Ham Sung Wan, Kumar S Ram, Wang Bonnie R, Rowe Vincent L, Weaver Fred A
Division of Vascular Surgery and Endovascular Therapy, Keck School of Medicine, University of Southern California, 1520 S San Pablo Street, Los Angeles, CA 90033, USA.
Arch Surg. 2010 Sep;145(9):832-9. doi: 10.1001/archsurg.2010.183.
To evaluate the long-term outcome of endovascular and open treatment for nonatherosclerotic renal artery disease (NARAD).
Retrospective review.
Academic institution.
Fifty-five patients (47 women; mean age, 40 years) with NARAD. Underlying disease included Takayasu arteritis in 31 and fibromuscular dysplasia in 24.
Open revascularization and renal artery percutaneous transluminal angioplasty with or without stenting.
Primary, primary assisted, and secondary patency rates; blood pressure; antihypertensive medication requirements; renal function; and mortality.
Seventy-nine renal interventions were performed, including 59 aortorenal bypass (16 ex vivo), 3 visceral-renal bypass, 12 endovascular (8 percutaneous transluminal angioplasty and 4 stent placements) procedures, and 5 nephrectomies. There were no in-hospital deaths. During a mean follow-up of 75 months, 1-, 3-, and 5-year primary patency rates for any intervention were 87%, 75%, and 75%, respectively; primary assisted/secondary patency rates were 92%, 86%, and 86%, respectively. Endovascular interventions at 1, 3, and 5 years had primary patency rates of 73%, 49%, and 49%, respectively, and primary assisted/secondary patency rates of 83%, 83%, and 83%, respectively. For open revascularization, 1-, 3-, and 5-year primary patency rates were 91%, 80%, and 80%, respectively; primary assisted/secondary patency rates were 94%, 87%, and 87%, respectively. For both interventions, blood pressure and the number of antihypertensives used were reduced compared with preintervention values (all P < .05). Serum creatinine level and estimated glomerular filtration rate were also improved after revascularization (both P < .05). There were 6 deaths. Five- and 10-year actuarial survival rates were 94% and 78%, respectively.
Endovascular and open management of NARAD confers long-term benefit for blood pressure, renal function, renal artery/graft patency, and survival. Open revascularization results in superior 1- and 5-year outcomes compared with endovascular management and provides the most durable outcome for NARAD.
评估非动脉粥样硬化性肾动脉疾病（NARAD）血管内治疗和开放手术治疗的长期疗效。
回顾性研究。
学术机构。
55例NARAD患者（47例女性；平均年龄40岁）。基础疾病包括31例高安动脉炎和24例纤维肌发育不良。
开放血管重建术以及肾动脉经皮腔内血管成形术（有或无支架置入）。
初次通畅率、初次辅助通畅率和二次通畅率；血压；抗高血压药物需求；肾功能；以及死亡率。
共进行了79例肾脏干预手术，包括59例主动脉-肾动脉搭桥术（16例体外搭桥）、3例内脏-肾动脉搭桥术、12例血管内手术（8例经皮腔内血管成形术和4例支架置入术）以及5例肾切除术。无院内死亡病例。在平均75个月的随访期内，任何干预措施的1年、3年和5年初次通畅率分别为87%、75%和75%；初次辅助/二次通畅率分别为92%、86%和86%。血管内干预手术的1年、3年和5年初次通畅率分别为73%、49%和49%，初次辅助/二次通畅率分别为83%、83%和83%。对于开放血管重建术，1年、3年和5年初次通畅率分别为91%、80%和80%；初次辅助/二次通畅率分别为94%、87%和87%。与干预前相比，两种干预措施后的血压和使用的抗高血压药物数量均有所降低（所有P < 0.05）。血管重建术后血清肌酐水平和估计肾小球滤过率也有所改善（均P < 0.05）。有6例死亡病例。5年和10年精算生存率分别为94%和78%。
NARAD的血管内治疗和开放手术治疗在血压、肾功能、肾动脉/移植物通畅率和生存率方面具有长期益处。与血管内治疗相比，开放血管重建术在1年和5年的疗效方面更优，为NARAD提供了最持久的治疗效果。
