[Transluminal angioplasty in renovascular hypertension with renal insufficiency].

From 1985 to 1986, 71 patients with renovascular hypertension were treated by percutaneous transluminal angioplasty (PTA). Among them, 13 (mean age 67 +/- 7 years) had a hypertension refractory to drug therapy (blood pressure: 194 +/- 33/103 +/- 15 mmHg) associated with an impaired renal function (creatinine clearance: 33 +/- 20 ml/mn). Ten had a stenosis in a solitary functioning kidney and a contralateral renal artery thrombosis. Three had bilateral renovascular stenosis. All patients had severe diffuse atherosclerotic disease, i.e. coronary heart disease (n = 7), carotid artery stenosis (n = 6), abdominal aortic aneurysm (n = 3) or arteritis (n = 5). Among these 13 patients, PTA could not be performed in one patient (failure to catheterize the stenosis) and two immediate renal artery dissections were observed: the first was accompanied by a thrombosis of the renal artery which could be successfully treated in emergency by surgical revascularization. The second occurred in a segmental renal branch and did not require surgery since it did not induced further impairment of renal function. Among the 10 remaining patients, nine PAT were classified as immediate angiographic success. One incomplete result required a second PTA 6 months later. Three important inguinal hematomas were observed and blood transfusion was required in 2. Seven patients have been reevaluated after a follow-up of 3 to 22 months. Restenosis occurred in two patients, 6 and 20 months respectively after PTA. A successful surgical revascularization was performed in these 2 patients.(ABSTRACT TRUNCATED AT 250 WORDS)