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Outcome after endovascular revascularization of atherosclerotic renal artery stenosis
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Radiology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Radiology.
2009 (English)In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 50, no 3, 256-64 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: With an aging population, more patients might be treated for atherosclerotic renal artery stenosis (ARAS). The goal of this treatment is to achieve a dialysis-free life or a well-controlled blood pressure with reduced risks of cardiovascular complications. PURPOSE: To analyze the clinical outcome of percutaneous transluminal renal artery angioplasty without stenting (PTRA) or with stenting (PTRS) for ARAS at one center. MATERIAL AND METHODS: The study group comprised 152 patients who underwent 203 PTRA/PTRS. All had hypertension, and 45% had azotemia. A retrospective collection of baseline and postprocedural number of antihypertensive drugs, blood pressure, and serum creatinine were analyzed during a follow-up of 3-18 months. RESULTS: Technical success rate was 95%, and clinical benefit was seen in 63% of patients. Complications included a 30-day mortality rate of 1.5%, a total complication rate of 35%, and major adverse events in 13%. The major adverse events were highly related to azotemia. Major adverse events within 30 days, with permanent disability, were seen in 5% and almost exclusively in patients with moderate or severe renal impairment. A subgroup analysis of 28 patients with renal duplex resistive index (RI) pre-PTRA/S and 6 months' follow-up showed a benefit of PTRA/PTRS in 17 (68%) of the 25 patients with RI <80 and in all three (100%) of the patients with RI >or=80. CONCLUSION: Endovascular treatment of ARAS has an excellent technical success rate, with a clinical improvement rate of >60%. However, it is associated with a considerable complication rate. Serious complications are seen mainly in azotemic patients. Predictors of clinical response could not be identified. Renal duplex RI is questioned as a predictor of clinical outcome.

Place, publisher, year, edition, pages
2009. Vol. 50, no 3, 256-64 p.
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Medical and Health Sciences
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URN: urn:nbn:se:uu:diva-118812DOI: 10.1080/02841850802668563ISI: 000264220100002PubMedID: 19172426OAI: oai:DiVA.org:uu-118812DiVA: diva2:299519
Available from: 2010-02-23 Created: 2010-02-23 Last updated: 2012-03-07Bibliographically approved

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Eklöf, HampusNyman, Rickard

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