Downloaded from www.ajronline.org by 114.83.204.252 on 10/31/15 from IP address 114.83.204.252. Copyright ARRS. For personal use only; all rights reserved

417

Renal Artery Stenosis Caused by Nonspecific Arteritis (Takayasu Disease): Results of Treatment with Percutaneous

Sanjiv Sharma1 Anita Saxena2 Kewal K.

2

Upendra Kaul2 S. N. Mehta3

Mira Rajani1

158:417-422,

Nonspecific

formation obstructions

India Institute of Medical

029, India. Address 2

Department

Medical 3

Sciences,

Department

Medical

Sciences,

Sciences, reprint requests

New Delhi 110 to S. Sharma.

of Cardiology, All India Institute of New Delhi 1 1 0 029, India. of Surgery,

All India Institute

New Delhi 1 1 0 029,

0361 -803X/92/1 582-0417 0 American Roentgen Ray Society

India.

of

February,

aortoarteritis,

arteritis of unknown and the pulmonary

May 15, 1991 ; accepted after revision September 3, 1991. I Department of Cardiovascular Radiology, All

Angioplasty

Renovascular hypertension is common in nonspecific aortoarteritis (Takayasu disease). The utility of percutaneous transluminal renal angioplasty in managing this disease has been reported infrequentiy, and technical problems in using this treatment method have not been described. We retrospectively evaluated the resufts of renal angioplasty in treating 33 stenoses in 20 patients. Each patient’s diagnosis was based on the criteria established by the Aortftis Syndrome Research Committee of Japan. Criteria for selection of patients for angioplasty were (1) severe hypertension uncontrolled by single-drug therapy, (2) angiographic evidence of at least 70% stenosis of the renal artery with a pressure gradient of more than 20 mm Hg, and (3) a normal sedimentation rate. The transfemoral route was used to treat all 33 stenoses. Follow-up examinations included blood pressure and medication evaluation I day, I week, and 46 weeks after treatment, and thereafter at 6-month intervals. Technical success was obtained in 28 lesions (85%) in 17 patients (85%). All failures occurred in the presence of coexistent abdominal aortic disease and tight, proximal stenosis of the renal artery. Technical difficulties were attributed to the tough, noncompliant nature of the stenoses, which were difficuft to cross and resisted repeated, prolonged balloon inflations. These patients experienced backache and a fall in systemic blood pressure during balloon inflation. In one patient, the ipsilateral renal vein was injured during angioplasty and required surgery. Clinical success was obtained in 14 (82%) of the 17 patients in whom technical success was achieved and included cure in six patients and improvement in eight others. Follow-up 1-18 months (mean, 8 months) after treatment showed restenosis in six (21%) of 28 lesions. We conclude that renal angioplasty in nonspecific arteritis is associated with technical difficulties; however, the short-term results are good and the complication rate is acceptable. AJR

Received

Transluminal

1992

also

known

cause that commonly arteries

of aneurysms are the most

[i -3].

It results

in the involved common,

as Takayasu disease, is a rare form of involves the aorta, its major branches, in stenosis,

blood vessels

frequently

involving

the renal arteries, and often resulting in renovascular The presence of obstructive renal arterial disease hypertension requires some form of revascularization

occlusion,

dilatation,

[4]. Of these, the abdominal

stenoses

aorta [1 , 2, 4].

or

or and

hypertension in patients with renovascular to relieve systemic hyperten-

sion. Reconstructive vascular surgery is associated with a high prevalence of graft occlusion [5]. Percutaneous transluminal renal angioplasty provides an alternative

mode of treatment for these patients. Its utility in the presence of nonspecific arteritis has been infrequently reported [2, 6-i 1], and most reports concern a relatively small group of patients. No specific technical problems related to transluminal renal angioplasty have been reported. In this report, we describe our experience with the use of percutaneous transluminal angioplasty to treat renovascular hypertension caused by nonspecific aortoartentis in 20 patients.

SHARMA

418

Materials

and

Downloaded from www.ajronline.org by 114.83.204.252 on 10/31/15 from IP address 114.83.204.252. Copyright ARRS. For personal use only; all rights reserved

treated

of 26 months,

20 patients with renovascular

by nonspecific arteritis percutaneous transluminal

with

hyper-

of the renal arteries were angioplasty. The group in-

cluded 1 1 females and nine males (mean age, 16 years; range, 5-28 years). In each case, the presence of renal artery stenosis was established

by digital

the diagnosis symptoms

kidneys; copic

of

findings;

subtraction

angiography artentis included by ischemia of the CNS,

absent

of

upper

in the

nonspecific

presence

for

of

(1)

extremities,

or

erythrocyte

sedimentation

rate and

protein [1 2]. Angiographic findings considered arteritis of the renal arteries included a

spectrum of changes ranging from minimal typical rat-tail narrowing, complete obstruction, tion

The criteria

the presence

decreased pulses, bruits, and fundos-

or

and (3) increased

presence of C-reactive diagnostic

(DSA).

nonspecific

caused

(2) fever,

of

additional

intimal irregularity to or aneurysm forma-

involvement

of

the

aorta

or

its

branches by a similar stenosing, occlusive, dilative, or aneurysmal lesion. Pathologic confirmation of the diagnosis of nonspecific artentis was not available in any of the cases. Patients were accepted for angioplasty if they had hypertension uncontrolled by single-drug therapy and angiographic evidence of at least 70% stenosis of the renal artery with a pressure gradient of more than 20 mm Hg and a normal sedimentation rate (

Renal artery stenosis caused by nonspecific arteritis (Takayasu disease): results of treatment with percutaneous transluminal angioplasty.

Renovascular hypertension is common in nonspecific aortoarteritis (Takayasu disease). The utility of percutaneous transluminal renal angioplasty in ma...
1MB Sizes 0 Downloads 0 Views