[Percutaneous angioplasty of the renal arteries. Long-term results of 222 operations].
OBJECTIVES: Determine the relative role of percutaneous angioplasty of the renal arteries in the treatment of renovascular hypertension. METHODS: From September 1984 to June 1993, we performed 222 angioplasties in 196 patients with renovascular hypertension. There were 186 atheromatous stenoses of the renal arteries and 36 fibromuscular dysplasias. Certain patients had associated moderate renal failure but variations in renal function were not considered in this study. RESULTS: The operation was hemodynamically successful in 180 cases (86%) including 165 cases with residual narrowing less than 30% and 27 between 30 and 50%. In 10 cases (4%), residual stenosis was greater than 50%. Complications at the site of angioplasty occurred in 13 cases (6%) including parietal damage (n = 10) due to hemodynamic pressure (n = 4), thrombosis (n = 2), and arterial rupture (n = 1). Mean follow-up in 131 patients was 2 years. Among these patients, clinical success was obtained in 93 (70%) including 12 complete cures (9%) and 81 improvements (62%). Cure of hypertension was better in patients with dysplasia (30% success rate) than in those with atheroma (5% success rate). Rate of clinical cure was higher for lesions of arterial branches (82%) than in main trunks (69%) or ostium (68%). Among the 38 cases of clinical failure (30%) there were 28 angiographically proven cases of restenosis including 16 which underwent redilatation leading to improvement in 6 (38%). CONCLUSION: These findings confirm the efficacy of percutaneous endoluminal angioplasty for the treatment of renovascular hypertension and suggest that this technique should be used as first line therapy.