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Percutaneous transluminal angioplasty of renal artery fibromuscular dysplasia: mid-term results.

Kim HJ, Do YS, Shin SW, Park KB, Cho SK, Choe YH, Choo SW, Choo IW, Kim DK - Korean J Radiol (2008 Jan-Feb)

Bottom Line: The technical success rate for primary PTRA was 79% (15/19) and the complication rate was 16% (3/19).Hypertension improved in 80% (12/15) of the patients after four weeks follow-up, and was finally cured or improved in 93% (14/15) during the mean follow-up period of 23.6 months.All of the patients were treated with a second PTRA without complications and all of the patients were cured of hypertension after the second PTRA.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Kangnam-Gu, Seoul, Korea.

ABSTRACT

Objective: To evaluate mid-term imaging, clinical follow-up, and restenosis rates from patients that had undergone percutaneous transluminal renal artery angioplasty (PTRA) for symptomatic renal artery fibromuscular dysplasia (FMD).

Materials and methods: Between March 1999 and July 2006, 16 consecutive renal artery FMD patients underwent PTRA for poorly controlled hypertension. The patients were enrolled into this retrospective study after receiving 19 primary and four secondary PTRAs in 19 renal artery segments. Follow-up monitoring of blood pressure, use of antihypertensive medication, and the serum creatinine level after PTRA were assessed at 1, 3, 6, 9, 12 months, and each following year. The degree of restenosis was evaluated with computed tomographic angiography (CTA) after PTRA at 6, 12 months, and every year if possible. Technical and clinical success rates for the treatment of FMD, and restenosis rates for the renal artery were evaluated.

Results: The technical success rate for primary PTRA was 79% (15/19) and the complication rate was 16% (3/19). Hypertension improved in 80% (12/15) of the patients after four weeks follow-up, and was finally cured or improved in 93% (14/15) during the mean follow-up period of 23.6 months. There was a cumulative 22% (4/18) restenosis rate during the follow-up period. All of the patients were treated with a second PTRA without complications and all of the patients were cured of hypertension after the second PTRA.

Conclusion: Percutaneous transluminal renal artery angioplasty for clinically symptomatic renal FMD is technically and clinically successful and safe to perform. For all patients with restenosis, there was a good response after undergoing a second PTRA.

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Related in: MedlinePlus

Stenosis shapes of renal artery fibromuscular dysplasia.A. focal stenosisB. beaded-multifocal stenosisC. diffuse segmental stenosis.
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Figure 1: Stenosis shapes of renal artery fibromuscular dysplasia.A. focal stenosisB. beaded-multifocal stenosisC. diffuse segmental stenosis.

Mentions: Out of 16 patients, three patients that had bilateral renal artery stenosis underwent bilateral PTRA procedures in the same setting. Lesion distribution in the renal artery was proximal for four cases, middle for 12 cases, and distal for one case. Two lesions involved middle and distal vessels simultaneously. Nine lesions had focal stenosis, five lesions had beaded stenosis, four lesions had diffuse segmental stenosis, and one lesion had focal and segmental stenosis as seen by selective angiography (Fig. 1). Technical success was seen for 79% (15/19) of the PTRAs. One patient had a residual stenosis after a primary PTRA with no clinical change during the 26 months of follow-up (Fig. 2), and three other patients had complications (3/19, 16%) associated with the primary PTRA: one patient suffered rupture of the renal artery, and two patients had flow-compromising dissection. A stent was inserted for each case of arterial rupture and dissection without complication. In one patient, a cutting balloon was used for residual renal artery stenosis after PTRA. The cutting balloon ruptured a renal artery. We inserted a balloon and inflated it with low pressure for 5 minutes. This caused near total occlusion of the renal artery. We inserted a self-expandable stent. Fortunately, final angiography and follow-up CT showed that the renal artery to have no leakage of contrast medium. One patient already had a flow-compromising dissection associated with renal artery FMD before the procedure. A stent was also inserted without complications. There were no serious adverse events associated with the interventions and no periprocedural mortalities.


