Sun Anqiang, Tian Xiaopeng, Zhang Nan, Xu Zaipin, Deng Xiaoyan, Liu Ming, Liu Xiao
Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China.
Radiologic Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
PLoS One. 2015 May 6;10(5):e0125121. doi: 10.1371/journal.pone.0125121. eCollection 2015.
Renal artery stenosis (RAS) and renal complications emerge in some patients after endovascular aneurysm repair (EVAR) to treat abdominal aorta aneurysm (AAA). The mechanisms for the causes of these problems are not clear. We hypothesized that for EVAR patients, lower limb exercise could negatively influence the physiology of the renal artery and the renal function, by decreasing the blood flow velocity and changing the hemodynamics in the renal arteries. To evaluate this hypothesis, pre- and post-operative models of the abdominal aorta were reconstructed based on CT images. The hemodynamic environment was numerically simulated under rest and lower limb exercise conditions. The results revealed that in the renal arteries, lower limb exercise decreased the wall shear stress (WSS), increased the oscillatory shear index (OSI) and increased the relative residence time (RRT). EVAR further enhanced these effects. Because these parameters are related to artery stenosis and atherosclerosis, this preliminary study concluded that lower limb exercise may increase the potential risk of inducing renal artery stenosis and renal complications for AAA patients. This finding could help elucidate the mechanism of renal artery stenosis and renal complications after EVAR and warn us to reconsider the management and nursing care of AAA patients.
肾动脉狭窄（RAS）和肾脏并发症在一些接受血管腔内动脉瘤修复术（EVAR）治疗腹主动脉瘤（AAA）的患者中出现。这些问题产生的原因机制尚不清楚。我们推测，对于接受EVAR的患者，下肢运动会通过降低血流速度和改变肾动脉血流动力学，对肾动脉生理和肾功能产生负面影响。为了评估这一假设，基于CT图像重建了腹主动脉术前和术后模型。在静息和下肢运动条件下对血流动力学环境进行了数值模拟。结果显示，在肾动脉中，下肢运动降低了壁面切应力（WSS），增加了振荡剪切指数（OSI），并增加了相对停留时间（RRT）。EVAR进一步增强了这些影响。由于这些参数与动脉狭窄和动脉粥样硬化有关，这项初步研究得出结论，下肢运动可能会增加AAA患者诱发肾动脉狭窄和肾脏并发症的潜在风险。这一发现有助于阐明EVAR术后肾动脉狭窄和肾脏并发症的机制，并提醒我们重新考虑AAA患者的管理和护理。
