Ballard J L
Division of Vascular Surgery, Loma Linda University Medical Center, 11175 Campus Street, Loma Linda, CA 92354, USA.
Ann Vasc Surg. 2001 Mar;15(2):260-6. doi: 10.1007/s100160010059. Epub 2001 Mar 1.
From June 1995 to February 2000, 16 patients with renovascular hypertension had bilateral transaortic renal artery endarterectomy (RA TEA) combined with either infrarenal aortic aneurysm repair (8 patients) or infrarenal aortodistal bypass for occlusive disease (8 patients). Aortic clamp level for RA TEA was supraceliac in eight patients and suprarenal in eight patients with a mean clamp time of 19 min (range 14 to 25 min). Perioperative complications occurred in four patients. These included respiratory insufficiency with prolonged intubation (1 patient), prolonged intubation with transient renal failure requiring temporary dialysis (1 patient), acute thrombosis of right limb of aortofemoral bypass graft (1 patient) and major left hemispheric cerebrovascular accident (1 patient). Results from this contemporary patient series demonstrate acceptable perioperative morbidity and mortality when RA TEA for treatment of renovascular hypertension is combined with infrarenal aortic reconstruction. In this setting, either supraceliac or suprarenal aortic clamping for short time periods appears to be well tolerated. Clinical outcome is enhanced by salvage of renal function, decrease in medication requirement, and improvement in blood pressure control.
1995年6月至2000年2月，16例肾血管性高血压患者接受了双侧经主动脉肾动脉内膜切除术（RA TEA），其中8例患者同时进行了肾下主动脉瘤修复术，8例患者因闭塞性疾病进行了肾下主动脉远端旁路移植术。8例患者进行RA TEA时主动脉阻断水平为腹腔动脉上，8例患者为肾上腺上，平均阻断时间为19分钟（范围14至25分钟）。4例患者出现围手术期并发症。这些并发症包括长时间插管导致的呼吸功能不全（1例）、长时间插管伴短暂肾功能衰竭需临时透析（1例）、主动脉股动脉旁路移植术右下肢急性血栓形成（1例）和左大脑半球重大脑血管意外（1例）。该当代患者系列的结果表明，当RA TEA用于治疗肾血管性高血压并与肾下主动脉重建联合进行时，围手术期发病率和死亡率是可接受的。在这种情况下，短时间的腹腔动脉上或肾上腺上主动脉阻断似乎耐受性良好。肾功能的挽救、药物需求的减少以及血压控制的改善提高了临床结局。
