McNeil J W, String S T, Pfeiffer R B
Mobile Infirmary Medical Center, AL.
J Vasc Surg. 1994 Sep;20(3):331-6; discussion 336-7. doi: 10.1016/0741-5214(94)90130-9.
This retrospective study is to determine the efficacy and durability of renal endarterectomy in patients undergoing simultaneous aortic reconstruction. In addition, the operative risk to patients with symptomatic and asymptomatic renal artery stenosis is evaluated.
The results of a retrospective study of 101 patients who underwent combined procedures are presented. All patients demonstrated at least a 75% stenosis of the renal artery ostium by arteriography and underwent surgical repair of aneurysmal (n = 33) or aortic occlusive (n = 68) disease. The indications for renal revascularization were hypertension necessitating multiple medications (47%), hypertension combined with renal insufficiency (18%), renal insufficiency alone (5%), and asymptomatic stenosis (30%). Blood pressure and antihypertension medications were monitored during the follow-up period (mean 3.3 years).
The perioperative mortality rate was 1%, with a postoperative morbidity rate of 15%. The conditions of 74% of patients with hypertension were improved or cured, 23% were unchanged, and 3% were worse after surgery. Systolic and diastolic blood pressure in all patients remained significantly diminished during follow-up visits at 3 months, 6 months, 1 year, 3 years, and 6 years (p < 0.01). There was no significant improvement in serum creatinine levels in patients with preexisting renal insufficiency. A small but statistically significant decrease in systolic blood pressure and serum creatinine level was noted after operative intervention in the symptom-free patients (p < 0.005). There were no deaths in the asymptomatic subgroup, and significant azotemia did not develop in any of these patients after operation.
Renal endarterectomy is an effective and durable method of renal revascularization. Furthermore, it is a technique that can be safely combined with aortic surgery and can be considered in the treatment of high-grade, asymptomatic lesions in patients undergoing aortic reconstruction.
本回顾性研究旨在确定在同时进行主动脉重建的患者中肾动脉内膜切除术的疗效和持久性。此外，还评估了有症状和无症状肾动脉狭窄患者的手术风险。
呈现了对101例行联合手术患者的回顾性研究结果。所有患者经动脉造影显示肾动脉开口至少有75%的狭窄，并接受了动脉瘤（n = 33）或主动脉闭塞性疾病（n = 68）的手术修复。肾血管重建的指征包括需要多种药物治疗的高血压（47%）、高血压合并肾功能不全（18%）、单纯肾功能不全（5%）以及无症状狭窄（30%）。在随访期（平均3.3年）内监测血压和抗高血压药物。
围手术期死亡率为1%，术后发病率为15%。74%的高血压患者术后病情改善或治愈，23%无变化，3%恶化。在3个月、6个月、1年、3年和6年的随访中，所有患者的收缩压和舒张压仍显著降低（p < 0.01）。已有肾功能不全的患者血清肌酐水平无显著改善。无症状患者术后干预后收缩压和血清肌酐水平有小幅但具有统计学意义的下降（p < 0.005）。无症状亚组无死亡病例，术后这些患者均未发生严重氮质血症。
肾动脉内膜切除术是一种有效且持久的肾血管重建方法。此外，它是一种可安全地与主动脉手术联合的技术，可考虑用于治疗接受主动脉重建患者的高级别无症状病变。
