Background: Significant renal artery, stenosis (RAS) in a solitary
functioning kidney (SFK) represents one of the most acceptable
indications for renal revascularization. Percutaneous transluminal renal
artery stenting (PTRAS) is increasingly being used as a first line
treatment for renal revascularization, associated with renal function
improvement or stabilization in the majority of the patients with
solitary kidneys, but also with deterioration in tip to 38% of the
cases. Atheroembolism during PTRAS has been postulated as a potential
cause for this acute renal function worsening. The aim of this study was
to report on the feasibility, safety, and early outcomes of PTRAS in a
series of patients with SFK using distal embolic protection (DEP).
Methods: All PTRAS procedures in SFKs performed under DEP between June
2002 and September 2007 were reviewed. Renal function, blood pressure,
and the number of anti-hypertensive medications were assessed pre- and
post-intervention. Renal function improvement and deterioration were
defined as a 20% increase and decrease in serum creatinine,
respectively compared with preoperative values. Primary and primary
assisted patency rates were also calculated. Statistical differences
between values before and after intervention were determined by the
Student t test and statistical significance was taken at P < .05.
Results: Protected PTRAS was performed in 14 patients with a SFK (9 men,
6 women, mean age 65.6 +/- 6.8 years). All patients were hypertensive
and had varying degrees of azotemia. Mean pre-intervention stenosis
degree was 86.8% +/- 7.8%. Immediate technical success was obtained in
100% of the patients. Renal function was cured (7.1%), improved
(50%), or stabilized (42.9%) in all 14 (100%) patients after the
procedure and no deterioration was noticed ill any patient at 6-month
follow-up. Pre- and postintervention serum creatinine levels were 3.01
+/- 1.15 mg/dL and 2.16 +/- 0.68 mg/dL, respectively, (P = .02).
Hypertension was improved in 6 (42.9%) patients and stabilized in the
remaining 8 (57.1%). Primary patency was 100% and 90% at 1 and 3
years, respectively, while primary assisted patency remained 100% for
the whole follow-up period (mean, 31.8 +/- 19.4 months).
Conclusion: These findings suggest that in patients with a SFK,
protected PTRAS represents a safe and effective treatment for halting
the progression of renal dysfunction to renal loss and warrants further
investigation. (J Vasc Surg 2008;48: 1414-22.
