¹Department of Vascular Diseases and Endovascular Reconstructions, University of Lund, University Hospital, Malmö, Sweden

Correspondence: Dr A Alhadad, Department of Vascular Diseases, University of Lund, Malmö University Hospital, S-205 02 Malmö, Sweden. E-mail: alaa.alhadad@skane.se

Received 15 February 2005; Revised 15 April 2005; Accepted 15 April 2005; Published online 26 May 2005.

Abstract

Fibromuscular dysplasia (FMD) mainly affects renal arteries. Percutaneous transluminal renal angioplasty (PTRA) and surgery are effective treatments, but long-time follow-up is lacking. Retrospective follow-up for 7.04.7 years of 69 consecutive patients (age 4413 years) treated for hypertension due to FMD, 59 patients underwent PTRA and eight patients surgery. In two patients no PTRA was performed. Technical success was achieved in 56 (95%) patients undergoing PTRA and all eight undergoing surgery. After successful PTRA, both systolic and diastolic blood pressures (SBP and DBP) had decreased at discharge (from 17433/10013 to 13819/8015 mmHg; P<0.0001), and remained lower at 1 month, 1 year, and last follow-up after 7.04.7 years (14025/8312 mmHg; P<0.0001). Serum-creatinine had decreased both at 1 year (from 8428 to 7513 mol/l; P=0.0030) and last follow-up (7516 mol/l; P=0.0017). The number of antihypertensive drugs decreased (from 2.31.2 before PTRA to 1.41.3 at discharge and at 1 month; P<0.0001, and 1.61.5 at last follow-up; P=0.0011). SBP decreased more after PTRA among patients with FMD only in the main renal artery than in those with branch artery involvement (4329 vs 2041 mmHg; P=0.0198). Beneficial effects on BP, creatinine and antihypertensive drugs also occurred after surgery. Patients on antihypertensive drugs at last follow-up had longer hypertension duration before PTRA than those without (5.97.7 vs 1.84.1 years; P=0.0349). Cure was achieved in 16 (24%), improvement in another 26(39%), and benefit in 42(63%). In conclusion, renal artery FMD, PTRA and surgery have beneficial long-term effects, negatively affected by hypertension duration and branch artery involvement.