Restenosis after renal artery angioplasty and stenting: Incidence and risk factors
Presented at the Thirty-third Annual Meeting of the Southern Association of Vascular Surgery, Tucson, Ariz, Jan 14, 2009.
Received 10 January 2009; accepted 12 May 2009. published online 14 July 2009.
Background
Management of renal artery stenosis (RAS) with primary renal artery percutaneous angioplasty and stenting (RA-PTAS) is associated with a low risk of periprocedural death and major complications; however, restenosis develops in a subset of patients and repeat intervention may be required. We examined the incidence of restenosis after RA-PTAS and associations with clinical factors.
Methods
Consecutive patients undergoing RA-PTAS for hemodynamically significant atherosclerotic RAS associated with hypertension or ischemic nephropathy, or both, between October 2003 and September 2007 were identified from a registry. Restenosis was defined using duplex ultrasound (DUS) imaging as a renal artery postintervention peak systolic velocity (PSV) ≥180 cm/s. The incidence and temporal distribution of restenosis was analyzed using survival analysis based on treated kidneys. Associations between clinical factors and recurrent stenosis were examined using proportional hazards regression.
Results
RA-PTAS was performed on 112 kidneys for atherosclerotic RAS during the study period. Initial postintervention renal artery DUS imaging confirming PSV <180 cm/s in 101 kidneys, which formed the basis of this analysis. Estimated restenosis-free survival was 50% at 12 months and 40% at 18 months. Decreased risk of restenosis was associated with preoperative statin use (hazard ratio [HR], 0.35; 95% confidence interval [CI], 0.16-0.74; P = .006) and increased preoperative diastolic blood pressure (DBP; HR, 0.70 per 10-mm Hg increase in preoperative DBP; 95% CI, 0.49-0.99; P = .049). No other factors assessed were associated with restenosis.
Conclusion
Restenosis occurs in a substantial number of patients treated with RA-PTAS. Preoperative statin medication use and increased preoperative DBP are associated with reduced risk of restenosis. In the absence of contraindications, statins should be considered standard therapy for patients with atherosclerotic renal artery stenosis.
aDepartment of Vascular and Endovascular Surgery, Wake Forest University School of Medicine, Winston-Salem, NC
bDepartment of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
Reprint requests: Kimberley J. Hansen, MD, Department of Vascular and Endovascular Surgery, Medical Center Blvd, Winston-Salem, NC 27157-1095
Dr Edwards is supported by the American Vascular Association and Lifeline Foundation Research Career Development Award. Grant support was also provided by The National Heart, Lung, and Blood Institute of the National Institutes of Health to Dr Edwards (Grant 1K23HL083981-01), Dr Geary (Grant R01 HL57557), and Dr Hansen (Grant 5K12HL083763-02).
Competition of interest: none.
Additional material for this article may be found online at www.jvascsurg.org.
ABSTRACT