Bell G M, Reid J, Buist T A
University Department of Medicine, Royal Infirmary, Edinburgh.
Q J Med. 1987 May;63(241):393-403.
Thirty-three patients with renal angiographic evidence of significant renal artery stenosis were referred for percutaneous transluminal angioplasty. The indications were poorly controlled hypertension (n = 13) or hypertension associated with deteriorating renal function (n = 20). Their mean age was 56 (23-73) years (12 males, 21 females). Causes of the renal artery stenosis were fibromuscular dysplasia (n = 8) and atheromatous changes (n = 25). Four patients were excluded, three due to technical failure. Forty-five angioplasties were performed in 29 patients with a mean observation period after angioplasty of 18 (one to 60) months. During this period eight patients (28 per cent) had a diastolic blood pressure of less than 90 mmHg without antihypertensive drugs, a further 15 patients (52 per cent) had improved blood pressure control with a significant reduction in the number and amount of antihypertensive drugs, but six patients (20 per cent) showed no improvement in blood pressure. Hypertension associated with the stenosis of fibromuscular dysplasia responded better to angioplasty than hypertension associated with atheromatous renal artery stenosis. Improvement in renal function was noted in eight patients with no change in 16 patients. Two patients with end-stage renal failure and atheromatous intrarenal vascular disease became dialysis dependent within four weeks of the procedure. One major and four minor complications occurred but there were no deaths related to angioplasty. Together with results from other centres this study indicates that percutaneous transluminal angioplasty should be considered the initial treatment choice for all patients with renovascular hypertension due to fibromuscular dysplasia and atheromatous renal artery stenosis.
33例经肾血管造影证实存在显著肾动脉狭窄的患者被转诊接受经皮腔内血管成形术。适应证为难以控制的高血压（n = 13）或与肾功能恶化相关的高血压（n = 20）。他们的平均年龄为56（23 - 73）岁（12名男性，21名女性）。肾动脉狭窄的病因是纤维肌发育异常（n = 8）和动脉粥样硬化改变（n = 25）。4例患者被排除，3例因技术失败。对29例患者进行了45次血管成形术，血管成形术后的平均观察期为18（1至60）个月。在此期间，8例患者（28%）在未使用降压药物的情况下舒张压低于90 mmHg，另有15例患者（52%）血压控制得到改善，降压药物的数量和剂量显著减少，但6例患者（20%）血压无改善。与纤维肌发育异常性狭窄相关的高血压对血管成形术的反应比对动脉粥样硬化性肾动脉狭窄相关的高血压更好。8例患者肾功能有改善，16例患者无变化。2例终末期肾衰竭且伴有动脉粥样硬化性肾内血管疾病的患者在手术后4周内开始依赖透析。发生了1例严重并发症和4例轻微并发症，但没有与血管成形术相关的死亡病例。结合其他中心的结果，本研究表明，经皮腔内血管成形术应被视为所有因纤维肌发育异常和动脉粥样硬化性肾动脉狭窄导致肾血管性高血压患者的初始治疗选择。
