Zierler R E, Bergelin R O, Polissar N L, Beach K W, Caps M T, Cantwell-Gab K, Davidson R C, Strandness D E
Department of Surgery, University of Washington, Seattle 98195-6410, USA.
Arch Intern Med. 1998 Apr 13;158(7):761-7. doi: 10.1001/archinte.158.7.761.
Atherosclerotic lesions of the carotid and lower extremity arteries may be associated with renal artery stenosis and influence the management of patients with renal artery disease.
To document the prevalence and clinical features of carotid and lower extremity arterial disease in patients with renal artery atherosclerosis.
An analysis of baseline data on 149 patients enrolled in a prospective natural history study of atherosclerotic renal artery stenosis. Patients with at least 1 abnormal renal artery by duplex scanning were eligible. Carotid artery disease was evaluated by duplex scanning, and ankle/brachial indices were used to assess the lower extremity arteries. Disease at each of the 3 arterial sites was classified as mild, moderate, or severe based on the extent of involvement on both sides. Serum urea nitrogen, creatinine, and lipid levels were also measured.
Severe renal, carotid, or lower extremity arterial disease was present in 44%, 19%, and 21% of the patients, respectively. There was a trend for patients with increasing degrees of renal artery disease to have increasing degrees of carotid and lower extremity arterial disease. The prevalence of severe carotid artery disease increased from 7% in the mild renal artery group to 28% in the severe renal artery group. Clinical factors that were most predictive of severe disease were elevated apolipoprotein B levels for the renal arteries, high serum urea nitrogen or creatinine levels for the carotid arteries, and smoking for the lower extremity arteries.
There was a strong association between severe renal artery atherosclerosis and severe carotid artery disease. Patients with renal artery disease also had a high prevalence of lower extremity arterial disease. In this patient population, screening for lower extremity arterial disease can be reserved for those with signs or symptoms of peripheral ischemia. Noninvasive carotid screening is justified in patients with renal artery disease to detect asymptomatic lesions that require either immediate surgical treatment or serial follow-up for disease progression.
颈动脉和下肢动脉的动脉粥样硬化病变可能与肾动脉狭窄相关，并影响肾动脉疾病患者的治疗。
记录肾动脉粥样硬化患者颈动脉和下肢动脉疾病的患病率及临床特征。
对纳入动脉粥样硬化性肾动脉狭窄前瞻性自然史研究的149例患者的基线数据进行分析。经双功超声扫描至少有1条肾动脉异常的患者符合入选标准。通过双功超声扫描评估颈动脉疾病，使用踝/臂指数评估下肢动脉。根据双侧受累程度将3个动脉部位的疾病分为轻度、中度或重度。同时测量血清尿素氮、肌酐和血脂水平。
分别有44%、19%和21%的患者存在重度肾、颈动脉或下肢动脉疾病。肾动脉疾病程度增加的患者，其颈动脉和下肢动脉疾病程度有增加趋势。重度颈动脉疾病的患病率从轻度肾动脉组的7%增至重度肾动脉组的28%。最能预测重度疾病的临床因素为：肾动脉疾病中载脂蛋白B水平升高；颈动脉疾病中血清尿素氮或肌酐水平升高；下肢动脉疾病中吸烟。
重度肾动脉粥样硬化与重度颈动脉疾病之间存在密切关联。肾动脉疾病患者下肢动脉疾病的患病率也较高。对于该患者群体，可仅对有外周缺血体征或症状的患者进行下肢动脉疾病筛查。对肾动脉疾病患者进行无创性颈动脉筛查是合理的，以检测需要立即手术治疗或因疾病进展而进行系列随访的无症状病变。
