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Home > Vascular Annual Meeting > balzer_operative_interventional

Operative vs. Interventional Treatment for Ostial Renal Artery Occlusive Disease: Results of a Prospective Randomized Trial

Kai M. Balzer¹, Sebastian Rossbach¹, Tomas Pfeiffer¹, Adina Voiculescu², Bernd Grabensee², Ulrich Moedder³, Wilhelm Sandmann.^1
1Department of Vascular Surgery and Kidney Transplantation, University Hospital Duesseldorf, Duesseldorf, Germany;²Department of Nephrology, University Hospital Duesseldorf, Duesseldorf, Germany;³Department of Radiology, University Hospital Duesseldorf, Duesseldorf, Germany.

OBJECTIVES: Patients with either renovascular hypertension (RVH) and/or renal insufficiency (RI) due to renal artery ostial occlusive disease (RAOOD) can successfully undergo an open surgical reconstruction procedure (OSRP), but since the publication of Blum et al. (N Eng J Med 1997 336:459-65) percutaneous balloon stent angioplasty (PTRA + stent) leaving a small part of the stent within the aorta has become very popular. However, despite stenting PTRA does not remove the often calcified atheromatosed plaque and a comparison of both treatment modalities concerning complications and durability has never been performed.

METHODS: From 1998 to 2004 we performed OSRP in 330 patients with RVH and/or RI for various locations of RAOD. During this time period 50 patients (female 18, male 32, mean age 64, 4 years) with RAOOD of at least 70% stenosis (DSA and duplex criteria) in one or both renal arteries, who did not require other aorto/iliac reconstructive procedures agreed and were randomized to either OSRP or PTRA + stent. Patients were followed on a regular basis for 3 years and longer. End points were re-occurrence of RAOD, impairment of either kidney function or RVH.

RESULTS: We treated 77 arteries (PTRA + stent n=28, OSRP n=49). There was no early mortality in either group, but perioperative morbidity was 13% in the interventional and 4% in the surgical group. Three year follow-up mortality was 18% in the interventional and 25% in the surgical group. Both groups showed significant improvement of RVH (p>0,001 in both groups) as well as improvement or stabilization in patients with impaired renal function. Freedom from recurrent RAOD (>70%) over 3 years was achieved in 90% of the surgical and 73% of the interventional group (p=0,140).

CONCLUSIONS: Both treatment modalities showed good early results concerning RVH, kidney function and renal perfusion. Despite a higher percentage of bilateral renal artery reconstruction in patients undergoing OSRP mortality was not higher and operative morbidity was lower compared to PTRA + stent. These findings and also better durability of OSRP imply, that surgical reconstruction remains the gold standard for patients with RAOOD before PTRA + stent may be considered.

AUTHOR DISCLOSURES: K.M. Balzer, None; S. Rossbach, None; T. Pfeiffer, None; A. Voiculescu, None; B. Grabensee, None; U. Moedder, None; W. Sandmann, None.