Renal Artery Stenosis in Patients with Peripheral Artery Disease: Prevalence, Risk Factors and Long-term Prognosis
Renal Artery Stenosis in Patients with Peripheral Artery Disease: Prevalence, Risk Factors and Long-term Prognosis
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DOI：
10.1016/j.ejvs.2016.10.029
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发表时间：
2017-03-01
影响因子：
5.7
通讯作者：
Lacroix, P.
中科院分区：
文献类型：
--
作者：
Aboyans, V.;Desormais, I.;Lacroix, P.
目的/背景：目的是确定接受数字减影血管造影（DSA）评估外周动脉疾病（PAD）的患者肾动脉狭窄（RAS）的患病率和临床决定因素，并评估其预后意义。方法：回顾性分析2000年1月至2006年1月进行的所有dsa，以评估未经历过任何下肢动脉血运重建的患者的PAD。所有的DSA研究都由两名对结果不知情的资深医生阅读，在有分歧的情况下达成共识。RAS定义为双肾动脉存在>= 50%狭窄。系统地审查了患者的电子医疗档案，并通过与家庭医生联系完成了随访，直至2014年1月。主要结局为复合结局，包括死亡、外周血运重建或任何肢体截肢。次要结局是全因死亡率，以及另一种复合结局，包括死亡和非致死性心肌梗死或中风或冠状动脉或颈动脉血运重建。结果：共研究了400例连续下肢首次DSA患者，其中三分之二为重度肢体缺血。13例患者因肾动脉显像差而被排除。57例(14%)患者检测到RAS。在多变量分析中，只有两个因素与RAS独立且显著相关：弥漫性PAD（累及近端和远端节段[比值比{OR} 3.50, 95%可信区间{CI} 1.16-10.54; p = 0.026]）和肾小球滤过率降低(比值比{OR} 0.55 / 30 mL/ min /1.73 m(2), 95% CI 0.41-0.75；p
Objective/Background: The objective was to determine the prevalence and clinical determinants of renal artery stenosis (RAS) in patients undergoing digital subtraction angiography (DSA) for the assessment of peripheral artery disease (PAD), and to evaluate its prognostic significance.Methods: All DSAs performed from January 2000 to January 2006 were retrospectively reviewed for assessment of PAD in patients naive for any prior revascularisation of lower-limb arteries. All DSA studies were read by two senior physicians blinded to outcome, and consensus was reached in cases of disagreement. RAS was defined as the presence of >= 50% stenosis in either renal artery. Patients' electronic medical files were systematically reviewed and follow-up was completed by contact with family physicians until January 2014. The primary outcome was composite, including death, peripheral revascularisation, or any limb amputation. Secondary outcomes were all-cause mortality, and another composite, including death and non-fatal myocardial infarction or stroke or coronary or carotid revascularisation.Results: In total, 400 consecutive patients having a first DSA of lower extremities, two thirds of whom were for critical limb ischaemia, were studied. Thirteen patients were excluded owing to poor renal artery imaging. RAS was detected in 57 patients (14%). Only two factors were independently and significantly associated with RAS in multivariate analysis: diffuse PAD (involving both proximal and distal segments [odds ratio {OR} 3.50, 95% confidence interval {CI} 1.16-10.54; p =.026]) and decreased glomerular filtration rate (OR 0.55 per 30 mL/ minute/1.73 m(2), 95% CI 0.41-0.75; p