肾动脉纤维肌性发育不良诊治进展

1938年Ledbetter等首次报道了血管纤维肌性发育不良的临床表现,但直至1961年才由Palubinskas等经血管造影证实,将这类病因不明的系统性血管疾病命名为纤维肌性发育不良(fibromuscular dysplasia,FMD)[1],并逐渐为医师所认识。FMD主要病理变化为中、小动脉受损,严重时可导致动脉狭窄、闭塞,动脉瘤或动脉夹层[2]。这一病变可累及肾动脉、颈动脉、椎动脉、颅内动脉、髂动脉及肠系膜动脉等,偶尔也可累及冠状动脉。研究显示最常累及的血管为肾动脉,约占FMD的80%,其他20%~     

经皮血管成形术治疗肾动脉纤维肌性发育不良的临床疗效

目的评价经皮血管成形术（PTA）治疗肾动脉纤维肌性发育不良（FMD）的疗效及安全性。方法连续入选我院近6年来因严重高血压入院,经肾动脉造影确诊为肾动脉FMD并行PTA的患者。回顾性分析其临床特点,并随访血压、降压药使用情况和PTA治疗效果。结果共入选20例患者,年龄13～47岁（平均24.5±7.8岁）,其中女性12例（60.0%）。肾动脉造影显示共23条肾动脉受累,其中21条肾动脉直径狭窄〉60%的患者行肾动脉成形术,包括单纯球囊扩张17例（80.9%）,球囊扩张加支架置入4例（19.1%）,技术成功率为95.2%（20/21）。经过1～6年随访,改为肾动脉逐年累积再狭窄发生率为15.0%,20.7%,26.3%,33.7%,33.7%,33.7%。结论 PTA治疗肾动脉FMD安全有效。     

肾动脉纤维肌层发育不良合并肾血管畸形所致难治性高血压一例

患者,女性,28岁.因＂间断头晕8年＂入院.患者8年前开始无明显诱因出现间断头晕,持续1～2分钟可自行缓解.2004年及2005年先后诊断为＂继发性高血压、嗜铬细胞瘤＂、＂原发性高血压＂。     

纤维肌性发育不良致肾梗死一例

患者,女性,45岁。因持续性腰背部疼痛2天,伴恶心、腹胀,停止排便,肛门有排气,无呕吐、腹泻,无畏寒、发热。体格检查：血压140／90mmHg。腹平软,左下腹压痛,无反跳痛、肌紧张。肝脾肋下未触及,移动性浊音阴性,左肾区轻度叩痛,肠鸣音正常,腹部未闻及血管杂音。     

肾动脉纤维肌性发育不良患者临床与血管造影特征的18年单中心病例总结

目的:旨在了解我国肾动脉纤维肌性发育不良(RA-FMD)患者的临床和血管造影特征.方法:回顾性连续收集中国医学科学院阜外医院2000年11月1日至2018年10月31日确诊RA-FMD的住院患者142例,分析其人口学、临床和血管造影资料,并与最近欧美纤维肌性发育不良注册数据库患者进行比较.结果:142例RA-FMD患者...     

裸支架辅助弹簧圈治疗纤维肌性发育不良所致肾动脉狭窄合并巨大动脉瘤一例

<正>1临床资料患者女性,33岁,1个月前常规体检超声发现右肾巨大动脉瘤,为求进一步诊治入院。既往无特殊病史,不吸烟,无高血压、糖尿病及高脂血症。入院体格检查：体温36.2℃,脉搏65次/min,呼吸18次/min,血压120/82 mmHg(1 mmHg=0.133kPa),未发现阳性体征。实验室检查：血钾4.4mmol/L,血钠143.1 mmol/L,血肌酐82.0μmol/L,尿素氮6.0 mmol/L,空腹血糖4.5 mmol/L,低密度脂蛋白胆固醇（LDL-C）2.5 mmol/L,血沉6 mm/L,C反应蛋白2.0 mg/L。同步四肢血压监测示：     

