Percutaneous Transluminal Angioplasty of the Renal Artery

The renin-angiotensin systems

The renin-angiotensin systems are important regulators of cardiovascular homeostasis and participate in a variety of pathological conditions. Recent advances have not only clarified the functioning of the systemic renin cascade but have also indicated the importance of the generation of angiotensin in tissues.

Renovascular hypertension in childhood: a changing perspective in management

Seventeen children with renovascular hypertension caused by intrinsic renal artery lesions received treatment during the past 10 years. At presentation nine were asymptomatic, four had headaches, and one had epistaxis; three infants had anorexia and failure to thrive. Routine intravenous pyelogram and radionuclide renal scan findings were abnormal in 29% and 31% of patients, respectively. Arteriography showed a branch artery stenosis in seven patients and a main artery lesion in 10. A renal vein renin ratio of greater than or equal to 1.5 between the affected and the contralateral kidney was obtained in 10 of 17 patients. Of 16 patients available for follow-up, 15 are normotensive after a mean follow-up of 3.7 years. Cure was achieved by partial nephrectomy and ligation of a stenosed vessel in two and nephrectomy in five (three having undergone an unsuccessful angioplasty procedure). Autotransplantation or angioplasty was curative in a further six. Transluminal balloon angioplasty was attempted in seven patients but was successful in only two with main renal artery stenoses. With preservation of renal parenchyma as the main goal, medical and surgical therapy can be individualized for each patient.

Three patients with arteritis

Three boys were treated for arteritis of the aorta and great vessels and bilateral renal artery stenosis. One presented at age 6 months with failure to thrive, excessive sweating, and vomiting: hypertension and cardiac failure were subsequently diagnosed. The two older boys (7 and 14 years) presented with symptomless hypertension. The clinical and angiographic findings in the three patients suggest that the illness may have been Takayasu's arteritis, which should be included in the differential diagnosis of hypertension in infancy and childhood. Renal autotransplantation was performed in all three patients with good results. Early renal autotransplantation may reduce the morbidity associated with this disease.

Percutaneous transluminal angioplasty. The radiologist's contribution to the treatment of vascular disease

Percutaneous transluminal angioplasty is a nonsurgical treatment for vascular disease. It is relatively safe and economical and may be an alternative, or an adjunct, to surgery, or may be helpful where no surgical alternative exists. Percutaneous transluminal angioplasty is applicable to nearly every system, except the carotid bifurcation plaque.