In this study comparing functional outcomes of renal angioplasty alone (PTRA) or angioplasty with stent placement in patients with renal artery stenosis (> or =60%) and renal insufficiency, 69 patients were treated with PTRA or stent placement. After censoring, the PTRA group included 15 patients with a mean age of 75 years, mean serum creatinine (Cr) of 2.9 +/- 1.4 mg/dL, and mean follow-up of 10 months. The stent placement group included 40 patients with a mean age of 71 years, mean Cr of 2.6 +/- 1.2 mg/dL, and mean follow-up of 12 months. Stenting was performed primarily in four cases and after suboptimal angioplasty in the remainder. Benefit was defined as either stabilization (+/-20%) or improvement in serum Cr levels. Technical success was achieved in 16 of 17 (94%) PTRA patients and 55 of 58 (95%) patients receiving stents. Complications included one surgically repaired axillary pseudoaneurysm, one distal stent positioning requiring a second stent, one stent protruding 5 mm into the aorta, two dissections requiring additional stents, one retroperitoneal hematoma, and one intrarenal atheroembolism treated with thrombolysis. Three patients (mean initial Cr 3.9 mg/dL) required hemodialysis within 30 days of stenting. One patient discontinued dialysis after stenting. There were two procedure-related deaths. An overall benefit was seen in 40% of patients after PTRA and 66% of patients after stent placement. For the stent placement and PTRA groups, cumulative clinical benefit was 77% and 80%, respectively, at 3 months; 69% and 64%, respectively, at 6 months; 61% and 41%, respectively, at 12 months; and 48% and 14%, respectively, at 24 months. A 50% loss of cumulative benefit was seen 34 months after stenting and 11.5 months after PTRA. In the stent and PTRA groups, benefit was noted in 77% and 57%, respectively, of patients with an initial Cr of 2.3 or less, 53% and 25%, respectively, of patients with an initial Cr level higher than 2.3, and 44% and 17%, respectively, of patients with an initial Cr level of 3.0 mg/dL or more. For patients with renal insufficiency, renal artery stenting provides superior clinical results compared with PTRA, mostly because late deterioration occurs after PTRA. Outcomes are related to pretreatment serum Cr level.

P:URPOSE: To evaluate the safety and efficacy of a hydrodynamic thrombectomy system in a prospective, multicenter randomized comparison with pulse-spray thrombolysis in hemodialysis grafts. MATERIALS AND METHODS: Nine centers enrolled 120 adult patients with recently (</=14 days) thrombosed hemodialysis grafts. Graft venography was used to confirm occlusion in 62 patients randomly assigned to thrombectomy and 58 to thrombolysis. For thrombolysis, a mixture of 5,000 U of heparin and 250,000 U of urokinase was distributed throughout the thrombus, first to the venous then to the arterial graft end. For thrombectomy, the catheter was passed in the same sequence. Technical success was removal of 80% or more of thrombus. Clinical success was technical success plus the ability to dialyze. Also assessed were total procedure time, thrombus treatment time, procedure-related blood loss, other complications, and 30- and 90-day outcomes. RESULTS: Patient demographics were comparable. Technical success rates were 95%(59 of 62) for thrombectomy and 90%(52 of 58) for thrombolysis (P:=.31). Clinical success rates were 89%(55 of 62) and 81%(47 of 58), respectively (P:=.24). At 30 days, 69%(43 of 62) and 66%(38 of 58), respectively, could be dialyzed through the graft (P:=.70); at 90 days, the rates were 40%(25 of 62) and 41%(24 of 58), respectively (P:=.91). None of these differences or those for procedure-related blood loss and early and late complications were statistically significant. Thrombus treatment times of 16.8 minutes for thrombectomy and 23.4 minutes for thrombolysis were significantly different (P:<.01). CONCLUSION: The hydrodynamic thrombectomy system is at least as efficacious and safe as pulse-spray thrombolysis but shortens thrombus treatment time.