肾动脉狭窄性高血压的介入治疗临床分析

Clinical analysis on interventional treatment of renovascular hypertension

目的探讨肾动脉狭窄(RAS)性高血压介入治疗的临床意义。方法回顾性分析30例RAS性高血压患者的DSA造影及临床资料。动脉粥样硬化(AS)16例、纤维肌性发育不良(FMD)8例、多发性大动脉炎(MA)5例、肾移植术后(PRT)1例。结果共35支狭窄动脉25支行经皮腔内肾血管成形术(PTRA),9支行支架植入(PTRAS)治疗,1支由于肾动脉几乎闭塞,微导丝未能通过狭窄部位而治疗失败。本组技术成功率97.1%;AS性、FMD性、MA性RAS治疗有效率分别为75.0%、87.5%、40.0%,再狭窄率分别为13.1%、25.0%、40.0%;随访7个月～3年,5例治愈;17例改善;8例无效,总有效率为73.3%(22/30);均未发生严重并发症。结论不同病因导致的RAS性高血压行介入治疗疗效明显:以FMD疗效最佳,AS疗效次之,MA疗效较差。

Objective To discuss the clinical significance of interventional treatment for renal artery stenosis（RAS）.Methods Reviewed 30 patients’DSA tomography and clinical materials who with RAS.There were 16,5,8 and 1 cases of arterial sclerosis（AS）,fibromuscular dysplasia（FMD）,multiple arteriitis（MA）,and post-renal transplantation（PRT） respectively.Results A total of 35 RAS were identified.Percutaneous transluminal renal angioplasty（PTRA） and percutaneous transluminal renal artery stenting（PTRAS） performed in 25 and 9 cases respectively,1 case failure was in a patient who had RAS.The efficiency ratio were 75.0%,87.5%,40.0% and restenosis ratio were 13.1%,25.0%,40.0% of AS,FDM,MA respectively.The technique achievement ratio was 97.1%.Success,improvement,and unchanged were 5,17,and 8 patients respectively.No severe complications occurred from 7 months to 3 years following-up.Conclusion PTRA or PTRAS has obviously therapeutic effect of renovascular hypertension.The FMD’s result was best,AS and MA were followed.