RESUMO
The prospective investigation of 185 patients (118 men and 67 women in the age of 35-79 years (on the average 60+/-9 years) with atherosclerotic renovascular disease was carried out. The disease was detected by one- (62%) and two- (38%) hemodynamic value (>50%) of renal artery stenosis. Renal function, arterial pressure, cardiovascular death cases were estimated in 4 groups of patients during the period of 2,5-126 months (on the average 33 months). The patients of the first group (n=103) were undergone the renal revascularization (51 open and 80 endovascular). The patients of the second group (n=20) were after combined open renal revascularization (25) and after performed reconstruction of abdominal aorta and its branches and lower extremities arteries concerning aneurysmatic and occlusive lesions. The patients of the third group (n=19) had only reconstruction of lower extremities arteries concerning their ischemia without renal revascularization. The patients of the fourth group (n=43) haven't been operated because of the refusal of intervention. The lowest rate of survival was in the fourth group, who used the conservative therapy. Long-term survival didn't differ after open and endovascular therapy. The Koks regression analysis showed, that the improvement of long-term survival of the patients was associated with renal revascularization [Exp(B)=0,25, p<0,001] and didn't depend on the method of renal arteries reconstruction. A strategy of careful selection of patients with the application of interdisciplinary approach should be the base of clinical practice in renovascular disease.
Assuntos
Aterosclerose/complicações , Rim , Complicações Pós-Operatórias/epidemiologia , Obstrução da Artéria Renal , Artéria Renal/cirurgia , Procedimentos Cirúrgicos Vasculares , Idoso , Causas de Morte , Feminino , Hemodinâmica , Humanos , Rim/irrigação sanguínea , Rim/fisiopatologia , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Estudos Prospectivos , Artéria Renal/fisiopatologia , Obstrução da Artéria Renal/epidemiologia , Obstrução da Artéria Renal/etiologia , Obstrução da Artéria Renal/fisiopatologia , Obstrução da Artéria Renal/cirurgia , Federação Russa/epidemiologia , Índice de Gravidade de Doença , Taxa de Sobrevida , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/métodos , Procedimentos Cirúrgicos Vasculares/estatística & dados numéricosRESUMO
A comparative analysis was made of clinical indices and long-term survival in 20 patients (13 men and 7 women of mean age 62 +/- 2 years), having multifocal atherosclerosis of the renal arteries (RA), abdominal aorta and arteries of lower extremities (LE) (11 aneurysms, 7 occlusive lesions of the aorta and 3 of its unpaired branches) who underwent combined reconstructions, with patients having similar lesions, but not operated (12) or operated only on RA or on the arteries of LE (45). The groups of patients had no great differences except more pronounced renal dysfunction (RD) in the first of them. In spite of high postoperative lethality (20%) mainly due to acute renal failure (3), long-term survival proved to be significantly higher (14 from 16), than in not operated (3 from 12) (p = 0.00001) and had better tendency than in those operated on the same basin (35 from 45). In addition, the patients after combined operations had substantially decreased systolic and diastolic arterial pressure (159 +/- 13 vs. 132 +/- 9, p = 0.00001; 91 +/- 5 vs. 83 +/- 7, p = 0.010) and also stabilized renal function.
