Clinical outcome and health care costs in renal revascularization-percutaneous transluminal renal angioplasty versus reconstructive surgery

Renovascular hypertension (increased pressure of the renal artery, supplying the kidney) may be accompanied by uremia (a toxic condition associated with kidney insufficiency). Intractable hypertension may be treated by reconstructive surgery on the kidney vessels, or more recently by percutaneous transluminal renal angioplasty. This less invasive procedure involves introduction of a balloon-tipped catheter into the blocked blood vessel; the balloon is inflated until the inside diameter of the vein is no longer too small. It has been suggested that this procedure is less expensive than the reconstructive procedure, but has a higher rate of complications. An analysis was made of clinical outcome and health care costs of 21 patients who underwent angioplasty and 16 who underwent reconstructive surgery. All patients had renovascular hypertension with or without uremia which was not responding to medication. Either partial or complete success was achieved in 19 of the 21 angioplasty patients. All surgical procedures were successful. Restenosis (repeat narrowing) occurred in six of the angioplasty patients but none of the surgical patients. Average follow-up was 49 months. At this time 69 percent of those in the angioplasty group experienced primary patency (completely open vessels), while it was 100 percent in the operated group. Ninety percent of the angioplasty patients showed improvement in their hypertension, and 81 percent of the operated group. The total average cost of surgery was 12 percent higher than for angioplasty (including the additional cost of treatment for the restenoses). (Consumer Summary produced by Reliance Medical Information, Inc.)