Yang Xinzhi, Li Pengyu, Zhang Bihui, Yan Ziguang, Niu Guochen, Yang Min
Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China.
Quant Imaging Med Surg. 2024 Oct 1;14(10):7433-7441. doi: 10.21037/qims-24-994. Epub 2024 Sep 26.
Spontaneous renal artery dissection (SRAD) is a rare cause of renal failure and renovascular hypertension, with the diagnosis often being delayed and treatment varying across different centers. The objective of this retrospective cohort study was to scrutinize the characteristics, treatment modalities, and outcomes of patients with SRAD at our center over the past ten years. Furthermore, the study sought to identify the most suitable treatment options for different categories of patients with SRAD.
Data from 21 consecutive patients who presented with symptoms of SRAD from December 2013 to December 2023 were collected. Lesion characteristics, treatment options, blood pressure (BP) control, serum creatinine and estimated glomerular filtration rate (eGFR) were analyzed. A paired -test was used for comparisons of BP, serum creatinine, and eGFR. An independent samples -test was used to analyze baseline BP and BP change in different treatment groups.
The mean age, weight, and height of patients with SRAD was 49.2±13.0 (range, 18-69) years, 69.0±9.7 (range, 50-80) kg, and 1.7±0.1 (range 1.6-1.8) m, respectively. New-onset hypertension was found in 8 (38.1%) patients. Renal artery dissecting aneurysm and renal artery stenosis were found in 1 (4.8%) and 4 (19.0%) patients, respectively. Supportive medical treatment alone, endovascular intervention, and nephrectomy were required in 15, 4 and 2 cases, respectively. Stable renal function and satisfactory hypertension control were obtained in all treatment groups, with a median follow-up of 18.1 (range, 12-32) months.
Medical management is a reasonable choice in most patients with SRAD. Interventional management is an efficacious strategy for the management of renovascular hypertension and the preservation of renal function.
自发性肾动脉夹层（SRAD）是肾衰竭和肾血管性高血压的罕见病因，诊断往往延迟，不同中心的治疗方法也有所不同。这项回顾性队列研究的目的是详细审查过去十年间我院SRAD患者的特征、治疗方式及预后情况。此外，该研究旨在为不同类型的SRAD患者确定最合适的治疗方案。
收集了2013年12月至2023年12月期间连续21例出现SRAD症状患者的数据。分析病变特征、治疗方案、血压（BP）控制情况、血清肌酐及估算肾小球滤过率（eGFR）。采用配对t检验比较BP、血清肌酐和eGFR。采用独立样本t检验分析不同治疗组的基线血压和血压变化。
SRAD患者的平均年龄、体重和身高分别为49.2±13.0（范围18 - 69）岁、69.0±9.7（范围50 - 80）kg和1.7±0.1（范围1.6 - 1.8）m。8例（38.1%）患者出现新发高血压。分别有1例（4.8%）和4例（19.0%）患者发现肾动脉夹层动脉瘤和肾动脉狭窄。分别有15例、4例和2例患者仅需支持性药物治疗、血管内介入治疗和肾切除术。所有治疗组均获得了稳定的肾功能和满意的高血压控制，中位随访时间为18.1（范围12 - 32）个月。
对于大多数SRAD患者，药物治疗是合理选择。介入治疗是治疗肾血管性高血压和保留肾功能的有效策略。
