Rodríguez Pérez J C, Maynar Moliner M, Pérez Borges P, Plaza Toledano C, Reyes Pérez R, Pulido Duque J M, Palop Cubillo L, Rodríguez Pérez A
Servicio de Nefrología, Hospital Nuestra Señora del Pino, Las Palmas de Gran Canaria.
Med Clin (Barc). 1997 Mar 15;108(10):366-72.
The purpose of this study was to evaluate the clinical results analyzing the cure, improvement and failure rates of percutaneous transluminal angioplasty (PTA) in patients with the diagnosis of renovascular hypertension with special reference to those with atherosclerotic vascular disease, according to their age, and their effect on blood pressure control and renal function.
In 93 hypertensive patients with a mean age of 43.4 years 123 renal artery PTA were performed: Twenty-six patients older than 50 years and eleven with 50 years or less had atherosclerosis, 27 fibromuscular dysplasia and a mixed disease was found in one patient. Twenty-eight patients with renal transplant were diagnosed as having arterial graft stenosis.
After renal PTA, there was a significant decrease in blood pressure in all cases. Patients with atherosclerotic renal vascular disease showed a decrease in systolic pressure (SP) from 168 +/- 19 before PTA to 154 +/- 8 mmHg at 96 months (p < 0.001) and diastolic (DP) from 113 +/- 10 before PTA to 90 +/- 4 mmHg at 96 months (p < 0.001) respectively after the procedure. Significant differences were also observed in patients with fibromuscular dysplasia. Most patients with renal transplant arterial stenosis had less than five years of follow-up and SP and DP decreased from 162 +/- 18 and 109 +/- 8 mmHg before PTA, to 147 +/- 10 (p < 0.001) and 91 +/- 7 mmHg (p < 0.001) at 12 months after dilation respectively. Clinical improvement was achieved in 91% of patients with atherosclerosis at 96 months and fifty percent of the patients with fibromuscular dysplasia were cured after the same period from the time of PTA. Twelve months after the renal transplant artery dilation was achieved a clinical improvement in 81% and a cure rate in 6% of the patients. Ostial lesions comprised the majority of blood pressure benefit failures. There was no significant improvement in renal function immediately after renal artery dilation except in those patients with fibromuscular dysplasia. Residual stenosis greater than 75% was present in 15 patients after the first PTA. Complications were seen in 4.8% and were related to renal failure and vessel dissection.
Angioplasty is effective in the long-term management of high arterial blood pressure and may preserve renal function according to renal artery disease.
本研究的目的是评估经皮腔内血管成形术（PTA）治疗肾血管性高血压患者的临床效果，分析其治愈率、改善率和失败率，并特别参照患有动脉粥样硬化性血管疾病患者的情况，根据其年龄探讨该手术对血压控制和肾功能的影响。
93例平均年龄为43.4岁的高血压患者接受了123次肾动脉PTA手术：26例年龄大于50岁的患者以及11例50岁及以下的患者患有动脉粥样硬化，27例患有纤维肌发育异常，1例患有混合性疾病。28例肾移植患者被诊断为动脉移植血管狭窄。
肾PTA术后，所有病例的血压均显著下降。患有动脉粥样硬化性肾血管疾病的患者收缩压（SP）从PTA术前的168±19 mmHg降至96个月时的154±8 mmHg（p<0.001），舒张压（DP）从术前的113±10 mmHg降至96个月时的90±4 mmHg（p<0.001）。纤维肌发育异常患者也观察到显著差异。大多数肾移植动脉狭窄患者的随访时间不足5年，SP和DP分别从PTA术前的162±18 mmHg和109±8 mmHg降至扩张后12个月时的147±10 mmHg（p<0.001）和91±7 mmHg（p<0.001）。96个月时，91%的动脉粥样硬化患者临床症状得到改善，同期50%的纤维肌发育异常患者治愈。肾移植动脉扩张12个月后，81%的患者临床症状得到改善，6%的患者治愈率达到6%。开口处病变是血压控制未达预期的主要原因。肾动脉扩张后，除纤维肌发育异常患者外，肾功能立即无明显改善。首次PTA术后，15例患者存在大于75%的残余狭窄。并发症发生率为4.8%，与肾衰竭和血管夹层有关。
血管成形术对高血压的长期治疗有效，并且根据肾动脉疾病情况可能保留肾功能。
