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 (