Figure 347

Surgical revascularization vs percutaneous transluminal renal angioplasty (PTRA) for renal artery disease. A, Success rates for atherosclerotic renal artery disease (ASO-RAD). B, Success rates for fibrous renal artery disease. Success of either PTRA or surgical renal revascularization is viewed in terms of "technical" success and "clinical" success. For PTRA, technical success reflects a lumen patency with less than 50% residual stenosis (ie, successful establishment of a patent lumen). For surgical revascular-ization, technical success is the demonstration of good blood flow to the revascularized kidney determined during surgery, or postoperatively by DPTA renal scan or other immediate postoperative imaging procedures. Technical success with either PTRA or surgical revascularization is rarely defined by postoperative angiography. "Clinical" success may be defined as improved blood pressure or improvement in kidney function, and/or resolution of flash pulmonary edema. Technical and clinical successes do not necessarily occur together because technical success may be apparent, but without improvement in blood pressure or renal function.

The "percent success" for PTRA and surgical revascularization depicted above are estimates, and reflect primarily "technical" success for both nonostial and ostial lesions in ASO-RAD. Technical success rates for surgical revascularization are high, approximating 90%, with little difference in the technical success rates between ostial and nonostial lesions. For PTRA, technical success rates are much higher for nonostial lesions. There is a high rate of restenosis at 1 year (=50% to 70%) for ostial ASO-RAD, which has promoted the use of renal artery stents for these lesions.

The success rates of surgical renal revascularization and PTRA for stenosis of the main renal artery in fibrous renal artery disease are comparable, approximately 90%. Hypertension is more predictably improved with surgical revascularization and PTRA in fibrous renal artery disease in comparison with ASO-RAD. Technical success rates with surgical renal revascularization are high for branch fibrous renal artery disease, but long-term technical and clinical success rates are not available for PTRA of branch lesions due to fibrous dysplasia. NA—not available. (Adapted from Pohl [18]; with permission.)

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