Klinik für Innere Medizin III - Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes and Saarland University, Homburg, Germany.
CBSET, Inc., Lexington, MA, USA.
EuroIntervention. 2023 Sep 18;19(7):612-620. doi: 10.4244/EIJ-D-23-00264.
Renal denervation is optimised when guided by knowledge of nerve distribution.
We aimed to assess sympathetic nerve distribution along the renal arteries, especially in post-bifurcation vessel segments.
Renal arteries and surrounding tissue from 10 body donors were collected and examined histologically. Immunohistochemical staining was used to analyse nerve distribution and to identify afferent and efferent sympathetic nerves.
A total of 6,781 nerves surrounding 18 renal arteries were evaluated. The mean lumen-nerve distance of the left renal artery (2.32±1.95 mm) was slightly greater than the right (2.29±2.03 mm; p=0.161); this varied across the arteries' courses: 3.7±2.3 mm in proximal segments, 2.5±2.0 mm in middle segments, 1.9±1.6 mm in distal prebifurcation segments and 1.3±1.0 mm in post-bifurcation segments (p<0.001). The number of nerves per quadrant was highest in the proximal segments (13.7±18.6), followed by the middle (9.7±7.9), distal prebifurcation (8.0±7.6), and distal post-bifurcation (4.3±4.0) segments (p<0.001). Circumferentially, the number of nerves was highest in the superior (7.8±9.4) and the ventral (7.6±13.1) quadrants (p=0.638). The mean tyrosine hydroxylase (TH) to calcitonin gene-related peptide (CGRP) ratio increased from proximal (37.5±33.5) to distal (72.0±7.2 in the post-bifurcation segments; p<0.001). Thirty-eight neuroganglia were identified along 14 (78%) renal arteries.
Nerves converge to the renal arteries' lumen in the distal segments and along branches, resulting in the lowest number of nerves per quadrant and the shortest lumen-nerve distance in the distal post-bifurcation segments. Efferent nerves occur predominantly, and the ratio of efferent to afferent nerves continues to increase in the vessels' course.
在了解神经分布的情况下，对肾脏进行去神经支配是最优的。
我们旨在评估肾动脉周围的交感神经分布情况，尤其是在分叉后血管段。
从 10 位尸体供体中收集肾脏动脉及其周围组织，并进行组织学检查。免疫组织化学染色用于分析神经分布并识别传入和传出交感神经。
总共评估了 18 条肾动脉周围的 6781 条神经。左肾动脉的平均管腔-神经距离（2.32±1.95mm）略大于右肾动脉（2.29±2.03mm；p=0.161）；这在动脉的各个部位有所不同：近段为 3.7±2.3mm，中段为 2.5±2.0mm，远端分叉前段为 1.9±1.6mm，分叉后段为 1.3±1.0mm（p<0.001）。每象限的神经数量在近段最高（13.7±18.6），其次是中段（9.7±7.9），远端分叉前段（8.0±7.6）和远端分叉后段（4.3±4.0）（p<0.001）。在周向方向，神经数量最多的是上象限（7.8±9.4）和腹侧象限（7.6±13.1）（p=0.638）。酪氨酸羟化酶（TH）与降钙素基因相关肽（CGRP）的比值从近段（37.5±33.5）增加到远段（分叉后段的 72.0±7.2；p<0.001）。在 14 条（78%）肾动脉上共发现了 38 个神经节。
在远段和分支处，神经向肾动脉管腔汇聚，导致远段分叉后段每象限神经数量最少，管腔-神经距离最短。传出神经占主导地位，且在血管的走行过程中，传出神经与传入神经的比例持续增加。
