Baumgartner I, Triller J, Mahler F
Department of Medicine, University Hospital, Bern, Switzerland.
Kidney Int. 1997 Mar;51(3):798-803. doi: 10.1038/ki.1997.112.
Evaluation of percutaneous transluminal renal angioplasty (PTRA) is today based primarily on clinical criteria rather than direct investigation of luminal width. In this study, we examined renal blood flow by color-coded duplex sonography (CCD) in order to correlate blood pressure as well as renal function with the true renovascular patency. Fifty consecutive patients suspected of suffering from renovascular disease and treated by PTRA were included for a prospective sonographic study. In all PTRA was performed on 63 renal arteries. Thirty-seven patients were diagnosed to have atherosclerosis and 13 patients to have fibromuscular dysplasia (FMD). Examinations were performed using CCD before PTRA, and one day, three months, six months and 12 months after PTRA. If CCD showed a restenosis > or = 60%, CCD was non-conclusive or hypertension deteriorated, angiography and, if necessary, catheter re-intervention were performed. The primary patency rate after 12 months was 73%, and could be improved to 94% overall when treated restenosis (N = 22) were included. Restenosis was more frequent in patients with mild residual stenosis identified by CCD one day after PTRA (P = 0.002). There was neither a significant difference in the restenosis rate in patients with atherosclerosis versus FMD, nor in patients with ostial versus non-ostial lesions. Hypertension was improved or cured in 70% of patients with atherosclerosis, and in 85% of those with FMD. Nevertheless, hypertension deteriorated in 12% of the patients without restenosis, and no deterioration was present in 14% of the patients with restenosis. A decrease in serum creatinine levels by more than 15% was observed in 12 of 22 patients with impaired renal function and patent renal artery during follow-up. These results suggest that optimal therapeutic efficiency can be obtained using PTRA followed by systematic CCD.
如今，经皮腔内肾血管成形术（PTRA）的评估主要基于临床标准，而非对管腔宽度的直接检查。在本研究中，我们采用彩色编码双功超声（CCD）检查肾血流，以便将血压及肾功能与真正的肾血管通畅情况相关联。50例连续的疑似患有肾血管疾病并接受PTRA治疗的患者被纳入一项前瞻性超声研究。总共对63条肾动脉进行了PTRA。37例患者被诊断为动脉粥样硬化，13例患者为纤维肌发育异常（FMD）。在PTRA前、PTRA后1天、3个月、6个月及12个月使用CCD进行检查。如果CCD显示再狭窄≥60%、CCD检查结果不明确或高血压病情恶化，则进行血管造影，必要时进行导管再次干预。12个月后的初始通畅率为73%，若将治疗再狭窄的患者（N = 22）纳入计算，总体通畅率可提高至94%。PTRA后1天经CCD检查发现有轻度残余狭窄的患者，再狭窄更为常见（P = 0.002）。动脉粥样硬化患者与FMD患者之间，以及开口处病变与非开口处病变患者之间的再狭窄率均无显著差异。70%的动脉粥样硬化患者及85%的FMD患者的高血压病情得到改善或治愈。然而，12%无再狭窄的患者高血压病情恶化，14%有再狭窄的患者则未出现病情恶化。在随访期间，22例肾功能受损且肾动脉通畅的患者中有12例血清肌酐水平下降超过15%。这些结果表明，采用PTRA并随后进行系统性CCD检查可获得最佳治疗效果。
