Muttardi Kayria, Haydar Ali, Phua Chee Kiang, Chapman Neil, Jenkins Michael, Cheshire Nicholas Jw, Bicknell Colin D
Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK.
JRSM Short Rep. 2013 May 7;4(6):2042533313484145. doi: 10.1177/2042533313484145. Print 2013 Jun.
To asses whether Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are underused in patients with aortic disease due to concerns regarding flow limiting (>70%) renal artery stenosis (RAS).
A prospective analysis of patients admitted for aortic surgery was performed (January-July 2009). Co-morbidity, ACEI/ARB use and renal function were recorded. Computerised tomography (CT) angiograms were reviewed by a single blinded radiologist for the presence and severity of RAS.
St Mary's Hospital, Vascular Unit, Imperial College Healthcare NHS Trust, London, UK.
75 randomly selected patients admitted to our vascular unit including elective and emergency admissions.
Indications for ACEI therapy were identified as determined by the National Institute of Health and Clinical Excellence (NICE) guidance. The ratio of the measurement distal to the stenosis and at the area of maximal stenosis on CT angiography were used to calculate the percentage RAS.
60 patients were identified (15 patients excluded due to previously modified renal vessels). The median age was 73 [interquartile range 68, 77]. Their underlying aortic disease included 52 (87%) aortic aneurysm, 6 (10%) with aortic dissection, 1 (1.7%) patient with occlusive disease and 1 (1.7%) patient with mycotic disease. Overall, 56/60 (93%) patients had at least one indication for ACEI therapy. 33/60 (55%) of patients were already receiving ACEI. CT angiogram examination demonstrated 17/60 (28%) patients have RAS of some degree, of which only 9/60 (15%) have flow limiting RAS.
A large proportion of aortic patients do not receive ACEI/ARB therapy despite definite indications and a low prevalence of flow-limiting RAS is low. After the exclusion of RAS at angiography, careful introduction of ACEI therapy with appropriate monitoring could be considered for many more patients.
评估由于担心存在血流限制性（>70%）肾动脉狭窄（RAS），血管紧张素转换酶抑制剂（ACEI）和血管紧张素受体阻滞剂（ARB）在主动脉疾病患者中是否未得到充分使用。
对2009年1月至7月因主动脉手术入院的患者进行前瞻性分析。记录合并症、ACEI/ARB使用情况和肾功能。由一名单盲放射科医生对计算机断层扫描（CT）血管造影进行评估，以确定是否存在RAS及其严重程度。
英国伦敦帝国学院医疗保健国民信托基金圣玛丽医院血管科。
随机选择75名入住我们血管科的患者，包括择期和急诊患者。
根据英国国家卫生与临床优化研究所（NICE）指南确定ACEI治疗的指征。使用CT血管造影上狭窄远端与最大狭窄区域的测量比值来计算RAS的百分比。
确定了60例患者（15例因先前肾血管改变而排除）。中位年龄为73岁[四分位间距68,77]。他们的潜在主动脉疾病包括52例（87%）主动脉瘤、6例（10%）主动脉夹层、1例（1.7%）闭塞性疾病患者和1例（1.7%）霉菌性疾病患者。总体而言，56/60（93%）的患者至少有一项ACEI治疗指征。33/60（55%）的患者已经在接受ACEI治疗。CT血管造影检查显示17/60（28%）的患者有某种程度的RAS，其中只有9/60（15%）有血流限制性RAS。
尽管有明确指征，但很大一部分主动脉疾病患者未接受ACEI/ARB治疗，且血流限制性RAS的患病率较低。在血管造影排除RAS后，对于更多患者可考虑在适当监测下谨慎引入ACEI治疗。
