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Outcome and Cost Comparison of Percutaneous Transluminal Renal Angioplasty, Renal Arterial Stent Placement, and Renal Arterial Bypass Grafting¹

¹ From the Department of Radiology, Dartmouth-Hitchcock Medical Center, One Medical Center Dr, Lebanon, NH 03756. From the 1998 RSNA scientific assembly. Received June 8, 1998; revision requested July 27; revision received December 11; accepted March 4, 1999. Supported in part by the Hitchcock Foundation. Address reprint requests to M.A.B. (e-mail: MAB@Hitchcock.org).

PURPOSE: To compare the outcomes and costs of percutaneous transluminal renal angioplasty (PTRA), percutaneous transluminal stent placement (PTSP) of renal arteries, and renal arterial bypass grafting (RABG) in treatment of renovascular hypertension.

MATERIALS AND METHODS: Medical records and angiograms of 130 patients who underwent PTRA, PTSP, or RABG were retrospectively studied to determine success and complication rates, angiographic stenoses, blood pressures, antihypertensive medications, and serum creatinine levels. Actual costs were analyzed in detail.

RESULTS: Technical success rates for PTRA, PTSP, and RABG were 91%, 98%, and 92%, respectively. Complication rates were 13%, 16%, and 38%, respectively. The mean arterial pressure was initially lowered by 29.2 mm Hg, 30.3 mm Hg, and 27.3 mm Hg, respectively, and maintained at 21.0 mm Hg, 19.8 mm Hg, and 20.2 mm Hg below baseline at 12 months. The number of antihypertensive medications was initially reduced on average by 0.63, 0.72, and 0.58, respectively, but returned to baseline in all patients by 12 months. The serum creatinine level did not change substantially with any treatment. Initial treatment costs were $1,402, $2,573, and $15,393, respectively.

CONCLUSION: PTRA, PTSP, and RABG were equally efficacious for control of renovascular hypertension. The initial treatment cost for bypass grafting was substantially higher than that for PTRA and PTSP of renal arteries.

Index terms: Arteries, transluminal angioplasty, 961.1282 • Cost-effectiveness • Grafts, 961.452 • Hypertension, renovascular, 81.72 • Renal arteries, stenosis or obstruction, 961.721, 961.722 • Stents and prostheses, 961.1268, 961.1269

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