Efficacy of Revascularization For Renal Artery Stenosis Caused by Fibromuscular Dysplasia: A Systematic Review and Meta-Analysis

In patients with fibromuscular dysplasia and renal artery stenosis, renal artery revascularization has been used to cure hypertension or to improve blood pressure control. To provide an up-to-date assessment of the benefits and risks associated with revascularization in this condition, we performed...

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Published in:Hypertension (Dallas, Tex. 1979) Tex. 1979), 2010-09, Vol.56 (3), p.525-532
Main Authors: Trinquart, Ludovic, Mounier-Vehier, Claire, Sapoval, Marc, Gagnon, Nathalie, Plouin, Pierre-François
Format: Article
Language:English
Subjects:
Angioplasty, Balloon
Arterial hypertension. Arterial hypotension
Biological and medical sciences
Blood and lymphatic vessels
Cardiology. Vascular system
Fibromuscular Dysplasia - complications
Fibromuscular Dysplasia - surgery
Fundamental and applied biological sciences. Psychology
Humans
Hypertension, Renovascular - etiology
Hypertension, Renovascular - surgery
Medical sciences
Renal Artery Obstruction - etiology
Renal Artery Obstruction - surgery
Treatment Outcome
Vertebrates: urinary system
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container_title Hypertension (Dallas, Tex. 1979)
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creator Trinquart, Ludovic
Mounier-Vehier, Claire
Sapoval, Marc
Gagnon, Nathalie
Plouin, Pierre-François
description In patients with fibromuscular dysplasia and renal artery stenosis, renal artery revascularization has been used to cure hypertension or to improve blood pressure control. To provide an up-to-date assessment of the benefits and risks associated with revascularization in this condition, we performed a systematic review of studies in which hypertensive patients with fibromuscular dysplasia renal artery stenosis underwent percutaneous transluminal renal angioplasty or surgical reconstruction. We assessed how often periprocedural complications and hypertension cure and improvement occurred. We selected 47 angioplasty studies (1616 patients) and 23 surgery studies (1014 patients). Combined rates of hypertension cure, defined according to the criteria in each study, after angioplasty or surgery were estimated to be 46% (95% CI40% to 52%) and 58% (95% CI53% to 62%), respectively, with substantial variations across studies. The probability of being cured was negatively associated with patient age and time of publication. Cure rates using current definitions of hypertension cure (blood pressure
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Cure rates using current definitions of hypertension cure (blood pressure &lt;140/90 mm Hg without treatment) were only 36% and 54% after angioplasty and surgery, respectively. The combined risks of periprocedural complications were 12% and 17% after angioplasty and surgery, respectively, with less major complications after angioplasty than surgery (6% versus 15%). In conclusion, angioplasty or surgical revascularization yielded moderate benefits in patients with fibromuscular dysplasia renal artery stenosis, with substantial variation across studies. 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Psychology</topic><topic>Humans</topic><topic>Hypertension, Renovascular - etiology</topic><topic>Hypertension, Renovascular - surgery</topic><topic>Medical sciences</topic><topic>Renal Artery Obstruction - etiology</topic><topic>Renal Artery Obstruction - surgery</topic><topic>Treatment Outcome</topic><topic>Vertebrates: urinary system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Trinquart, Ludovic</creatorcontrib><creatorcontrib>Mounier-Vehier, Claire</creatorcontrib><creatorcontrib>Sapoval, Marc</creatorcontrib><creatorcontrib>Gagnon, Nathalie</creatorcontrib><creatorcontrib>Plouin, Pierre-François</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Hypertension (Dallas, Tex. 1979)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Trinquart, Ludovic</au><au>Mounier-Vehier, Claire</au><au>Sapoval, Marc</au><au>Gagnon, Nathalie</au><au>Plouin, Pierre-François</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Efficacy of Revascularization For Renal Artery Stenosis Caused by Fibromuscular Dysplasia: A Systematic Review and Meta-Analysis</atitle><jtitle>Hypertension (Dallas, Tex. 1979)</jtitle><addtitle>Hypertension</addtitle><date>2010-09</date><risdate>2010</risdate><volume>56</volume><issue>3</issue><spage>525</spage><epage>532</epage><pages>525-532</pages><issn>0194-911X</issn><eissn>1524-4563</eissn><coden>HPRTDN</coden><abstract>In patients with fibromuscular dysplasia and renal artery stenosis, renal artery revascularization has been used to cure hypertension or to improve blood pressure control. 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subjects Angioplasty, Balloon
Arterial hypertension. Arterial hypotension
Biological and medical sciences
Blood and lymphatic vessels
Cardiology. Vascular system
Fibromuscular Dysplasia - complications
Fibromuscular Dysplasia - surgery
Fundamental and applied biological sciences. Psychology
Humans
Hypertension, Renovascular - etiology
Hypertension, Renovascular - surgery
Medical sciences
Renal Artery Obstruction - etiology
Renal Artery Obstruction - surgery
Treatment Outcome
Vertebrates: urinary system
title Efficacy of Revascularization For Renal Artery Stenosis Caused by Fibromuscular Dysplasia: A Systematic Review and Meta-Analysis
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