移植肾动脉狭窄的介入治疗

Interventional therapy of renal artery stenosis in kidney transplants

目的 探讨移植肾动脉狭窄介入性治疗的方法和疗效。方法 7例肾移植术后肾动脉狭窄的病人 ,经股动脉或腋动脉入路行狭窄肾动脉的球囊扩张或支架置入术。结果 7例病人中 3例行单纯球囊扩张术 (2例经股动脉 ,1例经腋动脉 ) ,4例同时行球囊扩张和支架置入 (2例经股动脉 ,2例经腋动脉 )。治疗后 5例病人血压恢复正常 ,2例口服降压药恢复正常。随访 9～ 36个月 ,6例未见狭窄 ,仅 1例支架置入术后 9个月出现移植肾动脉再狭窄 ,给予球囊扩张 ,血流基本恢复。结论 球囊扩张和 (或 )内支架置入仍然是移植肾动脉狭窄的安全有效的方法之一 ,术后再狭窄的预防和处理需要进一步探讨。

Objective To evaluate efficacy of percutaneous transluminal angioplasty (PTA) and stenting for treatment of transplanted renal artery stenosis (TRAS). Method Seven patients with TRAS were included in this study. By femoral or axillary approach, balloon angioplasty and /or metallic stents placement at stenostic renal artery were performed. Results Of the seven patients, balloon angioplasty was carried out in 3 (2 cases via femoral artery, 1 via axillary artery), both balloon angioplasty and metallic stents placement were performed in 4 (2 via femoral artery, 2 via axillary artery). After the procedure, blood pressure recovered to normal in 5 cases, controlled with administration of antihypertensive in the other 2 cases. By 9 to 36 month′s follow up, restenosis of renal artery occurred in only 1 case at 9 months after stent implantation. The second balloon angioplasty were taken and better renal artery blood flow was obtained in this case. Other 6 cases showed no restenosis. Conclusion PTA and stents placement were effective and safe approach in treatment of TRAS. Further investigation was needed to prevent and manage restenosis after these procedures.