Korean J Radiol.  2008 Feb;9(1):38-44. 10.3348/kjr.2008.9.1.38.

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

• KMID: 1734273
• DOI: http://doi.org/10.3348/kjr.2008.9.1.38

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.

Keyword

Percutaneous transluminal renal artery angioplasty; Fibromuscular dysplasia; Renal artery stenosis, angioplasty; Renovascular hypertension

MeSH Terms

Adolescent
Adult
Angiography
*Angioplasty, Balloon
Child
Female
Fibromuscular Dysplasia/complications/radiography/*therapy
Humans
Male
Middle Aged
Recurrence
Renal Artery Obstruction/etiology/radiography/*therapy
Retrospective Studies
Stents
Treatment Outcome

Figure

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  Fig. 1 Stenosis shapes of renal artery fibromuscular dysplasia. A. focal stenosis B. beaded-multifocal stenosis C. diffuse segmental stenosis.

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  Fig. 2 A 29-year-old woman with a focal stenosis in the midportion of the left renal artery. A. Angiography shows a focal stenosis (arrow). B. There is an approximate 40% residual stenosis (arrow) after percutaneous transluminal renal artery angioplasty. C. Six months later, CT angiography shows no interval change in the residual stenosis (arrow). D. Twenty-six months later, CT angiography shows no interval change in the residual stenosis (arrow).

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  Fig. 3 A 26-year-old-man with a beaded stenosis in the midportion of the right renal artery. A. Angiography shows a beaded stenosis of a renal artery (arrow). B, C. Follow-up CT angiography and angiography show restenosis (arrows) of the renal artery after 28 months. At that time, there was a sudden elevation of blood pressure. D. After a second percutaneous transluminal renal artery angioplasty, selective right renal angiography shows a successfully dilated renal artery. Clinical cure was achieved after performing a successful second percutaneous transluminal renal artery angioplasty.

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  Fig. 4 A 29 year-old-woman with a beaded stenosis in the midportion of the right renal artery. A. Angiography shows a beaded stenosis (arrow). B, C. Restenosis (arrows) of the renal artery was noted on CT angiography and angiography without clinical change after 12 months. D. After a second percutaneous transluminal renal artery angioplasty, selective right renal angiography shows successfully dilated renal artery. Clinical cure was achieved after performing a successful second percutaneous transluminal renal artery angioplasty.

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