纤维肌性发育不良

纤维肌性发育不良（fibromuscular dysplasia，FMD）国内又称纤维肌性发育异常、纤维肌肉发育不良、纤维肌性结构不良、纤维肌肉发育异常等，是一种累及动脉的非动脉粥样硬化性和非炎症性血管疾病，病理特点为血管壁的增生性纤维结构不良，造成血管的局限性狭窄，从而导致病变血管供应器官缺血，最常累及肾动脉，其次是颈内动脉，亦可出现其他部位的病变，临床表现与病变血管的部位及病变程度相关，可从无症状到出现类似血管炎的系统受累的表现。年轻女性多见，男女比可达1：4，发病年龄多在15～50岁。[第一段]     

纤维肌性发育不良的研究进展

纤维肌性发育不良(FMD)是一种不明原因的节段性、非动脉粥样硬化性、非炎症性疾病,常累及肾动脉和颈动脉,是年轻人缺血性卒中的原因之一.随着各种血管造影技术的发展,FMD的检出率越来越高.文章对FMD的研究进展做了综述.     

肾动脉狭窄的介入治疗及其并发症

经皮腔内肾动脉成形术（ＰＴＲＡ）可用于肾动脉狭窄所致的高血压治疗。短期及中远期疗效好，并发症发生率不高，再狭窄率低。     

Response of blood pressure after percutaneous transluminal renal artery angioplasty and stenting

AIM: To evaluate the short and intermediate term out-come of percutaneous transluminal renal artery angioplasty (PTRA) and stenting particularly on blood pressure (BP) control and renal function and to evaluate predictors of poor BP response after successful PTRA and stenting. METHODS: We conducted a prospective analysis of all patients who underwent PTRA and stenting in our institute between August 2010 to September 2012. A total number of 86 patients were underwent PTRA and renal stenting. Selective angiography was done to confirm at least 70% angiographic stenosis. The predilatation done except few cases with critical stenosis, direct stenting was done in the rest of cases. All patients received aspirin 325 mg orally, and clopidogrel 300 mg orally within 24 h before the procedure. Heparin was used as the procedural anticoagulant agent. Optimal results with TIMI-Ⅲ flow obtained in all cases. Following stent placement, aspirin 150 mg orally once daily was continued for a minimum of 12 mo and clopidogrel 75 mg orally once daily for at least 4 wk. The clinical, radiological, electrocardiography, echocardiography and treatment data of all patients were recorded. The BP measurement, serum creatinine and glomerular filtration rate (GFR) were recorded before the procedure and 1 and 6 mo after PTRA. RESULTS: A total of 86 patients were included in the study. The mean age of study population was 55.87±11.85 years old and 67 (77.9%) of patients were male. There was a significant reduction in both systolic and diastolic BP at 1 mo after the procedure: 170.15±20.10 mmHg vs 146.60±17.32 mmHg and 98.38±10.55 mmHg vs 89.88±9.22 mmHg respectively (P=0.0000). The reduction in BP was constant throughout the follow-up period and was evident 6 mo after the procedure: 144.23±18.19 and 88.26±9.79 mmHg respectively (P=0.0000). However, no improvement in renal function was observed at any time during the follow-up period. After multivariate analysis, we found male sex, low GFR (<60 mL/min) and higher baseline mean BP as a poor predictors of successful outcome on BP response after PTRA and stenting. CONCLUSION: The PTRA and stenting can be considered as an effective therapeutic intervention for improving BP control with minimal effect on renal function. The male sex, higher baseline BP and low GFR are associated with poor BP response after successful PTRA and stenting.     

