Kløw N E, Paulsen D, Vatne K, Rokstad B, Lien B, Fauchald P
Department of Radiology, National Hospital, Oslo, Norway.
Acta Radiol. 1998 Nov;39(6):594-603. doi: 10.3109/02841859809175483.
To evaluate the angiographic and clinical results of all percutaneous transluminal renal angioplasties (PTRAs) performed at one centre in Norway since the introduction of the method. Most of the PTRAs were performed with the coaxial technique (guiding-catheter-assisted angioplasty).
In 419 patients, 595 PTRAs of 552 stenoses were performed from 1982 to 1993. The cases included 295 patients with arteriosclerotic vascular disease (AVD), 49 with fibromuscular dysplasia (FMD), and 74 transplantation patients (TX). Angiographic and clinical follow-up were undertaken.
Initial angiographic success was obtained in 92% of the patients and another 3% improved. The rates of immediate success were 92%, 98% and 84% for AVD, FMD and TX respectively. The corresponding rates for primary patency were 57%, 67% and 54%, and for secondary patency (after 1 to 6 angioplasties) 77%, 93% and 64%. Lower long-term results were obtained for: recanalized vessels; long lesions; bifurcation stenoses; stenoses in patients with abdominal aortic aneurysm; smaller vessels; and segmental branches in native and TX kidneys. Of 252 patients with hypertension, 8% were cured and another 58% improved. Of 215 patients with reduced renal function, 38% were normalized or improved and 42% unchanged. Major complications including 2 deaths were seen in 2.9% of the procedures and other complications in 4.7%.
PTRA with a guiding catheter can be performed in most patients with a high success rate and a low complication rate. This study points to two major problems with PTRA: the high restenosis rate and the low response to treatment of hypertension. The careful selection of patients for PTRA is important for increasing the success rate, and follow-up to detect restenosis is mandatory.
评估自该方法引入以来在挪威一个中心进行的所有经皮腔内肾血管成形术（PTRA）的血管造影和临床结果。大多数PTRA采用同轴技术（导引导管辅助血管成形术）进行。
1982年至1993年，对419例患者的552处狭窄进行了595次PTRA。病例包括295例动脉硬化性血管疾病（AVD）患者、49例纤维肌发育不良（FMD）患者和74例移植患者（TX）。进行了血管造影和临床随访。
92%的患者获得了初始血管造影成功，另有3%的患者病情有所改善。AVD、FMD和TX患者的即刻成功率分别为92%、98%和84%。相应的一期通畅率分别为57%、67%和54%，二期通畅率（在进行1至6次血管成形术后）分别为77%、93%和64%。以下情况的长期结果较差：再通血管；长病变；分叉狭窄；腹主动脉瘤患者的狭窄；较小血管；以及自体肾和移植肾的节段分支。252例高血压患者中，8%治愈，另有58%病情改善。215例肾功能减退患者中，38%恢复正常或病情改善，42%无变化。2.9%的手术出现包括2例死亡在内的主要并发症，4.7%出现其他并发症。
使用导引导管进行PTRA在大多数患者中成功率高、并发症率低。本研究指出了PTRA的两个主要问题：高再狭窄率和对高血压治疗的低反应率。仔细选择PTRA患者对于提高成功率很重要，并且必须进行随访以检测再狭窄。
