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首页> 外文期刊>Journal of vascular surgery >Percutaneous transluminal revascularization for renal artery stenosis: Veterans Affairs Puget Sound Health Care System experience.
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Percutaneous transluminal revascularization for renal artery stenosis: Veterans Affairs Puget Sound Health Care System experience.

机译：经皮腔内血运重建术治疗肾动脉狭窄：退伍军人事务普吉特海湾卫生保健系统的经验。

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PURPOSE: The safety and efficacy of percutaneous transluminal intervention for renal artery stenosis is improving. This study evaluates the immediate and long-term anatomic and functional outcomes of percutaneous transluminal angioplasty and stenting for atherosclerotic renal artery stenosis in a Veterans Affairs population. METHODS: We performed a retrospective analysis of records from patients who underwent renal artery angioplasty with or without stenting at the Veterans Affairs Puget Sound Health Care System between January 1990 and June 1999. Indications for intervention included hypertension (78%) and rising serum creatinine (78%). Seventy-six patients (74 men, average age of 67 years, range 42-83 years) underwent 88 attempted interventions. Seventy-two percent of contralateral kidneys had significant disease (47% had a >60% stenosis; 16% were nonfunctioning or absent). RESULTS: Of the 88 planned interventions, 86 were successfully performed with placement of 46 stents (52%). Technical success (defined by <30% residual stenosis) was achieved in 78 vessels (89%). The procedure-related complication rate was 5%. Patient mortality by life table analysis was 49% at 5 years. Assisted primary patency rate at 5 years was 100%. Primary and secondary restenosis rates were 37% +/- 8% and 31% +/- 8% at 5 years, respectively. Sixty-eight percent of patients treated for hypertension demonstrated clinical benefit (improved or cured hypertension). This clinical benefit was maintained in 52% of the patients at 5 years, as measured by life table analysis. Serum creatinine was lowered or maintained in 88% of the patients, but this clinical benefit was only maintained in 25% of patients at 5 years. CONCLUSIONS: Transluminal intervention for clinically symptomatic atherosclerotic renal artery stenosis is technically successful and safe. There are excellent assisted-patency and low restenosis rates. There is immediate clinical benefit for most patients, as evidenced by improved control of hypertension and preservation of renal function. However, within 5 years the benefit is not maintained for either hypertension (50%) or renal function (20%). Therefore, although technically successful, functional outcomes after endoluminal intervention are not maintained in the long term.
机译：目的：经皮腔内介入治疗肾动脉狭窄的安全性和有效性正在提高。这项研究评估了退伍军人事务人群中经皮腔内血管成形术和支架置入术对动脉粥样硬化性肾动脉狭窄的近期和长期的解剖学和功能结局。方法：我们对1990年1月至1999年6月在Veterans Affairs Puget Sound卫生保健系统接受或不采用支架的肾动脉血管成形术患者的记录进行了回顾性分析。干预措施包括高血压（78％）和血清肌酐升高（ 78％）。 76名患者（74名男性，平均年龄67岁，范围42-83岁）接受了88次尝试性干预。 72％的对侧肾脏患有严重疾病（47％的狭窄> 60％; 16％的无功能或缺失）。结果：在计划的88项干预措施中，有86项成功地放置了46个支架（52％）。在78艘血管（占89％）中取得了技术成功（定义为残余狭窄<30％）。手术相关并发症发生率为5％。通过生命表分析的患者死亡率在5年时为49％。 5年辅助一次通畅率为100％。 5年时原发性和继发性再狭窄率分别为37％+/- 8％和31％+/- 8％。接受高血压治疗的患者中有68％表现出临床获益（改善或治愈的高血压）。根据生命表分析，该临床获益在5年时保持在52％的患者中。血清肌酐降低或维持在88％的患者中，但是这种临床获益仅在5年时维持在25％的患者中。结论：经腔内介入治疗临床上有症状的动脉粥样硬化性肾动脉狭窄在技术上是成功且安全的。辅助通畅性极佳，再狭窄率低。对大多数患者有直接的临床益处，这可以通过改善对高血压的控制和保留肾功能来证明。但是，在5年内，高血压（50％）或肾功能（20％）的益处均无法维持。因此，尽管在技术上取得了成功，但腔内干预后的功能结局无法长期维持。

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