Short- and long-term outcomes of percutaneous transluminal angioplasty/stenting of renal fibromuscular dysplasia over a ten-year period
Short- and long-term outcomes of percutaneous transluminal angioplasty/stenting of renal fibromuscular dysplasia over a ten-year period
复制标题
DOI：
10.1016/j.jvs.2011.09.006
复制
发表时间：
2012-02-01
影响因子：
4.3
通讯作者：
AbuRahma, All F.
中科院分区：
文献类型：
--
作者：
Mousa, Albeir Y.;Campbell, John E.;AbuRahma, All F.
目的：本研究的目的是评估经皮腔内介入治疗因纤维肌肉发育不良（RAFMD）和/或RAFMD合并主动脉-口动脉粥样硬化疾病的症状性肾动脉狭窄患者的短期和长期结果。方法：对所有经导管治疗的肾动脉RAFMD患者进行回顾性分析。在1999年1月至2009年12月间进行了三次治疗。记录血压（BP）测量值、降压药物数量和由收缩压>40 +/-舒张压bbb90定义的高血压。肾功能由估计的肾小球滤过率（eGFR）定义。再狭窄定义为狭窄60%，并通过肾动脉双工和/或血管造影确定。无事件（再狭窄、肾功能衰竭或复发性高血压）使用生命表分析。结果：35例RAFMD患者共行43次手术。32例（91%）为女性，平均年龄61.9岁。技术成功率为100%，1例（2.3%）患者需要在FMD节段夹层放置辅助支架，4例（9.3%）患者需要在非FMD主动脉-口动脉粥样硬化病变中放置辅助支架。短期结果：大多数患者（69%）对高血压有立即的临床获益，6%在没有降压药物的情况下治愈，63%在小于或等于术前降压药物的情况下改善。干预后，17%的患者肾功能中度下降(60 mL/分钟eGFR显著增加（从51%增加到69%；P = 0.002）。在整个队列中，肾功能（平均eGFR）从71.9 mL/min + 5.8显著增加到80.8 mL/min + 5.2 （P = 0.007）。长期结果：无复发或加重高血压（收缩压为>40，舒张压为bbb90）（93%， 75%和41%），无肾功能降低（eGFR）
Objectives: The purpose of this study was to evaluate short and long-term outcomes of percutaneous transluminal intervention in patients with symptomatic renal artery stenosis due to fibromuscular dysplasia (RAFMD) and/or the combination of RAFMD with aorto-ostial atherosclerotic disease.Methods: A retrospective analysis of all patients with renal artery RAFMD who underwent transcath.eter therapy between January 1999 and December 2009 was performed. Blood pressure (BP) measurement, number of BP medications, and hypertension defined by a systolic BP >140 +/- diastolic BP >90 were recorded. Renal function was defined by estimated glomerular filtration rate (eGFR). Restenosis was defined by stenosis >60% and was determined by renal artery duplex and/or angiography. Freedom from event (restenosis, renal failure, or recurrent hypertension) was performed using life table analysis.Results: Forty-three procedures were performed on 35 patients with RAFMD. Thirty-two patients (91%) were women, with mean age of 61.9 years old. Technical success was 100% with adjunctive stent placement required in the FMD segment for dissection in 1 patient (2.3%) and in the non-FMD aorto-ostial atherosclerotic lesion in 4 patients (9.3%). Short-term outcomes: the majority (69%) had an immediate clinical benefit for hypertension, 6% were cured without BP medications, and 63% improved with less than or equal to preoperative BP medications. Postintervention, 17% remained at moderately reduced renal function (60 mL/minute eGFR increased significantly (from 51% to 69%; P = .002). For the entire cohort, renal function (mean eGFR) significantly increased from 71.9 mL/minute + 5.8 to 80.8 mL/minute + 5.2 (P = .007). Long-term outcomes: freedom from recurrent or worsening hypertension (>140 systolic blood pressure [SBP] and >90 diastolic blood pressure [DBP]) was (93%, 75%, and 41%) and freedom from reduced renal function (eGFR