During the ten year period from 1981 to 1991, percutaneous transluminal renal angioplasty
(PTRA) was performed in 180 renal arteries in 137 patients, where the underlying renovascular
disease was fibromuscular dysplasia (FMD) in 30 patients (22%) and arteriosclerotic
vascular disease (AVD) in 107 (78%). A preinterventional work-up and a re-evaluation
of the patients after one year was designed for the assessment of the clinical, functional
and technical outcome. Successful technical dilatation was achieved in 97% of procedures
with FMD patients and in 82% of procedures with AVD patients. A beneficial effect
on the blood pressure and the renal function was registered in both groups. The overall
cure and improvement rate for hypertension was 86% in the FMD group and 64% in the
AVD group after one year's follow-up. A significant gain in the total renal function
was registered in both groups, the average increase in glomerular filtration rate
being 13% (P < 0.001) for the FMD group and 11% (P < 0.001) for the AVD group one
year after PTRA. Renal function was improved or unchanged in 89% of FMD patients and
74% of AVD patients. The improvement in renal function was made by the revascularized
kidney. Renal vein renin investigation predicted the clinical outcome with an excellent
diagnostic accuracy as no renin negative patient became normotensive, and renin positive
patients, who did not turn normotensive, were in almost 90% of the cases affected
by technical failure or restenosis/contralateral stenosis. Thus, the sensitivity of
renal vein renin investigation was 95% and the specificity 75%. The outcome for patients
with hypertension and renal insufficiency was considerably poorer than for the whole
group of patients, with only a 20% success rate for hypertension, but 50% in this
group had increased or unchanged GFR after intervention. The angiographic one-year
follow-up revealed a recurrence rate of 6.7% for FMD and 15.1% for AVD. For the entire
series of patients, the incidence of major complications was 5.4%, including one indirect
fatality, while the incidence of minor complications was 5%. In conclusion, PTRA will
cure or improve blood pressure in most patients with renovascular hypertension, and
it preserves and even improves renal function in these patients. Complications and
recurrence are in fact not very common and PTRA appears be the best first approach
in all but ostial lesions for treatment of renovascular hypertension.