Henrik Weibull

Long-term results after percutaneous transluminal angioplasty of atherosclerotic renal artery stenosis—the importance of intensive follow-up*

The aim of this study was to investigate the long-term results of percutaneous transluminal angioplasty of atherosclerotic renal artery stenosis (PTRA) in patients with renovascular hypertension with or without impending renal insufficiency who were followed up intensively with aggressive reintervention. Diagnostic work-up was based on angiography, pressure gradient and renal venous renin measurement. Patients were scheduled for regular follow-up after the PTRA and a deterioration in blood pressure or renal function was an indication for re-evaluation, and reintervention if necessary. Sixty-five patients had 71 renal artery stenoses where PTRA was attempted. It was technically successful in 59 stenoses and two occlusions and failed in ten (14%). At the end of follow-up (median 56 months [2-99]), the primary patency rate was 55%, 27 had restenosed and four were occluded, all but two within 12 months. Seventeen were treated by a further PTRA and eight by surgical reconstruction. At the end of follow-up the secondary patency after all interventions was 90%. One patient died 1 month after PTRA, and at the end of follow-up 21 patients (32%) had died, most of them (80%) from cardiovascular disease. Multivariate analyses showed a significantly reduced survival rate in patients with multiocular atherosclerosis, renal insufficiency, contralateral renal artery stenosis and ischaemic heart disease. At the end of follow-up 90% of the patients were cured or improved with regard to blood pressure. In patients with impending renal insufficiency renal function was improved in 50% and unchanged in 39%. With this strategy 55% of the patients needed only one treatment with PTRA, 25% needed a re-PTRA and 20% had to be operated on. PTRA can be recommended as initial treatment of atherosclerotic renal artery stenosis provided intensive follow-up and aggressive reintervention are performed when indicated.

Complications after Percutaneous Transluminal Angioplasty of Peripheral and Renal Arteries

This review deals with complications after percutaneous transluminal angioplasty (PTA). First some methodologic points are discussed. It seems important to standardize the way in which complications are reported. Our own complications in peripheral and renal PTA are summarized and taken as a basis for an analysis of various types of complications. Principally these may occur at different levels: at the puncture site, at the dilatation site as well as distant and general complications. To make comparisons with surgical series relevant it is suggested that all complications and mortality within 30 days are reported.

Complications after percutaneous transluminal angioplasty in the iliac, femoral, and popliteal arteries.

During a 5-year period percutaneous transluminal angioplasty (PTA) was attempted in 134 iliac, femoral, and popliteal arteries in 127 patients. Complications were systematically registered and classified as major, minor, and radiologic. Seventeen major complications (12.7%), including three deaths, occurred, as well as five minor (3.7%) and 13 radiologic complications (9.7%). The last group showed no clinical symptoms. The frequency of complications in our series is high compared with that found in a survey of 13 studies with 2043 patients. The most marked discrepancy was our high frequency of septic symptoms. A mortality rate of 2.2% was also higher in our series, but we have consequently registered the 30-day mortality rate to make comparisons with surgical series relevant. Radiologic alterations are usually not reported in other series probably because they are regarded as a part of the method, but we consider these alterations as potentially dangerous and important to report because they can result in clinically relevant complications. Because of the complications PTA should only be performed in centers in which complications can be optimally treated.

Analysis of complications after percutaneous transluminal angioplasty of renal artery stenoses

During a five-year-period percutaneous transluminal renal angioplasty (PTRA) was attempted in 90 renal arteries with 109 stenoses and 3 occlusions in 78 patients. Complications were systematically recorded and classified as major, minor and radiological-technical. Twenty-one major complications (20.8%) including one fatality occurred as well as 17 minor, (16.8%) and 37 radiological-technical (36.6%) problems. The last group showed no clinical symptoms. The frequency of complications in our series is high compared with that in a survey of ten papers reviewing results in 675 patients. The most marked discrepancy was our high frequency of septic problems. Radiological changes are not usually reported in other series, probably because they are regarded as methodological but we considered these as potentially dangerous and important to report as they can lead to clinically relevant complications. Because of the problems reported here PTRA should only be performed in centres where complications can be properly dealt with.

Symptoms and Signs of Thrombotic Occlusion of Atherosclerotic Renal Artery Stenosis

Twenty-four patients, with an occluded renal artery diagnosed at angiography or operation, in whom previous angiography had demonstrated an atherosclerotic renal artery stenosis, were compared with a group of patients with a renal artery stenosis that remained patent after a similar interval. The risk of occlusion was found to increase with age, the degree of stenosis and advanced generalised atherosclerosis. At the presumed time of occlusion few patients had symptoms which when present were vague and easily overlooked. The most suggestive sign of occlusion was a rise in serum creatinine which was seen in the majority of the patients.

Does Cerebral Angiography of Cadaveric Kidney Donors Interfere with Graft Function

Cerebral angiography is used to diagnose brain death of cadaver kidney donors. Clinical and animal data suggest that angiographic contrast media may potentiate the noxious effect of renal ischemia. In order to find out if cerebral angiography of cadaveric kidney donors prior to nephrectomy interferes with function or survival of the renal grafts, two groups of cadaveric donors were compared. One group had been exposed to contrast medium from cerebral angiography in median 18 hours before nephrectomy and the other had not. There was no difference in graft survival and function between the two groups. In a previous investigation angiography was performed two hours before explantation and in that investigation there was a shorter graft survival in the angiography group than in a control group. A delay of 12 hours is suggested between cerebral angiography and explantation, to decrease the combined harmful effects of contrast media and ischemia on renal grafts.

Islet cell antibody reactivity with human fetal pancreatic islets

To evaluate the possibility of autoimmune processes against pancreatic islets in fetal life, we tested islet cell antibody (ICA) reactivity with 14 fetal pancreata obtained after abortion at the 15th up to the 19th week of gestation. Pancreatic islets positive for a monoclonal proinsulin antibody but non-reactive with ICA negative control serum were found in 9/14 pancreata and all (9/9) of them showed a positive reaction with the ICA standard. It is concluded that ICA reactivity may be detected in fetal human pancreata. Further studies on fetal islet cell antibody reactivity in the development of insulin dependent diabetes mellitus (IDDM) are warranted.