Libertino J A, Beckmann C F
Department of Urology, Lahey Clinic, Burlington, Massachusetts.
Urol Clin North Am. 1994 May;21(2):235-43.
Unfortunately, no randomized trials have compared PTRA for renovascular hypertension with surgical or medical treatment. PTRA appears to be a safe and relatively simple procedure with complication rates lower than those of operation. The outcome of renal angioplasty depends on the type of stenosis. In all published series, the cure rates for fibromuscular disease are significantly higher than for atherosclerotic disease, and PTRA appears to be the procedure of choice in the treatment of hypertension in patients with fibromuscular disease. The role of renal angioplasty in patients with renovascular hypertension due to atherosclerotic diseases is uncertain. Most large published series describing the success of angioplasty in patients with atherosclerotic lesions have been highly selective, primarily including patients with focal stenotic lesions. Despite this selectivity, the cure rate has been only 19%. In completely unselected patients, atherosclerotic lesions are associated with a very high rate of technical failure, possibly as high as 60%. From the data available, focal isolated stenotic lesions of the renal artery due to atherosclerotic disease can be treated with a reasonable rate of success. The success rate in patients with bilateral disease, osteal stenosis, or total occlusion of the renal arteries appears to be very limited. In these patients, angioplasty should be attempted only when a surgical contraindication exists.
不幸的是，尚无随机试验将经皮腔内肾血管成形术（PTRA）治疗肾血管性高血压与手术或药物治疗进行比较。PTRA似乎是一种安全且相对简单的手术，并发症发生率低于手术治疗。肾血管成形术的结果取决于狭窄的类型。在所有已发表的系列研究中，纤维肌性疾病的治愈率显著高于动脉粥样硬化疾病，PTRA似乎是治疗纤维肌性疾病患者高血压的首选方法。肾血管成形术在动脉粥样硬化疾病所致肾血管性高血压患者中的作用尚不确定。大多数已发表的描述血管成形术治疗动脉粥样硬化病变患者成功经验的大型系列研究都具有高度选择性，主要纳入了局灶性狭窄病变患者。尽管存在这种选择性，治愈率也仅为19%。在完全未经过筛选的患者中，动脉粥样硬化病变导致的技术失败率非常高，可能高达60%。根据现有数据，动脉粥样硬化疾病所致的肾动脉局灶性孤立狭窄病变可以得到合理的成功治疗。双侧病变、肾动脉开口处狭窄或完全闭塞患者的成功率似乎非常有限。在这些患者中，仅当存在手术禁忌证时才应尝试血管成形术。
