Department of Urology, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
Sci Rep. 2020 Nov 12;10(1):19720. doi: 10.1038/s41598-020-76812-w.
Catheter-based renal denervation (RDN) was introduced to treat resistant hypertension. However, the reduction in blood pressure after the RDN was modest. Catheter-based RDN was performed only at main renal arteries, except for accessory and branch arteries due to the diameter being too small for the catheter to approach. Here, we retrospectively analyzed the anatomy of diverse renal arteries via 64-channel multi-detector computed tomography angiograms of 314 consecutive donors who underwent living donor nephrectomy from January 2012 to July 2017. Occurrence rates of one or more accessory renal arteries in donors were 25.3% and 19.4% on the left and right sides, respectively. Early branching rates before 25 mm from the aorta to the right and left renal arteries were 13.7% and 10.5%, respectively. Overall, 63.1% and 78.3% of donors had no accessory artery bilaterally and no branched renal artery, respectively. As a result, 47.1% had only main renal arteries without an accessory artery and early-branching artery. Approximately half of the donors had multiple small renal arteries bilaterally, for which catheter-based denervation may not be suitable. Thus, preoperative computed tomography angiography requires careful attention to patient selection, and there is a need for improved methods for denervation at various renal arteries.
经导管肾去神经术（RDN）被引入治疗难治性高血压。然而，RDN 后血压的降低幅度不大。由于导管无法接近，经导管 RDN 仅在主要肾动脉进行，不包括副肾动脉和分支动脉。在这里，我们回顾性分析了 314 例连续接受活体供肾切除术的供者的 64 通道多探测器 CT 血管造影的不同肾动脉解剖结构。供者中单侧或双侧存在一条或多条副肾动脉的发生率分别为 25.3%和 19.4%。在距主动脉至右肾和左肾动脉 25mm 之前，早期分支率分别为 13.7%和 10.5%。总体而言，双侧均无副肾动脉和无分支肾动脉的供者分别占 63.1%和 78.3%。因此，47.1%的供者仅有无副肾动脉和早期分支动脉的主肾动脉。大约一半的供者双侧都有多条小肾动脉，对于这些患者，经导管去神经术可能并不适用。因此，术前 CT 血管造影需要仔细注意患者选择，并且需要改进在各种肾动脉进行去神经术的方法。
