de Donato G, Setacci C, Chisci E, Setacci F, Palasciano G
Unit of Vascular and Endovascular Surgery, Department of Surgery, University of Siena, Siena, Italy.
J Cardiovasc Surg (Torino). 2007 Aug;48(4):403-9.
The aim of this study was to evaluate the technical success and clinical outcome of surgical revascularization, angioplasty and/or stenting for renal artery stenosis (RAS) in patients with renovascular hypertension (RVH). The secondary aim was to identify independent negative predictors of blood pressure control after successful renal revascularization.
From January 1998 to July 2006, we treated 97 cases of RAS in 83 RVH patients. Inclusion criteria were RAS > or =80% associated with hypertension refractory to medical control with at least three drugs including a diuretic. Therapeutic options were surgical revascularization in 15 cases (11 renal endarterectomies, 4 aortorenal bypasses) and endoluminal treatment in 82 (14 balloon angioplasties, 68 stents).
Technical success was 100% for both surgical and endovascular procedures; 13 cases of restenosis (> or =80%) were detected: 12 (14.6%) in the endoluminal group and one (6.6%) in the surgical group (P=0.68). During the follow-up period (average 37 months, range 6-94), blood pressure control improved in 43% of patients, disease stabilized in 37% and the natural course of RVH deteriorated in 20%. Multivariate Cox regression analysis showed that only a long history of antihypertensive drug use was a predictor of inefficacy of blood pressure control after revascularization (P<0.04).
The complete resolution of RVH associated with severe RAS appears unrealistic in several cases. Early and long-term results in terms of technical success and restenosis were acceptable and similar for surgical and endovascular renal intervention. An early diagnosis of RVH could improve the control of hypertension after successful renal revascularization.
本研究旨在评估肾血管性高血压（RVH）患者行肾动脉狭窄（RAS）手术血运重建、血管成形术和/或支架置入术的技术成功率和临床结局。次要目的是确定成功进行肾血运重建术后血压控制的独立负性预测因素。
1998年1月至2006年7月，我们治疗了83例RVH患者中的97例RAS病例。纳入标准为RAS≥80%，且与至少使用包括利尿剂在内的三种药物仍难以控制的高血压相关。治疗选择为15例（11例肾动脉内膜切除术，4例主动脉-肾动脉搭桥术）手术血运重建和82例腔内治疗（14例球囊血管成形术，68例支架置入术）。
手术和血管内手术的技术成功率均为100%；检测到13例再狭窄（≥80%）：腔内治疗组12例（14.6%），手术组1例（6.6%）（P=0.68）。在随访期（平均37个月，范围6 - 94个月）内，43%的患者血压控制得到改善，37%的患者病情稳定，20%的患者RVH自然病程恶化。多因素Cox回归分析显示，只有长期使用抗高血压药物是血运重建术后血压控制无效的预测因素（P<0.04）。
在一些病例中，与严重RAS相关的RVH完全缓解似乎不现实。手术和血管内肾介入在技术成功率和再狭窄方面的早期和长期结果是可以接受的，且相似。RVH的早期诊断可改善成功进行肾血运重建术后的高血压控制。