Percutaneous transluminal angioplasty of renal artery fibromuscular dysplasia: mid-term results.

Kim HJ, Do YS, Shin SW, Park KB, Cho SK, Choe YH, Choo SW, Choo IW, Kim DK - Korean J Radiol (2008 Jan-Feb)

Stenosis shapes of renal artery fibromuscular dysplasia.A. focal stenosisB. beaded-multifocal stenosisC. diffuse segmental stenosis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2627178&req=5

Figure 1: Stenosis shapes of renal artery fibromuscular dysplasia.A. focal stenosisB. beaded-multifocal stenosisC. diffuse segmental stenosis.
Mentions: Out of 16 patients, three patients that had bilateral renal artery stenosis underwent bilateral PTRA procedures in the same setting. Lesion distribution in the renal artery was proximal for four cases, middle for 12 cases, and distal for one case. Two lesions involved middle and distal vessels simultaneously. Nine lesions had focal stenosis, five lesions had beaded stenosis, four lesions had diffuse segmental stenosis, and one lesion had focal and segmental stenosis as seen by selective angiography (Fig. 1). Technical success was seen for 79% (15/19) of the PTRAs. One patient had a residual stenosis after a primary PTRA with no clinical change during the 26 months of follow-up (Fig. 2), and three other patients had complications (3/19, 16%) associated with the primary PTRA: one patient suffered rupture of the renal artery, and two patients had flow-compromising dissection. A stent was inserted for each case of arterial rupture and dissection without complication. In one patient, a cutting balloon was used for residual renal artery stenosis after PTRA. The cutting balloon ruptured a renal artery. We inserted a balloon and inflated it with low pressure for 5 minutes. This caused near total occlusion of the renal artery. We inserted a self-expandable stent. Fortunately, final angiography and follow-up CT showed that the renal artery to have no leakage of contrast medium. One patient already had a flow-compromising dissection associated with renal artery FMD before the procedure. A stent was also inserted without complications. There were no serious adverse events associated with the interventions and no periprocedural mortalities.

Bottom Line: The technical success rate for primary PTRA was 79% (15/19) and the complication rate was 16% (3/19).Hypertension improved in 80% (12/15) of the patients after four weeks follow-up, and was finally cured or improved in 93% (14/15) during the mean follow-up period of 23.6 months.All of the patients were treated with a second PTRA without complications and all of the patients were cured of hypertension after the second PTRA.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Kangnam-Gu, Seoul, Korea.

ABSTRACT

Objective: To evaluate mid-term imaging, clinical follow-up, and restenosis rates from patients that had undergone percutaneous transluminal renal artery angioplasty (PTRA) for symptomatic renal artery fibromuscular dysplasia (FMD).

Materials and methods: Between March 1999 and July 2006, 16 consecutive renal artery FMD patients underwent PTRA for poorly controlled hypertension. The patients were enrolled into this retrospective study after receiving 19 primary and four secondary PTRAs in 19 renal artery segments. Follow-up monitoring of blood pressure, use of antihypertensive medication, and the serum creatinine level after PTRA were assessed at 1, 3, 6, 9, 12 months, and each following year. The degree of restenosis was evaluated with computed tomographic angiography (CTA) after PTRA at 6, 12 months, and every year if possible. Technical and clinical success rates for the treatment of FMD, and restenosis rates for the renal artery were evaluated.

Results: The technical success rate for primary PTRA was 79% (15/19) and the complication rate was 16% (3/19). Hypertension improved in 80% (12/15) of the patients after four weeks follow-up, and was finally cured or improved in 93% (14/15) during the mean follow-up period of 23.6 months. There was a cumulative 22% (4/18) restenosis rate during the follow-up period. All of the patients were treated with a second PTRA without complications and all of the patients were cured of hypertension after the second PTRA.

Conclusion: Percutaneous transluminal renal artery angioplasty for clinically symptomatic renal FMD is technically and clinically successful and safe to perform. For all patients with restenosis, there was a good response after undergoing a second PTRA.

Show MeSH
Related in: MedlinePlus