Which of the following statements about percutaneous renal artery transluminal angioplasty (PRTA) are true?
- Patients with renovascular hypertension are usually cured after successful PRTA.
- Patients with renovascular hypertension due to atherosclerosis are more likely to benefit from PRTA than those in whom it is due to fibromuscular dysplasia.
- PRTA of ostial atherosclerotic lesions is more successful than PRTA of nonostial lesions.
- PRTA is associated with a higher morbidity and mortality than angioplasty for peripheral vascular disease.
Medicine
D. PRTA is associated with a higher morbidity and mortality than angioplasty for peripheral vascular disease.
DISCUSSION: The results of treatment for renovascular hypertension depend on the nature of the obstructing lesion and its anatomic location. Treatment of obstruction due to fibromuscular dysplasia is technically successful in 90% of patients and helps to control hypertension in almost 85%. However, fewer than 60% are cured. The results of treating atherosclerotic causes are substantially worse. Approximately 60% of patients show improvement in blood pressure control, but fewer than 25% are cured. The results of treating nonostial atherosclerotic lesions are better than those for ostial lesions. Unfortunately, the majority of patients with renovascular hypertension have ostial atherosclerotic lesions as the obstructing lesion. The complication rate associated with PRTA is substantially higher than that for angioplasty of vascular disease of the lower extremities, averaging almost 20% in patients with atherosclerotic lesions. Renal insufficiency is more likely. The mortality averages 1%, but higher rates are reported.
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