1 Cardiovascular and Interventional Radiology, Inova Alexandria Hospital, Alexandria, VA, USA.
2 Department of Radiology, Division of Vascular and Interventional Radiology, Michigan Health System, Ann Arbor, MI, USA.
J Endovasc Ther. 2019 Apr;26(2):258-264. doi: 10.1177/1526602818806653. Epub 2019 Jan 25.
To determine if stent placement across the renal vein inflow affects kidney function and renal vein patency.
Between June 2008 and September 2016, 93 patients (mean age 39 years, range 15-70; 54 women) with iliocaval occlusion underwent venous stent placement and were retrospectively reviewed. For this analysis, the patients were separated into treatment and control groups: 51 (55%) patients had suprarenal and infrarenal iliocaval venous disease requiring inferior vena cava stent reconstruction across the renal vein inflow (treatment group) and 42 (45%) patients had iliac vein stenting sparing the renal veins (control group). Treatment group patients received Wallstents (n=15), Gianturco Z-stents (n=24), or suprarenal and infrarenal Wallstents such that the renal veins were bracketed with a "renal gap" (n=12). Stenting technical success, stent type, glomerular filtration rate (GFR), and creatinine before and after stent placement were recorded, along with renal vein patency and complications.
All procedures were technically successful. In the 51-patient treatment group, 15 (29%) patients received Wallstents and 24 (47%) received Gianturco Z-stents across the renal veins, while 12 (24%) were given a "renal gap" with no stent placement directly across the renal vein inflow. In the control group, 42 patients received iliac vein Wallstents only. Mean prestent GFR was 59±1.8 mL/min/1.73 m and mean prestent creatinine was 0.8±0.2 mg/dL for the entire cohort. Mean prestent GFR and creatinine values in the Wallstent, Gianturco Z-stent, and "renal gap" subgroups did not differ from the iliac vein stent group. Mean poststent GFR and creatinine values were 59±3.3 mL/min/1.73 m and 0.8±0.3 mg/dL, respectively. There were no differences between mean pre- and poststent GFR (p=0.32) or creatinine (p=0.41) values when considering all patients or when comparing the treatment subgroups and the control group. There were no differences in the poststent mean GFR or creatinine values between the Wallstent (p=0.21 and p=0.34, respectively) and Gianturco Z-stent (p=0.43 and p=0.41, respectively) groups and the "renal gap" group. One patient with a Wallstent across the renal veins developed right renal vein thrombosis 7 days after the procedure.
Stent placement across the renal vein inflow did not compromise renal function. A very small risk of renal vein thrombosis was seen.
确定肾静脉流入处放置支架是否会影响肾功能和肾静脉通畅性。
在 2008 年 6 月至 2016 年 9 月期间，93 例（平均年龄 39 岁，范围 15-70；54 名女性）髂股静脉闭塞患者接受静脉支架置入治疗，并进行回顾性分析。在此分析中，患者被分为治疗组和对照组：51 例（55%）患者存在需要在下腔静脉支架重建时跨越肾静脉流入处的肾上、下腔静脉病变（治疗组），42 例（45%）患者存在肾静脉免于支架置入的髂静脉病变（对照组）。治疗组患者接受 Wallstents（n=15）、Gianturco Z-stents（n=24）或肾上、下腔 Wallstents，使肾静脉被“肾间隙”（n=12）包裹。记录支架置入术的技术成功率、支架类型、肾小球滤过率（GFR）和支架置入前后的肌酐值，以及肾静脉通畅性和并发症。
所有手术均技术成功。在 51 例治疗组患者中，15 例（29%）患者接受 Wallstents 跨越肾静脉，24 例（47%）患者接受 Gianturco Z-stents 跨越肾静脉，而 12 例（24%）患者采用“肾间隙”技术，肾静脉流入处无直接支架置入。对照组中，42 例患者仅接受髂静脉 Wallstents。整个队列的平均术前 GFR 为 59±1.8 mL/min/1.73 m，平均术前肌酐值为 0.8±0.2 mg/dL。Wallstents、Gianturco Z-stents 和“肾间隙”亚组的术前 GFR 和肌酐值与髂静脉支架组无差异。术后平均 GFR 和肌酐值分别为 59±3.3 mL/min/1.73 m 和 0.8±0.3 mg/dL。考虑所有患者或比较治疗亚组和对照组时，术前和术后 GFR（p=0.32）或肌酐（p=0.41）值无差异。Wallstents（p=0.21 和 p=0.34）、Gianturco Z-stents（p=0.43 和 p=0.41）与“肾间隙”组之间的术后平均 GFR 或肌酐值无差异。1 例 Wallstents 跨越肾静脉的患者在术后 7 天出现右肾静脉血栓形成。
肾静脉流入处放置支架不会影响肾功能。肾静脉血栓形成的风险很小。
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