Angioplasty and stenting of renal arteries: in search for prognostic criteria

Viktor Ginzburg¹, Talia Volak², Georgy Grinberg¹, Olga Maiizler¹, Anatolyi Leitsin¹, Gabriel Sandro¹

1 Vascular Surgery Department, "Soroka" Medical Centre, Ben-Gurion University,
2 Clinic for Hypertension, Beer Sheva, Israel

Objective: transcutaneous angioplasty with stenting of renal arteries has for a long time been considered the generally accepted technique of treatment for atherosclerotic stenosis of renal arteries. Publications concerning the results of recent studies (ASIRAL, DRATIC, STAR) call into doubt the value of this method. However, these studies have been criticized for their methodological shortcomings. In our work we attempted to reveal the interrelationship between the clinical and radiological parameters of patients presenting with atherosclerotic narrowing of renal arteries and the results of transcutaneous angioplasty with stenting.

Patients and methods. We carried out a retrospective study based on analyzing the case histories of all patients having endured transcutaneous angioplasty with stenting of renal arteries at the Vascular Surgery Department of the "Soroka" Medical Centre (Beer Sheva, Israel) over the period from 2000 to 2007. The criteria for inclusion of patients into the study group were as follows: 1) diagnosis of atherosclerotic stenosis of renal arteries based on the Doppler ultrasound scan; 2) treatment using transcutaneous angioplasty with stenting of renal arteries; 3) dispensary follow up during 18 months after the procedure. The patients with atherosclerotic stenosis of renal arteries or those unavailable for follow up were excluded from the study. All available clinical radiological data were grouped into tables and subjected to statistical analysis (SPSS, Student’s t-test, the ANOVA, and chi-squared test). The findings regarding arterial pressure and the level of blood creatinine were registered at terms equalling 1, 6, 12, and 18 months after the procedure.

Results. A total of forty one patients were included into the final statistical analysis; the patients’ average age amounted to 67.6±8.7 years and 70.7% were male patients. We observed a considerable decrease in the average indices of arterial pressure one month after the procedure (systolic pressure dropped from 160±24.7 to 141.8±23.6 mm Hg and diastolic pressure fell from 83±12.9 to 58.8±11.8 mm Hg; p<0.001). The decrease in arterial pressure maintained during the whole follow-up period. After 18 months the mean indices of systolic pressure amounted to 135.0±35.1 mm Hg, with those of diastolic pressure equalling 71.3±16.5 mm Hg, p>0.001). The renal function (blood serum creatinine level) remained stable during the whole period of low up.

Conclusions. The obtained findings demonstrated that successful transcutaneous angioplasty with stenting of atherosclerotic stenosis of renal arteries helps control arterial hypertension. No direct positive effect of this procedure on the renal function was revealed. In our opinion, the main problem in selecting the patients this intervention is indicated for consists in not knowing the criteria correlating with successful outcomes, therefore further studies should be aimed at revealing these criteria.

KEY WORDS: percutaneous transluminal renal artery angioplasty, renal artery stenting, hypertension, renal function.

P. 123-127

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