Endovascular and open revascularization for nonatherosclerotic renal artery disease.

OBJECTIVE To evaluate the long-term outcome of endovascular and open treatment for nonatherosclerotic renal artery disease (NARAD). DESIGN Retrospective review. SETTING Academic institution. PATIENTS Fifty-five patients (47 women; mean age, 40 years) with NARAD. Underlying disease included Takayasu arteritis in 31 and fibromuscular dysplasia in 24. INTERVENTIONS Open revascularization and renal artery percutaneous transluminal angioplasty with or without stenting. MAIN OUTCOME MEASURES Primary, primary assisted, and secondary patency rates; blood pressure; antihypertensive medication requirements; renal function; and mortality. RESULTS Seventy-nine renal interventions were performed, including 59 aortorenal bypass (16 ex vivo), 3 visceral-renal bypass, 12 endovascular (8 percutaneous transluminal angioplasty and 4 stent placements) procedures, and 5 nephrectomies. There were no in-hospital deaths. During a mean follow-up of 75 months, 1-, 3-, and 5-year primary patency rates for any intervention were 87%, 75%, and 75%, respectively; primary assisted/secondary patency rates were 92%, 86%, and 86%, respectively. Endovascular interventions at 1, 3, and 5 years had primary patency rates of 73%, 49%, and 49%, respectively, and primary assisted/secondary patency rates of 83%, 83%, and 83%, respectively. For open revascularization, 1-, 3-, and 5-year primary patency rates were 91%, 80%, and 80%, respectively; primary assisted/secondary patency rates were 94%, 87%, and 87%, respectively. For both interventions, blood pressure and the number of antihypertensives used were reduced compared with preintervention values (all P < .05). Serum creatinine level and estimated glomerular filtration rate were also improved after revascularization (both P < .05). There were 6 deaths. Five- and 10-year actuarial survival rates were 94% and 78%, respectively. CONCLUSIONS Endovascular and open management of NARAD confers long-term benefit for blood pressure, renal function, renal artery/graft patency, and survival. Open revascularization results in superior 1- and 5-year outcomes compared with endovascular management and provides the most durable outcome for NARAD.