Radiologic diagnosis of renovascular hypertension and percutaneous transluminal renal angioplasty.

Percutaneous transluminal renal angioplasty (PTRA) is a low risk, cost-effective procedure with a high degree of technical and therapeutic success in most categories of renovascular hypertension (RVH) when performed at experienced centers. The role of radiology in screening and diagnosis is discussed with special attention to renal vein sampling for renin assay (RVR) and digital subtraction angiography (DSA). The results of PTRA are compared with surgery. At New York Hospital, PTRA is the procedure of first choice in fibromuscular dysplasia, unilateral nonostial atheroma, arteritis, renal transplantation, and pediatrics. In patients with bilateral and ostial atherosclerotic disease and/or azotemia, the choice between surgery or PTRA depends on the surgical risk category of the patient.