Clinical evaluation of endovascular interventions for renal artery stenosis/occlusion due to Takayasu arteritis

Objective To evaluate the clinical effect of interventional treatment for renal artery stenosis (RAS) and/or renal artery occlusion (RAO) due to Takayasu’s arteritis (TA). Methods Twenty-six consecutive cases with RAS and/or RAO due to TA underwent endovascular interventions such as percutaneous recanalization of renal arteries, percutaneous transluminal renal angioplasty (PTRA) and implantation of endoluminal stent (ES). Improvement of blood flow in renal artery shown by angiography was evaluated by professional radiologists. Primary patency rate was determined. The late effect on blood pressure (BP) and renal function were analyzed. Results All patients had renovascular hypertension (mean BP, 178/102 mmHg; with antihypertensive medications). Mean estimated glomerular filtration rate (GFR) without hemodialysis was 81 ml/min. The overall technical success rate in 26 cases was 96.2%. Among the 5 cases with RAO, the success rate of recanalization was 80%. After that, PTRA and ES implantation were performed. Twenty-one cases with RAS underwent PTRA. The technical success rate was 81%. The effect of PTRA was not satisfactory in 4 cases (6 renal arteries) with RAS. ES implantation was performed. The technical success rate was 100%. During follow-up (mean, 32.3±4 months), one patient was lost after 48 months. One renal artery in 1 case showed pseudo-aneurysm at 1.5 months after PTRA. It was excluded by stent-graft. One patient died of renal failure. At 1 and 5 years of follow-up, primary patency rates were 76% and 64%, respectively. Interventions resulted in a decrease in BP to a mean of 145/83 mmHg (P0.001). Mean estimated GFR increased to 90 ml/min (P0.05). Conclusion Optimal application of various vascular interventional techniques according to the pathological characteristics of RAS and/or RAO due to TA has a satisfactory clinical effect on BP, and enhances long-term renal function.