The efficacy of endovascular interventional in severe stenosis of bilateral renal stenosis / 中华急诊医学杂志

ABSTRACT

Objective To analyze the clinical effect of intravascular intervention for treating the severe stenosis of bilateral renal arteries (BRASS).Methods A total of 40 patients with BRASS admitted in Fuwai Hospital from September 2008 to December 2010 were retrospectively analyzed.These patients,23 males and 17 females,aged from 21 to 76 years with average age of (59.75 ± 17.59) years,with luminal narrowing over 70％ in bilateral renal arteries,met the criteria of BRASS evidenced by angiography of renal arteries,and were subjected to renal artery interventional therapy. The etiological factors included arteriosclerosis (34 cases),Takayasu arteritis (3 cases) and congenital fibromuscular dysplasia (3 cases).After percutaneous endovascular intervention,the therapeutic effects were evaluated by lowering the systemic blood pressure and serum creatinine level in 12-month follow-up in average after operation. The data were analyzed with SPSS 13.0 statistical software.ResultsAmong the 80 reual arteries in 40 patients,18 arteries were treated with percutaneous transluminal balloon angioplasty (PTBA),while the other 62 arteries were treated with percutaneous transluminal renal artery stenting (PTRAS).Mter endovascular intervention,the mean systolic blood pressure decreased from ( 165.0 ± 27.0) mm Hg to ( 135.7 ± 25.3 ) mm Hg on the second day after operation ( P ＜ 0.01 ) ; and the mean diastolic blood pressure decreased from ( 88.9 ±15.1 ) mm Hg to (74.8 ± 13.2) mm Hg on the second day after operation ( P ＜ 0.01 ).Accordingly,the kinds of anti-hypertension drug used decreased from ( 3.1 ± 0.9 ) to ( 2.3 ± 1.2) ( P ＜ 0.01 ).Only one patient died suddenly 3 months after intervention,and one died of acute myocardial infarction 7 months after operation.The other 38 patients were followed up for 12 months.At last,the mean systolic blood pressure of patients decreased from ( 165.0 ±27.0) mm Hg to ( 133.53 ± 15.94) mm Hg and the mean diastolic blood pressure decreased from (88.9 ± 15.1 ) mm Hg to (77.37 ± 13.47 )mm Hg. Of all 38 patients,2 were cured (5.3％),27 were improved (71.1％) and 9 failed to treatment (23.7％).Of all 38 patients,76.4％ got hypertension lowered.Moreover,renal function (Scr) was improved in 2 patients (6.3％ ),steady in 21 patients ( 65.6％ ),declined in 9 patients ( 28.1％ ) resulted in azotemia stage.Of 38 patients,71.9％ patients got overall benefit from endovascular intervention in respect of renal function improved.Conclusions The procedure of PTBA or PTRAS offered a minimally invasive,relatively safe and effective technique for BRASS patients to decrease blood pressure and stabilize renal function.