Percutaneous transluminal renal stenting for transplant renal artery stenosis

Objectives : Renal transplantation is a well‐accepted therapeutic option for patients with end stage renal disease. Renal artery stenosis occurring in a transplanted kidney is a potentially serious condition and adversely affects graft survival and prognosis. The objective of this study is to document the immediate and intermediate term clinical results of renal stenting in this rare subset of renal artery stenosis. Background: There is limited data about the effectiveness of renal stenting in transplant renal artery stenosis. Methods : Eight patients, aged between 22 and 51 (42.5 ± 9.25) years, were referred to our tertiary care interventional cardiology services for renal intervention. The diagnosis of transplant renal artery stenosis was based on clinical presentation (uncontrolled hypertension (n = 4, 50%), worsening renal function (n = 3, 37.5%) or flash pulmonary oedema (n = 1, 12.5%)] and Doppler ultrasound. Results : All patients had live donor renal transplant using end to end anastomosis 2 to 11 (6.25 ± 3.24) months prior to intervention. Angiography revealed discrete stenosis at the anastomotic site. Intrarenal stenting performed from femoral access using 6 F accessories produced excellent angiographic results. There were no access site or procedure related complications. The intervention produced excellent immediate and intermediate term clinical results. In three patients, there was stabilization of renal function during 62 ± 9.16 months of follow‐up with decrease in serum creatinine by 38.86 ± 6.62 %; P = 0.0476. In four patients with refractory hypertension, excellent blood pressure control was achieved with a reduction in mean blood pressure by 25.95 ± 5.48 mm Hg (from 122.4 ± 5.7 to 96.45 ± 2.45 mm Hg; P = 0.0002) during 65.25 ± 23.79 months follow‐up. There was decrease in antihypertensive drug requirement from 3.75 ± 0.5 to 1.75 ± 0.5. During follow‐up, Doppler ultrasound documented a high peak systolic velocity in one asymptomatic patient with well controlled blood pressure and preserved renal function. Sustained benefits of percutaneous revascularization were supported by normal Doppler parameters in the remaining patients. Conclusions : Percutaneous renal stenting provides excellent angiographic and clinical results sustained at intermediate term follow‐up in patients with symptomatic transplant renal artery stenosis. © 2011 Wiley‐Liss, Inc.     

Fibromuscular dysplasia in an adult male as a cause of renal artery stenosis and secondary hypertension treated with renal artery stenting

Background

Renovascular hypertension due to fibromuscular dysplasia is an uncommon cause of secondary hypertension and is more common in females. This entity is an important treatable cause of secondary hypertension.

动脉硬化性肾动脉狭窄行经皮肾动脉成形支架植入术后临床疗效分析

目的 探讨经皮肾动脉成形支架植入术在治疗动脉硬化性肾动脉狭窄时对患者血压和肾功能的影响。方法 2010年7月至2013年7月共有48例动脉硬化性肾动脉狭窄患者行肾动脉成形支架植入术,根据其术前肾功能情况将患者分为两组,A组患者（20例）术前估测肾小球滤过率（eGFR）＜60ml/（min·1.73m2）,B组患者（28例）术前eGFR≥60ml/（min·1.73m2）。结果 48例患者共植入了52个支架,随访24个月,患者的收缩压和舒张压较术前明显下降,差异具有统计学意义（P＜0.05）。A组患者的术后eGFR较术前明显升高,差异具有统计学意义（P＜0.05）。结论 肾动脉成形支架植入术对于动脉硬化性肾动脉狭窄患者是一种安全有效的治疗方法,可有效降低患者血压,术前已经出现轻中度肾功能损害的患者术后肾功能得到明显改善。     

Percutaneous transluminal angioplasty of the popliteal artery without the use of stents: A review of 116 consecutive procedures

PURPOSE

To evaluate the safety and efficacy of percutaneous transluminal angioplasty (PTA), without the use of stents, for the treatment of popliteal artery stenosis.

METHODS

From March 1997 to December 2003, 116 consecutive PTAs of the popliteal artery were performed in 98 patients. All patients underwent preoperative and postoperative colour duplex scans and preoperative angiography. In all cases, the superficial femoral artery was patent and without significant stenosis. Follow-up patency was assessed by clinical examination and colour duplex scanning in all patients.

