Angioplasty/stenting shows benefit in renal fibromuscular dysplasia


A study set to evaluate short- and long-term outcomes of patients undergoing percutaneous transluminal angioplasty with/out stent of renal artery fibromuscular dysplasia has shown that angioplasty is a feasible and durable tool for treating the condition.


Albeir Mousa, Vascular & Endovascular Surgery Division, West Virginia University, Charleston, USA, presented results of a retrospective analysis of all patients with renal artery fibromuscular dysplasia treated between January 1999 and December 2009, at the Society for Vascular Surgery Annual Meeting.


Blood pressure measurement, number of blood pressure medications, and hypertension defined by a systolic blood pressure>140 +/- diastolic blood pressure >90 were recorded.


Renal function was defined by estimated glomerular filtration rate (eGFR). Restenosis was defined by stenosis >60% and was determined by renal artery duplex and/or angiography. Freedom from event (restenosis, renal failure, or recurrent hypertension) was performed using Life Table analysis. Forty-three procedures were performed on 35 patients with renal artery fibromuscular dysplasia. Thirty-two (91%) were female, with mean age of 61.9.


Technical success was 100% with adjunctive stent placement required in the fibromuscular dysplasia segment for dissection in one patient (2.3%) and in the non- fibromuscular dysplasia aorto-ostial atherosclerotic lesion in four patients (9.3%).



Short-term outcomes


The majority (69%) had an immediate clinical benefit for hypertension, 6% were cured without blood pressure medications, and 63% improved with less than or equal to pre-operative blood pressure medications. Post-intervention, 17% remained at moderately reduced renal function (<60), while the percent above >60ml/min eGFR increased significantly (from 51% to 69%; p=0.002). For the entire cohort, renal function (mean eGFR) significantly increased from 71.9ml/min + 5.8 to 80.8ml/min + 5.2 (p=0.007).



Long-term outcomes



Freedom from recurrent or worsening hypertension (>140 systolic blood pressure and >90 diastolic blood pressure) was (93%, 75%, and 41%) and freedom from reduced renal function (eGFR<30ml/min) was (100%, 95%, and 64%) at 1, 5, and 8 years, respectively.


Patients with reduced baseline renal function (<60ml/min) and combined atherosclerotic disease were more likely to experience long-term reduced renal function (eGFR<30ml/min; p=0.003). Primary and assisted primary patency was (95%, 71%, and 50%) and (100%, 100%, and 100%) at one, five, and nine years, respectively.

“Renal angioplasty is a safe and durable modality for treating renal artery fibromuscular dysplasia with favorable short and long-term clinical outcomes. Patients with combined atherosclerotic disease and fibromuscular dysplasia were older and were more likely to have declining renal function over time. Early intervention may be imperative to achieve possible cure of hypertension,” Mousa said.