Percutaneous transluminal angioplasty and surgery of the renal artery.

The management of patients with renal artery disease has changed in recent years. This has occurred due to the advent of PTA as an effective method of treatment for certain patients, an enhanced appreciation of advanced atherosclerotic renal artery disease as a correctable cause of renal failure, and improved results of surgical revascularisation in both older patients with severe aortic atherosclerosis and younger patients with branch renal artery disease. PTA currently yields excellent results and is the treatment of choice for patients with fibrous dysplasia of the main renal artery and non-ostial atherosclerotic lesions. Most reports in the literature indicate that surgical revascularisation provides more effective therapy for patients with ostial atherosclerotic lesions. Surgical revascularisation also remains the treatment of choice for the majority of patients with branch renal artery disease, a renal artery aneurysm, renal artery occlusion, and recurrent renal artery stenosis after failed PTA or surgery. Excellent clinical results can be achieved with both PTA and surgical revascularisation in properly selected patients.