Messina L M, Zelenock G B, Yao K A, Stanley J C
Department of Surgery, University of Michigan Medical Center, Ann Arbor.
J Vasc Surg. 1992 Jan;15(1):73-80; discussion 80-2. doi: 10.1067/mva.1992.33257.
Recurrent pulmonary edema in patients with poorly controlled hypertension and renal insufficiency appears to be a marker of bilateral renal artery occlusive disease. The effectiveness of renal revascularization to prevent recurrent pulmonary edema in this distinct subgroup with renal artery occlusive disease was analyzed in 17 consecutive patients treated at the University of Michigan Hospital between 1984 and 1990. Their mean preoperative blood pressure was 207/110 mm Hg, and mean serum creatinine clearance was 3.8 mg/dl. Pulmonary edema occurred despite evidence of normal ventricular function in 65% of these patients. Bilateral renal artery occlusive disease affected 94% of the patients, and 54% had an occluded renal artery. Renal revascularization was accomplished by iliorenal bypass (41%), aortorenal bypass (29%), endarterectomy (24%), and transluminal angioplasty (6%). Contralateral nephrectomy (41%) and concomitant aortic reconstruction (24%) were also required frequently. No postoperative deaths occurred, and no patient had early postoperative pulmonary edema. Control of hypertension was improved in all patients, two of whom were discharged from the hospital on no antihypertensive medications. Two of the three patients requiring dialysis before operation were able to discontinue dialysis after operation. Late follow-up (mean, 2.4 years) revealed hypertension to be cured in one patient (6%), and improved in 16 patients (94%). Pulmonary edema occurred in one patient during late follow-up. Late follow-up showed renal function (mean creatinine, 1.7 mg/dl) to be improved in 77%, stable in 12%, and worse in two patients; one required dialysis. A single episode of pulmonary edema in a patient with poorly controlled hypertension and renal insufficiency should prompt consideration of this clinical syndrome and early diagnostic angiography.(ABSTRACT TRUNCATED AT 250 WORDS)
血压控制不佳且伴有肾功能不全的患者反复出现肺水肿，似乎是双侧肾动脉闭塞性疾病的一个标志。1984年至1990年间，在密歇根大学医院接受治疗的17例连续性患者中，分析了肾血管重建术对预防这一患有肾动脉闭塞性疾病的独特亚组患者反复出现肺水肿的有效性。他们术前平均血压为207/110 mmHg，平均血清肌酐清除率为3.8 mg/dl。尽管这些患者中有65%的人心室功能正常，但仍出现了肺水肿。94%的患者患有双侧肾动脉闭塞性疾病，54%的患者有一条肾动脉闭塞。肾血管重建术通过髂肾旁路术（41%）、主动脉肾旁路术（29%）、动脉内膜切除术（24%）和经皮腔内血管成形术（6%）完成。对侧肾切除术（41%）和同期主动脉重建术（24%）也经常需要进行。术后无死亡病例，也没有患者术后早期出现肺水肿。所有患者的高血压得到改善，其中两名患者出院时无需服用抗高血压药物。术前需要透析的三名患者中有两名术后能够停止透析。晚期随访（平均2.4年）显示，一名患者（6%）高血压治愈，16名患者（94%）病情改善。一名患者在晚期随访期间出现肺水肿。晚期随访显示，77%的患者肾功能（平均肌酐1.7 mg/dl）得到改善，12%的患者稳定，两名患者病情恶化；一名患者需要透析。血压控制不佳且伴有肾功能不全的患者出现单次肺水肿，应促使考虑这一临床综合征并尽早进行诊断性血管造影。（摘要截选至250词）
