Figure 343

Percutaneous transluminal renal angioplasty (PTRA) of the renal artery. A, High-grade (more than 75%) nonostial atherosclerotic stenosis of the left main renal artery in a patient with a solitary functioning kidney (right renal artery totally occluded). Note gradient of 170 mm Hg across the stenotic lesion. B, Balloon angioplasty of the left main renal artery was successfully performed with reduction in the gradient across the stenotic lesion from 170 mm Hg pre-PTRA to 15 mm Hg post-PTRA. Repeat aortogram 3 years later demonstrated patency of the left renal artery.

PTRA of the renal artery has emerged as an important interventional modality in the management of patients with renal artery stenosis. PTRA is most successful and should be the initial interventive therapeutic maneuver for patients with the medial fibroplasia type of fibrous renal artery disease (eg, Fig.3-5A). Excellent technical success rates have also been attained for nonostial atherosclerotic lesions of the main renal artery, as shown here.

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