| 钟红珊,徐克,张曦彤,苏洪英,冯博,梁松年.大动脉炎肾动脉狭窄/闭塞的介入治疗及临床观察[J].中国医学影像技术,2007,23(12):1870~1875 |
| 大动脉炎肾动脉狭窄/闭塞的介入治疗及临床观察 |
| Clinical evaluation of endovascular interventions for renal artery stenosis/occlusion due to Takayasu arteritis |
| 投稿时间：2007-08-24 修订日期：2007-10-17 |
| DOI： |
| 中文关键词: 大动脉炎 肾动脉狭窄/闭塞性病变 介入治疗 |
| 英文关键词:Takayasu’s arteritis Renal artery stenosis/occlusion (RAS/RAO) Endovascular interventions |
| 基金项目: |
| 作者 | 单位 | | 钟红珊 | 中国医科大学附属第一医院放射科,辽宁省肿瘤与血管疾病介入治疗中心,辽宁 沈阳 110001 | | 徐克 | 中国医科大学附属第一医院放射科,辽宁省肿瘤与血管疾病介入治疗中心,辽宁 沈阳 110001 | | 张曦彤 | 中国医科大学附属第一医院放射科,辽宁省肿瘤与血管疾病介入治疗中心,辽宁 沈阳 110001 | | 苏洪英 | 中国医科大学附属第一医院放射科,辽宁省肿瘤与血管疾病介入治疗中心,辽宁 沈阳 110001 | | 冯博 | 中国医科大学附属第一医院放射科,辽宁省肿瘤与血管疾病介入治疗中心,辽宁 沈阳 110001 | | 梁松年 | 中国医科大学附属第一医院放射科,辽宁省肿瘤与血管疾病介入治疗中心,辽宁 沈阳 110001 |
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| 中文摘要: |
| 目的 对大动脉炎所致肾动脉狭窄和(或)闭塞的介入治疗进行疗效观察与评价。 方法 26例大动脉炎所致肾动脉狭窄和(或)闭塞患者均于非活动期接受了经皮肾动脉开通术、经皮肾动脉腔内血管成形术(PTRA)和经皮肾动脉内支架置入术等综合性介入治疗。对所有患者受累肾动脉病变特点,术前血压和肾功能指标及抗高血压药物服用情况进行收集和统计。术后根据动脉造影图像判断肾动脉的血流改善情况。术后随访(32.3±4)个月,评价首次治疗开通率,并对术后中远期血压和肾功能指标进行独立样本t检验统计学评估。 结果 术前患者均诊断为肾动脉性高血压(服用抗高血压药物后,平均血压178/102 mmHg)。非透析状态下平均肾小球滤过率(GFR)81 ml/min。26例患者介入治疗的总技术成功率96.2%。其中5例RAO开通术的成功率为80%,开通后接受了PTRA及肾动脉内支架置入术。21例RAS患者接受了PTRA治疗,技术成功率为81%。其中PTRA效果不理想的病例接受了肾动脉内支架置入治疗,技术成功率100%。在术后随访过程中,1例于术后48个月失访。1例PTRA术后1.5个月在原病变部位形成假性动脉瘤,置入覆膜血管内支架后成功修复。1例患者死于术前即已存在的肾功能衰竭。1年和5年的首次治疗开通率分别为76%和64%。根据末次随访结果,患者血压水平下降至145/83 mmHg(P＜0.001),平均GFR上升为90 ml/min(P＜0.05)。 结论 根据大动脉炎肾动脉狭窄和(或)闭塞的病变特点合理应用多种血管介入技术可获得满意的临床疗效。 |
| 英文摘要: |
| Objective To evaluate the clinical effect of interventional treatment for renal artery stenosis (RAS) and/or renal artery occlusion (RAO) due to Takayasu’s arteritis (TA). Methods Twenty-six consecutive cases with RAS and/or RAO due to TA underwent endovascular interventions such as percutaneous recanalization of renal arteries, percutaneous transluminal renal angioplasty (PTRA) and implantation of endoluminal stent (ES). Improvement of blood flow in renal artery shown by angiography was evaluated by professional radiologists. Primary patency rate was determined. The late effect on blood pressure (BP) and renal function were analyzed. Results All patients had renovascular hypertension (mean BP, 178/102 mmHg; with antihypertensive medications). Mean estimated glomerular filtration rate (GFR) without hemodialysis was 81 ml/min. The overall technical success rate in 26 cases was 96.2%. Among the 5 cases with RAO, the success rate of recanalization was 80%. After that, PTRA and ES implantation were performed. Twenty-one cases with RAS underwent PTRA. The technical success rate was 81%. The effect of PTRA was not satisfactory in 4 cases (6 renal arteries) with RAS. ES implantation was performed. The technical success rate was 100%. During follow-up (mean, months), one patient was lost after 48 months. One renal artery in 1 case showed pseudo-aneurysm at 1.5 months after PTRA. It was excluded by stent-graft. One patient died of renal failure. At 1 and 5 years of follow-up, primary patency rates were 76% and 64%, respectively. Interventions resulted in a decrease in BP to a mean of 145/83 mmHg (P＜0.001). Mean estimated GFR increased to 90 ml/min (P＜0.05). Conclusion Optimal application of various vascular interventional techniques according to the pathological characteristics of RAS and/or RAO due to TA has a satisfactory clinical effect on BP, and enhances long-term renal function. |
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