Abstract
Background
Renal artery fibromuscular dysplasia (RAFMD) is a non-atherosclerotic cause of renal artery stenosis often affecting the young. Percutaneous transluminal renal angioplasty (PTRA) is the treatment of choice but there are few studies of the outcome of the procedure.
Methods
This retrospective analysis included 64 patients (56.2 % female; mean age at diagnosis, 28.0 years) with RAFMD who underwent PTRA between November 2003 and August 2015. Technical and clinical success rates and restenosis rates were evaluated.
Results
Seventy-six procedures were performed on 64 RAFMD patients. Technical success was 96.9 %, as defined by <30 % residual stenosis, with stent placement required in 11 patients (17.2 %). In the short term (1 month), the majority (79.7 %) had an immediate clinical benefit, with cure of hypertension in 35.9 %, and improvement in hypertension and a lower requirement for antihypertensive medications in 43.8 %. In the long term (mean, 47.5 months; range, 5–141 months), the survival rate was 96.9 %, freedom from restenosis was 84.4 %, and 76.6 % of patients showed a sustained clinical benefit (cure rate 40.6 %, improvement rate 35.9 %). Eight patients were treated with a second procedure and two had a third procedure, with half of these patients showing an improvement in hypertension.
Conclusion
PTRA for symptomatic RAFMD is safe and clinically successful. More than half of patients experience an immediate clinical benefit with sustained long-term effects. For patients with restenosis, there was a good response to a second PTRA.
Similar content being viewed by others
References
Persu A, Giavarini A, Touze E, Januszewicz A, Sapoval M, Azizi M et al (2014) European consensus on the diagnosis and management of fibromuscular dysplasia. J Hypertens 32:1367–1378
Olin JW, Gornik HL, Bacharach JM, Biller J, Fine LJ, Gray BH et al (2014) Fibromuscular dysplasia: state of the science and critical unanswered questions: a scientific statement from the American Heart Association. Circulation 129:1048–1078
Varennes L, Tahon F, Kastler A, Grand S, Thony F, Baguet JP et al (2015) Fibromuscular dysplasia: what the radiologist should know: a pictorial review. Insights Imaging 6:295–307
Chrysant SG, Chrysant GS (2014) Treatment of hypertension in patients with renal artery stenosis due to fibromuscular dysplasia of the renal arteries. Cardiovasc Diagn Ther. 4:36–43
Kiando SR, Barlassina C, Cusi D, Galan P, Lathrop M, Plouin PF et al (2015) Exome sequencing in seven families and gene-based association studies indicate genetic heterogeneity and suggest possible candidates for fibromuscular dysplasia. J Hypertens. 33:1802–1810 (discussion 10)
Savard S, Azarine A, Jeunemaitre X, Azizi M, Plouin PF, Steichen O (2013) Association of smoking with phenotype at diagnosis and vascular interventions in patients with renal artery fibromuscular dysplasia. Hypertension 61:1227–1232
Slovut DP, Olin JW (2004) Fibromuscular dysplasia. N Engl J Med. 350:1862–1871
Safian RD, Textor SC (2001) Renal-artery stenosis. The New England journal of medicine. 344:431–442
Olin JW, Sealove BA (2011) Diagnosis, management, and future developments of fibromuscular dysplasia. J Vasc Surg 53(826–36):e1
Davies MG, Saad WE, Peden EK, Mohiuddin IT, Naoum JJ, Lumsden AB (2008) The long-term outcomes of percutaneous therapy for renal artery fibromuscular dysplasia. J Vasc Surg 48:865–871
Olin JW, Froehlich J, Gu X, Bacharach JM, Eagle K, Gray BH et al (2012) The United States Registry for Fibromuscular Dysplasia: results in the first 447 patients. Circulation 125:3182–3190
Mounier-Vehier C, Haulon S, Devos P, Lions C, Jaboureck O, Gaxotte V et al (2002) Renal atrophy outcome after revascularization in fibromuscular dysplasia disease. J Endovasc Ther. 9:605–613
Kincaid OW, Davis GD, Hallermann FJ, Hunt JC (1968) Fibromuscular dysplasia of the renal arteries. Arteriographic features, classification, and observations on natural history of the disease. Am J Roentgenol Radium Ther Nucl Med. 104:271–282
Kim HJ, Do YS, Shin SW, Park KB, Cho SK, Choe YH et al (2008) Percutaneous transluminal angioplasty of renal artery fibromuscular dysplasia: mid-term results. Korean J Radiol. 9:38–44
Rundback JH, Sacks D, Kent KC, Cooper C, Jones D, Murphy T et al (2002) Guidelines for the reporting of renal artery revascularization in clinical trials. Am Heart Assoc Circ. 106:1572–1585
