Ghilardi G, Longhi F, Bortolani E, Vandone P
Istituto di Chirurgia Generale, Università di Milano.
Panminerva Med. 1992 Oct-Dec;34(4):181-4.
Thirty-four cases of combined abdominal aortic aneurysm (AAA) and renal artery stenosis (RAS) are reported. Hypertension was found at admission in 32 subjects, the other two being well responsive to drug therapy. Angiography and selective renal vein renin assay were always performed: renal artery stenosis was unilateral in 21 (61.7%) subjects and bilateral in 13 (38.3%). In 9 cases renal artery stenosis was not correlated to the hypertensive state. Mild chronic renal insufficiency was demonstrated preoperatively in 20 patients (58.8%). Simultaneous surgical treatment was carried out in 25 cases (73.5%). Mortality was 4% (one subject), severe renal insufficiency 8% (two subjects) and permanent renal failure 4% (one subject) All complications occurred among the group with bilateral RAS. While surgical repair of AAA is always mandatory, simultaneous surgical treatment of AAA and RAS should be carried out in carefully selected cases, due to elevated mortality rates reported in the literature, in order to cure renovascular hypertension, when it is demonstrated as related to RAS, or to preserve renal functionality, when RAS is contralateral to a functionally excluded or hypotrophic kidney or it exceeds 80% of the diameter of the artery.
本文报告了34例腹主动脉瘤（AAA）合并肾动脉狭窄（RAS）的病例。32例患者入院时发现有高血压，另外2例对药物治疗反应良好。所有患者均进行了血管造影和选择性肾静脉肾素测定：21例（61.7%）患者肾动脉狭窄为单侧，13例（38.3%）为双侧。9例患者的肾动脉狭窄与高血压状态无关。20例患者（58.8%）术前证实有轻度慢性肾功能不全。25例（73.5%）患者进行了同期手术治疗。死亡率为4%（1例），严重肾功能不全为8%（2例），永久性肾衰竭为4%（1例）。所有并发症均发生在双侧RAS组。虽然AAA的手术修复总是必要的，但由于文献报道的死亡率较高，AAA和RAS的同期手术治疗应在精心挑选的病例中进行，以便在证实肾血管性高血压与RAS相关时治愈该疾病，或者当RAS与功能上被排除或萎缩的肾脏对侧，或超过动脉直径的80%时，保留肾功能。
