Percutaneous transluminal renal artery angioplasty using the coaxial technique. Ten years of experience from 591 procedures in 419 patients

PURPOSE: To evaluate the angiographic and clinical results of all percutaneous transluminal renal angioplasties (PTRAs) performed at one centre in Norway since the introduction of the method. Most of the PTRAs were performed with the coaxial technique (guiding-catheter-assisted angioplasty). MATERIAL AND METHODS: In 419 patients, 595 PTRAs of 552 stenoses were performed from 1982 to 1993. The cases included 295 patients with arteriosclerotic vascular disease (AVD), 49 with fibromuscular dysplasia (FMD), and 74 transplantation patients (TX). Angiographic and clinical follow-up were undertaken. RESULTS: Initial angiographic success was obtained in 92% of the patients and another 3% improved. The rates of immediate success were 92%, 98% and 84% for AVD, FMD and TX respectively. The corresponding rates for primary patency were 57%, 67% and 54%, and for secondary patency (after 1 to 6 angioplasties) 77%, 93% and 64%. Lower long-term results were obtained for: recanalized vessels; long lesions; bifurcation stenoses; stenoses in patients with abdominal aortic aneurysm; smaller vessels; and segmental branches in native and TX kidneys. Of 252 patients with hypertension, 8% were cured and another 58% improved. Of 215 patients with reduced renal function, 38% were normalized or improved and 42% unchanged. Major complications including 2 deaths were seen in 2.9% of the procedures and other complications in 4.7%. CONCLUSION: PTRA with a guiding catheter can be performed in most patients with a high success rate and a low complication rate. This study points to two major problems with PTRA: the high restenosis rate and the low response to treatment of hypertension. The careful selection of patients for PTRA is important for increasing the success rate, and follow-up to detect restenosis is mandatory.