Schroten NF, Damman K, Valente MA, Smilde TD, van Veldhuisen DJ, Navis G et al (2016) Long-term changes in renal function and perfusion in heart failure patients with reduced ejection fraction. Clin Res Cardiol. 105:10–16
K/DOQI clinical practice guidelines for chronic kidney disease (2002) Evaluation, classification, and stratification. Am J Kidney Dis. 39:S1–S266
Osadnik T, Wasilewski J, Lekston A, Strzelczyk J, Kurek A, Gutowski AR et al (2014) Comparison of modification of diet in renal disease and chronic kidney disease epidemiology collaboration formulas in predicting long-term outcomes in patients undergoing stent implantation due to stable coronary artery disease. Clin Res Cardiol. 103:569–576
Bell RM, Rear R, Cunningham J, Dawnay A, Yellon DM (2014) Effect of remote ischaemic conditioning on contrast-induced nephropathy in patients undergoing elective coronary angiography (ERICCIN): rationale and study design of a randomised single-centre, double-blind placebo-controlled trial. Clin Res Cardiol 103:203–209
Kim ES, Olin JW, Froehlich JB, Gu X, Bacharach JM, Gray BH et al (2013) Clinical manifestations of fibromuscular dysplasia vary by patient sex: a report of the United States registry for fibromuscular dysplasia. J Am Coll Cardiol 62:2026–2028
Liu Y, Gao J, Shou J, Xia H, Shen Y, Zhu S et al (2016) The prevalence of cigarette smoking among rural-to-urban migrants in china: a systematic review and meta-analysis. Subst Use Misuse 51:206–215
de Fraissinette B, Garcier JM, Dieu V, Mofid R, Ravel A, Boire JY et al (2003) Percutaneous transluminal angioplasty of dysplastic stenoses of the renal artery: results on 70 adults. Cardiovasc Intervent Radiol 26:46–51
Knipp BS, Dimick JB, Eliason JL, Cowan JA, Henke PK, Proctor MS et al (2004) Diffusion of new technology for the treatment of renovascular hypertension in the United States: surgical revascularization versus catheter-based therapy, 1988–2001. J Vasc Surg 40:717–723
Trinquart L, Mounier-Vehier C, Sapoval M, Gagnon N, Plouin PF (2010) Efficacy of revascularization for renal artery stenosis caused by fibromuscular dysplasia: a systematic review and meta-analysis. Hypertension 56:525–532
Tegtmeyer CJ, Selby JB, Hartwell GD, Ayers C, Tegtmeyer V (1991) Results and complications of angioplasty in fibromuscular disease. Circulation 83:I155–I161
Davidson RA, Barri Y, Wilcox CS (1996) Predictors of cure of hypertension in fibromuscular renovascular disease. Am J Kidney Dis. 28:334–338
Mousa AY, Campbell JE, Stone PA, Broce M, Bates MC, AbuRahma AF (2012) Short- and long-term outcomes of percutaneous transluminal angioplasty/stenting of renal fibromuscular dysplasia over a ten-year period. J Vasc Surg 55:421–427
Smit JV, Wierema TK, Kroon AA, de Leeuw PW (2013) Blood pressure and renal function before and after percutaneous transluminal renal angioplasty in fibromuscular dysplasia: a cohort study. J Hypertens 31:1183–1188
Pagliaro B, Tocci G, Pagannone E, Musumeci MB, Testa M, Sensini I et al (2014) An atypical clinical presentation of renovascular hypertension. Int J Cardiol 177:e107–e110
Savard S, Steichen O, Azarine A, Azizi M, Jeunemaitre X, Plouin PF (2012) Association between 2 angiographic subtypes of renal artery fibromuscular dysplasia and clinical characteristics. Circulation 126:3062–3069
Giavarini A, Savard S, Sapoval M, Plouin PF, Steichen O (2014) Clinical management of renal artery fibromuscular dysplasia: temporal trends and outcomes. J Hypertens. 32:2433–2438
Wang LC, Scott DJ, Clemens MS, Hislop SJ, Arthurs ZM (2015) Mechanism of stent failure in a patient with fibromuscular dysplasia following renal artery stenting. Ann Vasc Surg 29(123):e19–e21
Acknowledgments
This work was supported by grants from the PUMC Graduate Innovation Fund (2015-1002-01-14) and the National Science Foundation of China (No. 81541010).
Author information
Authors and Affiliations
Corresponding authors
Ethics declarations
Conflict of interest
The authors have no conflicts of interest to disclose.
Rights and permissions
About this article
Cite this article
Yang, Y.K., Zhang, Y., Meng, X. et al. Clinical characteristics and treatment of renal artery fibromuscular dysplasia with percutaneous transluminal angioplasty: a long-term follow-up study. Clin Res Cardiol 105, 930–937 (2016). https://doi.org/10.1007/s00392-016-1001-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00392-016-1001-1