Percutaneous transluminal dilatation: the treatment of choice for renal artery stenosis causing hypertension

Stents for atherosclerotic renovascular disease

There is extensive documentation of excellent clinical results with renal stents in patients who have technically failed angioplasty and who would have been expected to otherwise have a high incidence of clinical failure. In addition, the technical success of renal stents is vastly superior to that of conventional angioplasty in atherosclerotic renovascular disease, and stents have been a major factor in making the endovascular treatment of ASRVD both practical and reliable in experienced hands. Restenosis rates appear roughly equivalent or lower for stents versus PTA as far as can be determined without good comparative studies. Restenosis appears to be decreasing to 15%-20% in more recent series, perhaps because of the accumulation of knowledge regarding patient selection and techniques. It is, therefore, clear that the use of stents to treat technical failures of angioplasty will result in overall improved patency in the treated population; however, it remains to be determined whether stents should be routinely placed with the intention of inhibiting restenosis, in the presence of technically successful angioplasty with minimal residual stenosis or pressure gradient. Such a determination may require comparative study that is more complicated than a simple randomized comparison of angioplasty versus stents.

Peripheral vascular disease. Treatment with balloon angioplasty

Peripheral vascular disease imposes daily inconveniences and limitations on many patients. The primary care physician and vascular specialist can work together to alleviate the restrictions of this disorder by prompt recognition, investigation, and therapy. It is no longer necessary to wait until patients are extremely debilitated before offering intervention. Initial success rates of percutaneous transluminal (balloon) angioplasty are very high and increasing, and restenosis rates are acceptable and decreasing. The procedure is economical and has a short convalescent period and low patient risk. Physicians should be aware that underuse of medical technology may be as costly as overuse. In upcoming years, further advances will allow even more patients with peripheral vascular disease to be treated with lesser expense; lower risk; and greater salvage of lives, limbs, and life-styles.