Lenz Tomas, Schulte Karl-Ludwig
KfH Kidney Center & IPNH, Ludwigshafen, Germany -
Panminerva Med. 2016 Mar;58(1):94-101. Epub 2016 Jan 5.
Severe renal artery stenosis may cause renovascular hypertension; in case of bilateral narrowing or in a stenotic solitary kidney, renal insufficiency (e.g. ischemic kidney disease) or pulmonary flash edema may ensue. Renal artery stenosis can be treated by revasularization, using either percutaneous angioplasty (with or without stenting) or less common open surgical procedures, both with excellent primary patency rates. However, several randomized trials of renal artery angioplasty or stenting in patients with arteriosclerotic disease have failed to demonstrate a longer-term benefit with regard to blood pressure control and renal function over medical management. It has not yet been demonstrated that renal revascularization leads to a prolongation of event-free survival. Furthermore, endovascular procedures are associated with substantial risks. If revascularization is envisaged careful patient selection, e.g. patients with refractory hypertension or progressive renal failure, is important to maximize the potential benefit.
严重肾动脉狭窄可能导致肾血管性高血压；若双侧狭窄或单肾狭窄，则可能继而出现肾功能不全（如缺血性肾病）或肺水肿。肾动脉狭窄可通过血管重建术治疗，可采用经皮血管成形术（有无支架置入）或不太常见的开放性手术，二者的初始通畅率均很高。然而，针对动脉粥样硬化疾病患者进行肾动脉血管成形术或支架置入的多项随机试验未能证明在血压控制和肾功能方面比药物治疗有更长期的益处。目前尚未证明肾血管重建可延长无事件生存期。此外，血管内手术存在重大风险。若考虑进行血管重建，仔细选择患者，如难治性高血压或进行性肾衰竭患者，对于最大化潜在益处很重要。
