Predictors of complications and extended length of stay following percutaneous transluminal renal artery angioplasty

Patients with renal artery stenosis (RAS) who fail medical management may be evaluated for Percutaneous transluminal renal artery angioplasty/stenting (PTRA/S). Comorbidities increasing the risk of complications following PTRA have not been explored well. Patients undergoing PTRA/S for RAS were sampled using National Inpatient Sample (NIS) Database. Demographics, length of stay (LOS), and comorbidities were gathered using ICD-10 codes. Complications included heart failure, myocardial infarction, cardiac arrest, major bleeding, stent thrombosis, renal artery dissection/embolism, aortic dissection/rupture and atheroembolism. Extended length of stay (ELOS) was defined as LOS >4 days. Univariate and multivariate logistic regression analyses were used to identify predictors for complications and ELOS. A sum of 517 patients underwent PTRA. Most prevalent comorbidities were peripheral vascular disease, coronary artery disease and dyslipidemia. On multivariate analysis, comorbidities significant for predicting major complications were end-stage renal disease, chronic liver disease, heart failure and coagulable disorders whereas comorbidities significant for predicting ELOS were age, chronic obstructive pulmonary disease, chronic kidney disease, anemia, chronic heart failure, and coagulable disorders. As we continue to identify the ideal candidates for PTRA, it is important to consider the comorbidities that predispose these patients to increased periprocedural complications and ELOS.