Patency of percutaneous transluminal renal angioplasty: A prospective sonographic study

Abstract

Evaluation of percutaneous transluminal renal angioplasty (PTRA) is today based primarily on clinical criteria rather than direct investigation of luminal width. In this study, we examined renal blood flow by color-coded duplex sonography (CCD) in order to correlate blood pressure as well as renal function with the true renovascular patency. Fifty consecutive patients suspected of suffering from renovascular disease and treated by PTRA were included for a prospective sonographic study. In all PTRA was performed on 63 renal arteries. Thirty-seven patients were diagnosed to have atherosclerosis and 13 patients to have fibromuscular dysplasia (FMD). Examinations were performed using CCD before PTRA, and one day, three months, six months and 12 months after PTRA. If CCD showed a restenosis ≤60%, CCD was non-conclusive or hypertension deteriorated, angiography and, if necessary, catheter re-intervention were performed. The primary patency rate after 12 months was 73%, and could be improved to 94% overall when treated restenoses (N = 22) were included. Restenosis was more frequent in patients with mild residual stenosis identified by CCD one day after PTRA (P = 0.002). There was neither a significant difference in the restenosis rate in patients with atherosclerosis versus FMD, nor in patients with ostial versus non-ostial lesions. Hypertension was improved or cured in 70% of patients with atherosclerosis, and in 85% of those with FMD. Nevertheless, hypertension deteriorated in 12% of the patients without restenosis, and no deterioration was present in 14% of the patients with restenosis. A decrease in serum creatinine levels by more than 15% was observed in 12 of 22 patients with impaired renal function and patent renal artery during follow-up. These results suggest that optimal therapeutic efficiency can be obtained using PTRA followed by systematic CCD.