Chew Lee Lian, Tan Bien Soo, Kumar Krishna, Htoo Maung Myint, Wong Kok Seng, Cheng Christopher W S, Teo Terence K B, Irani Farah Gillani, Choong Hui Lin, Tay Kiang Hiong
Interventional Radiology Centre, Department of Diagnostic Radiology, Singapore General Hospital, Singapore.
Ann Acad Med Singap. 2014 Jan;43(1):39-43.
This study aimed to assess the outcome of percutaneous transluminal angioplasty (PTA) as the primary treatment for transplant renal artery stenosis (TxRAS).
A retrospective review of PTA of TxRAS from April 1999 to December 2008 was performed. Twenty-seven patients (17 males (M):10 females (F)) with the mean age of 49.5 years underwent PTA of TxRAS in the review period. Indications for PTA were suboptimal control of hypertension (n=12), impaired renal function (n=6) and both suboptimal control of hypertension and impaired renal function (n=9). All patients had doppler ultrasound scans prior to their PTA. In addition, 5 of these patients had computed tomography angiography (CTA) and another 7 had magnetic resonance angiography (MRA) evaluation. Mean follow-up period was 57.0 months (range, 7 to 108 months).
The stenotic lesions were located proximal to the anastomosis (n=2), at the anastomosis (n=15), and distal to the anastomosis (n=14). Technical success rate was 96.3%. One case was complicated by extensive dissection during PTA, resulting in subsequent graft failure. The overall clinical success rate was 76.9%. Seven out of 26 patients had restenoses (26.9% of cases). These were detected at a mean of 14.3 months post angioplasty (range, 5 to 38 months). All 7 patients underwent a second PTA successfully. Three of these patients required more than 1 repeat PTA.
PTA is safe and effective in the management of symptomatic TxRAS and should be the primary treatment of choice. Close surveillance for restenosis is required and when diagnosed, re-angioplasty can be performed.
本研究旨在评估经皮腔内血管成形术（PTA）作为移植肾动脉狭窄（TxRAS）主要治疗方法的疗效。
对1999年4月至2008年12月期间TxRAS的PTA进行回顾性研究。在此期间，27例患者（17例男性：10例女性）平均年龄49.5岁接受了TxRAS的PTA治疗。PTA的适应证为高血压控制不佳（n = 12）、肾功能受损（n = 6）以及高血压控制不佳和肾功能受损两者兼具（n = 9）。所有患者在接受PTA之前均进行了多普勒超声扫描。此外，其中5例患者进行了计算机断层血管造影（CTA），另外7例进行了磁共振血管造影（MRA）评估。平均随访期为57.0个月（范围为7至108个月）。
狭窄病变位于吻合口近端（n = 2）、吻合口处（n = 15）和吻合口远端（n = 14）。技术成功率为96.3%。1例患者在PTA期间并发广泛夹层形成，导致随后的移植肾失功。总体临床成功率为76.9%。26例患者中有7例发生再狭窄（占病例的26.9%）。这些再狭窄在血管成形术后平均14.3个月（范围为5至38个月）被检测到。所有7例患者均成功接受了第二次PTA。其中3例患者需要进行1次以上的重复PTA。
PTA在有症状的TxRAS治疗中安全有效，应作为首选的主要治疗方法。需要密切监测再狭窄情况，一旦诊断，可进行再次血管成形术。