RESULTS

There was no perioperative mortality. Primary patency after two years was 86% for intermittent claudication (IC) patients and 54% for critical limb ischemia (CLI) patients. Secondary patency rates were 98% for IC patients versus 92% for CLI patients after one year, 94% for IC patients versus 83% for CLI patients after two years and 69% for IC patients versus 7% for CLI patients after five years (P<0.001).

CONCLUSION

Popliteal artery PTA is safe and efficient, especially in IC patients with single lesions.     

经皮肾动脉腔内成形术治疗肾血管性高血压40例

本文报道经皮肾动脉腔内成形术(PTRA)40例,其中大动脉炎26例,纤维结构发育不良10例,动脉粥样硬化4例,合并缺血性肾萎缩7例。总技术成功率为82.6%,近期临床治愈—显效率为78.8%。21例随访6～58个月(平均21.8个月),远期临床治愈—显效率为85.7%,其中大动脉炎(13/15例)为86.7%。本文对适应证选择、技术操作及并发症等同题进行了讨论。     

髂动脉及股动脉内支架植入术的长期临床

目的 本项研究分析了经皮腔内成形术及支架植入术治疗髂动脉及股动脉动脉硬化性狭窄的早期及晚期临床疗效。方法和结果 从１９９４年１２月至１９９７年３月,为３３名患者的３７条髂、股动脉血管内植入４３个Ｗａｌｌｓｔｅｎｔ支架,手术全部成功。临床随访（２６±１４）个月,术后间歇性跛行及休息痛等症状均消失。２３例患者中的１７例（２０条血管）进行血管造影随访,随访时间（１０ ± ５）个月。血管造影随访时髂动脉支架内再狭窄率为０（０／８）;股动脉再狭窄率为３３％（３／９）,全部３例患者的３条再狭窄的股动脉,均成功地再次行ＰＴＡ。结论 髂动脉和股动脉ＰＴＡ和支架术是一种安全有效的方法,成功率高,并发症少。     

颈内动脉肌纤维发育不良患者的DSA诊断和治疗

目的探讨颈动脉肌纤维发育不良（FMD）患者的临床特征、诊断及治疗。方法从南京卒中注册系统中检索出2010年5月—2011年5月的6例颈动脉肌纤维发育不良患者,提取这些患者的临床表现、实验室检查和影像学检查、治疗和随访结果等资料。6例FMD患者中1,例合并颈内动脉闭塞,1例合并大脑中动脉闭塞,2例合并夹层动脉瘤。对本组患者的治疗措施有,单纯给予3例患者抗血小板聚集药物治疗;1例患者因合并烟雾病未行抗血小板聚集治疗,只进行对症治疗;2例患者接受颈动脉支架置入及药物治疗。结果①6例FMD患者均经DSA确诊,均有颈内动脉管壁不规则或串珠样改变4,例患者表现为双侧FMD,2例表现为左侧FMD;②给予相应治疗后,6例患者均未出现新发症状,原有症状缓解,2例接受颈内动脉支架置入术的患者,术后均无残余狭窄。③3个月随访均未见缺血事件发生。接受支架置入术的患者,术后6个月复查DSA,支架形态良好,无再狭窄。结论 FMD患者可合并颈内动脉闭塞或颈内动脉夹层动脉瘤。血管内成形术可作为目前有效且安全的治疗方法之一。     

Concomitant renal and iliac fibromuscular dysplasia

Fibromuscular dysplasia (FMD) usually involves the renal arteries and is an important cause of secondary hypertension in younger women. We report an unusual case of FMD in a middle‐aged woman, not only involving both the renal and iliac arteries but also presenting in a pattern more typical of atherosclerosis. © 2009 Wiley‐Liss, Inc.