developed perioperative haematomas at the arterial puncture site.
Conclusions: Percutaneous angioplasty, in patients with critical ostial stenosis of the renal arteries and resultant hypertension, is a safe method of treatment and yields a decline in blood pressure or a decrease in the number and dose of antihypertensive drugs in most patients.