Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine.
Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine.
Int Heart J. 2023 Mar 31;64(2):306-309. doi: 10.1536/ihj.22-311. Epub 2023 Mar 15.
Renovascular hypertension (RVH) is a common cause of secondary hypertension. However, there have been no reports on RVH due to radiation-induced abdominal aorta stenosis after renal autotransplantation. A 27-year-old woman with a history of neuroblastoma treated by radiation therapy and RVH treated with renal autotransplantation presented with hypertension and dyspnea. At age 19, she had experienced hypertensive heart failure due to RVH from radiation-induced left renal artery stenosis and had undergone renal autotransplantation involving the extraction of her left kidney. Her systolic blood pressure (BP) was well-controlled but had increased progressively. She was diagnosed with hypertensive heart failure and admitted to hospital. Although her dyspnea soon subsided after treatment, her BP remained high. Renal artery ultrasound revealed no obvious stenosis. The ankle brachial pressure index (ABI) showed a significant bilateral decrease to 0.71/0.71 (right/left) from 0.94/0.95 eight years before. Magnetic resonance angiography and aortic angiography revealed severe stenosis in the abdominal aorta, and the systolic pressure gradient of intra-aortic blood flow, distal and proximal to a stenotic lesion, was 58 mmHg. These arterial stenoses in the irradiated area were highly suggestive of radiation-induced vasculopathy. She finally underwent an endovascular VIABAHN VBX balloon-expandable stent-graft placement for this radiation-induced abdominal aorta stenosis, which resolved the pressure gradient. After the procedure, her ABI improved to 0.91/0.88 and her BP was well-controlled. This is the first case of successful stent-graft placement for RVH after renal autotransplantation due to radiation-induced abdominal aorta stenosis as a consequence of neuroblastoma.
肾血管性高血压（RVH）是继发性高血压的常见原因。然而，目前尚无报道称肾移植后因放射治疗引起的腹主动脉狭窄而导致 RVH。一位 27 岁女性，患有神经母细胞瘤，曾接受过放射治疗，因 RVH 接受了肾移植，现出现高血压和呼吸困难。19 岁时，她因放射治疗引起的左肾动脉狭窄导致 RVH 出现高血压性心力衰竭，并接受了肾移植，包括提取她的左肾。她的收缩压（BP）控制良好，但逐渐升高。她被诊断为高血压性心力衰竭并住院。尽管她的呼吸困难在治疗后很快缓解，但她的 BP 仍然很高。肾动脉超声检查未见明显狭窄。踝臂血压指数（ABI）显示双侧显著下降，从 8 年前的 0.94/0.95 降至 0.71/0.71（右侧/左侧）。磁共振血管造影和主动脉血管造影显示腹主动脉严重狭窄，狭窄病变远端和近端的主动脉内血流收缩压梯度为 58mmHg。这些受照射区域的动脉狭窄高度提示为放射诱导性血管病。她最终因放射治疗引起的腹主动脉狭窄而接受了血管内 VIABAHN VBX 球囊扩张支架置入术，以缓解压力梯度。手术后，她的 ABI 改善至 0.91/0.88，BP 得到良好控制。这是首例因神经母细胞瘤放射治疗引起的肾移植后 RVH 成功放置支架的病例。
