NEW YORK (Reuters Health) – Percutaneous intervention may not be necessary for the majority of hypertensive patients with atherosclerotic renovascular disease.

In a large retrospective study, researchers from Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina found that significant progression of renal artery stenosis occurs in only a small percentage of patients and does not always require intervention.

“Intervention for renal artery stenosis should be reserved for strict indications, namely declining renal function or hypertension that is resistant to traditional methods of control,” Dr. Ross P. Davis, a vascular surgery fellow in the Department of Vascular and Endovascular Surgery, told Reuters Health. “Those indications are supported by the available literature; more extensive applications of these interventions, in the absence of these strict indications, have less support from the literature available at this time,” Dr. Davis added.

Despite exponential growth in percutaneous transluminal renal angioplasty for atherosclerotic renovascular disease during the past 5 years, there is ongoing debate about appropriate management of the condition, the study team notes in the September issue of the Journal of Vascular Surgery. Part of this stems from an incomplete understanding of the natural history of renovascular disease in hypertensive adults.

To investigate, Dr. Davis and colleagues reviewed the medical records of 434 hypertensive men and women (mean age 64.6 years) who had two or more renal duplex sonography scans without intervention between October 1993 and July 2008.

Of the 863 kidneys examined, 178 (20.6%) had significant stenosis at baseline. During a mean follow up of 34.4 months, however, only 72 kidneys (8.3%) showed anatomic progression of the disease — 54 kidneys (6.3%) progressed to significant stenosis and 18 (2.1%) progressed to occlusion.

“Although anatomic progression of atherosclerotic renovascular disease was associated with an increased rate of decline in renal length, progression did not predict a decline in excretory renal function,” the researchers report.

“You can identify that the patient has stenosis, but not necessarily that it is causing, or is going to cause, a problem for that patient,” Dr. Davis said in a university statement. “The fact that you have stenosis doesn’t necessarily mean you have to have something done about it.”

“As physicians, we need to be careful about reserving those interventions for specific indications, not just for all patients whose ultrasound reports confirm the presence of artery narrowing,” Dr. Davis added. “There need to be other indicators of progressive renovascular disease present to consider subjecting patients to the risks and costs of these procedures.”

“These results and the results of other reports call into question the practice of renal artery intervention for anatomic renovascular disease in the absence of strict clinical indications,” the study investigators conclude.

Reference:
J Vasc Surg 2009;50:564-571.