Ginzburg Viktor, Volak Talia, Grinberg Georgy, Maiizler Olga, Leitsin Anatolyi, Sandro Gabriel
Vascular Surgery Department, Soroka Medical Centre, Ben-Gurion University, Beer Sheva, Israel.
Angiol Sosud Khir. 2013;19(2):123-7, 119-23.
transcutaneous angioplasty with stenting of renal arteries has for a long time been considered the generally accepted technique of treatment for atherosclerotic stenosis of renal arteries. Publications concerning the results of recent studies (ASIRAL, DRATIC, STAR) call into doubt the value of this method. However, these studies have been criticized for their methodological shortcomings. In our work we attempted to reveal the interrelationship between the clinical and radiological parameters of patients presenting with atherosclerotic narrowing of renal arteries and the results of transcutaneous angioplasty with stenting.
We carried out a retrospective study based on analyzing the case histories of all patients having endured transcutaneous angioplasty with stenting of renal arteries at the Vascular Surgery Department of the "Soroka" Medical Centre (Beer Sheva, Israel) over the period from 2000 to 2007. The criteria for inclusion of patients into the study group were as follows: 1) diagnosis of atherosclerotic stenosis of renal arteries based on the Doppler ultrasound scan; 2) treatment using transcutaneous angioplasty with stenting of renal arteries; 3) dispensary follow up during 18 months after the procedure. The patients with atherosclerotic stenosis of renal arteries or those unavailable for follow up were excluded from the study. All available clinical radiological data were grouped into tables and subjected to statistical analysis (SPSS, Student's t-test, the ANOVA, and chi-squared test). The findings regarding arterial pressure and the level of blood creatinine were registered at terms equalling 1, 6, 12, and 18 months after the procedure.
A total of forty one patients were included into the final statistical analysis; the patients' average age amounted to 67.6±8.7 years and 70.7% were male patients. We observed a considerable decrease in the average indices of arterial pressure one month after the procedure (systolic pressure dropped from 160±24.7 to 141.8±23.6 mm Hg and diastolic pressure fell from 83±12.9 to 58.8±11.8 mm Hg; p< 0.001). The decrease in arterial pressure maintained during the whole follow-up period. After 18 months the mean indices of systolic pressure amounted to 135.0±35.1 mm Hg, with those of diastolic pressure equalling 71.3±16.5 mm Hg, p>0.001). The renal function (blood serum creatinine level) remained stable during the whole period of low up.
The obtained findings demonstrated that successful transcutaneous angioplasty with stenting of atherosclerotic stenosis of renal arteries helps control arterial hypertension. No direct positive effect of this procedure on the renal function was revealed. In our opinion, the main problem in selecting the patients this intervention is indicated for consists in not knowing the criteria correlating with successful outcomes, therefore further studies should be aimed at revealing these criteria.
长期以来，经皮肾动脉血管成形术加支架置入术一直被视为治疗肾动脉粥样硬化狭窄的公认技术。有关近期研究（ASIRAL、DRATIC、STAR）结果的出版物对该方法的价值提出了质疑。然而，这些研究因其方法学缺陷而受到批评。在我们的研究中，我们试图揭示肾动脉粥样硬化狭窄患者的临床和放射学参数与经皮肾动脉血管成形术加支架置入术结果之间的相互关系。
我们进行了一项回顾性研究，分析了2000年至2007年期间在以色列贝尔谢巴“索罗卡”医疗中心血管外科接受经皮肾动脉血管成形术加支架置入术的所有患者的病历。纳入研究组的患者标准如下：1）基于多普勒超声扫描诊断为肾动脉粥样硬化狭窄；2）采用经皮肾动脉血管成形术加支架置入术治疗；3）术后18个月进行门诊随访。肾动脉粥样硬化狭窄患者或无法进行随访的患者被排除在研究之外。所有可用的临床放射学数据被整理成表格并进行统计分析（SPSS、学生t检验、方差分析和卡方检验）。术后1、6、12和18个月记录动脉血压和血肌酐水平的结果。
共有41例患者纳入最终统计分析；患者平均年龄为67.6±8.7岁，男性患者占70.7%。我们观察到术后1个月动脉压平均指数显著下降（收缩压从160±24.7降至141.8±23.6 mmHg，舒张压从83±12.9降至58.8±11.8 mmHg；p<0.001）。在整个随访期间，动脉压持续下降。18个月后，收缩压平均指数为135.0±35.1 mmHg，舒张压平均指数为71.3±16.5 mmHg，p>0.001）。在整个随访期间，肾功能（血清肌酐水平）保持稳定。
获得的研究结果表明，成功的经皮肾动脉血管成形术加支架置入术有助于控制动脉高血压。未发现该手术对肾功能有直接的积极影响。我们认为，选择该干预措施的主要问题在于不知道与成功结果相关的标准，因此进一步的研究应旨在揭示这些标准。
