Department of Radiology, CHU de Toulouse Rangueil, 31400 Toulouse, France; Interventional Radiology, Department of Radiology, Az. Osp-Univ OORR-Torrette, Via Conca 71, 60126 Ancona, Italy.
Department of Radiology, CHU de Toulouse Rangueil, 31400 Toulouse, France.
Diagn Interv Imaging. 2019 Sep;100(9):493-502. doi: 10.1016/j.diii.2019.03.010. Epub 2019 Apr 2.
The purposes of this retrospective study were to assess the efficacy of endovascular techniques for the treatment of transplant renal artery stenosis (TRAS) by analyzing technical and clinical success and to compare the results of percutaneous transluminal angioplasty (PTA) alone to those of stenting.
A retrospective analysis was conducted on 31 patients who underwent endovascular treatment for TRAS between January 2012 and December 2017. There were 23 men and 8 women with a mean age of 60.5±14 (SD) years (range: 24-81 years). Ten patients (10/31; 32%; 8 men, 2 women; median age, 63 years) were treated with PTA alone and 21/31 (68%; 15 men, 6 women; median age, 65 years) with metallic stent placement. Several variables including serum creatinine level, glomerular filtration rate, arterial blood pressure value, antihypertensive medication obtained before and after treatment were compared. Technical success was assessed for each procedure. Clinical success was defined as a 15% drop in serum creatinine level, a decrease greater than 15% in mean blood pressure values or a decrease greater than 10% in mean blood pressure values with a reduction in the number of antihypertensive drugs needed for hypertension control.
Technical success was obtained in all patients [31/31; 100%; 95% confidence interval (CI): 89-100%] and clinical success in 27/31 patients (87%; 95%CI: 71-95%). Four patients (4/31; 13%; 95%CI: 5-29%) underwent repeat endovascular intervention. Mean serum creatinine level and mean arterial blood pressure values were significantly lower after treatment (177.4 and 93.8μmol/l, respectively) compared to before treatment (319.4 and 106.7μmol/l, respectively) in the stent group but not in the group treated with PTA alone (P=0.0012 and P=0.002, respectively).
The endovascular approach is safe and effective in the management of TRAS and stenting, depending on the morphology of the stenosis, should be the treatment of choice when possible.
本回顾性研究的目的是通过分析技术和临床成功率来评估血管内技术治疗移植肾动脉狭窄（TRAS）的疗效，并比较单纯经皮腔内血管成形术（PTA）与支架置入术的结果。
对 2012 年 1 月至 2017 年 12 月期间接受血管内治疗的 31 例 TRAS 患者进行回顾性分析。患者包括 23 名男性和 8 名女性，平均年龄 60.5±14（SD）岁（范围：24-81 岁）。10 例患者（10/31；32%；8 名男性，2 名女性；中位年龄 63 岁）接受单纯 PTA 治疗，21 例患者（21/31；68%；15 名男性，6 名女性；中位年龄 65 岁）接受金属支架置入术。比较治疗前后血清肌酐水平、肾小球滤过率、动脉血压值、降压药物等多个变量。评估每个手术的技术成功率。临床成功定义为血清肌酐水平下降 15%，平均血压值下降大于 15%，或平均血压值下降大于 10%，同时降压药物的使用量减少。
所有患者均获得技术成功[31/31；100%；95%置信区间（CI）：89-100%]，27/31 例患者（87%；95%CI：71-95%）获得临床成功。4 例患者（4/31；13%；95%CI：5-29%）接受重复血管内介入治疗。支架组治疗后血清肌酐水平（177.4μmol/L）和平均动脉血压值（93.8μmol/L）明显低于治疗前（319.4μmol/L 和 106.7μmol/L），而单纯 PTA 治疗组无明显差异（P=0.0012 和 P=0.002）。
血管内方法在 TRAS 的治疗中是安全有效的，取决于狭窄的形态，在可能的情况下，支架置入应作为首选治疗方法。
