ABSTRACT
Observational data suggest roughly 10-16% of patients will progress to total arterial occlusion when followed beyond 1-2 years, with increasing probability observed in those arteries with higher-grade obstructions.11,50,51 In patients with RVD and renal failure, survival without intervention is poor. Mailloux et al reported a median survival of 27 months and 10% survival at 5 years in this population.52 Other investigators have observed a mortality rate of nearly 40% in patients with bilateral RAS followed for a median of 52 months who did not have renal revascularization.53,54 To date, no randomized studies designed to evaluate the impact of renal revascularization on ‘hard’ endpoints such as mortality andor cardiovascular events have been reported. Most existing studies examine clinical surrogates that impact long-term morbidity and mortality, principally hypertension and renal function. Study design, patient selection, and high crossover rates have limited the usefulness of the available clinical data. Recently, consensus guidelines have been published which may assist in the design and implementation of future clinical trials investigating renal revascularization.2 This section will focus on the current state of knowledge on the three major trial endpoints: control of hypertension, preservationimprovement in renal function, and reduction of cardiovascular events.
