Matalon T A, Thompson M J, Patel S K, Brunner M C, Merkel F K, Jensik S C
Department of Diagnostic Radiology and Nuclear Medicine, Rush-Presbyterian-St Luke's Medical Center, Chicago, IL 60612.
J Vasc Interv Radiol. 1992 Feb;3(1):55-8. doi: 10.1016/s1051-0443(92)72186-1.
A recent report has challenged the efficacy and safety of percutaneous transluminal angioplasty (PTA) for the treatment of transplant renal artery stenosis (TRAS). From January 1983 to December 1990, 24 PTA procedures were performed for TRAS in 18 patients. The stenoses were anastomotic in two cases, in the main renal artery in 14, and segmental in eight. After PTA, the residual stenosis was less than 20% in 14 (58%), 20%-50% in four (17%), and greater than 50% in six (25%). The mean diastolic blood pressure decreased from 106 mm Hg 1 day prior to PTA to 82 mm Hg 1 day after PTA. Long-term follow-up mean diastolic blood pressure (at 2-32 months) was 93 mm Hg (P less than .01). Eleven of the 18 patients (63%) had a 10% or greater reduction in diastolic blood pressure on long-term follow-up. Major complications occurred in two patients; one groin hematoma required surgical evacuation, and one polar infarct led to hypertension that was difficult to control. No surgical revisions of the transplant renal artery were necessary. The authors' data indicate that PTA should remain the treatment of choice for nonanastomotic TRAS.
最近的一份报告对经皮腔内血管成形术（PTA）治疗移植肾动脉狭窄（TRAS）的疗效和安全性提出了质疑。1983年1月至1990年12月，对18例患者进行了24次TRAS的PTA手术。狭窄部位在吻合口处2例，主肾动脉处14例，节段性8例。PTA术后，残余狭窄小于20%的有14例（58%），20% - 50%的有4例（17%），大于50%的有6例（25%）。平均舒张压从PTA前1天的106 mmHg降至PTA后1天的82 mmHg。长期随访（2 - 32个月）的平均舒张压为93 mmHg（P < 0.01）。18例患者中有11例（63%）在长期随访中舒张压降低了10%或更多。2例患者出现了严重并发症；1例腹股沟血肿需要手术清除，1例肾极梗死导致难以控制的高血压。无需对移植肾动脉进行手术修正。作者的数据表明，PTA应仍然是非吻合口TRAS的首选治疗方法。
