支架植入术治疗肾血管性高血压的中远期疗效

目的:评价肾动脉内支架植入术(PTRAS)治疗肾血管性高血压的中远期疗效。方法:对42例肾血管性高血压(动脉粥样硬化性肾动脉狭窄21例,静止性大动脉炎肾动脉狭窄18例,肌纤维发育不良肾动脉狭窄3例),成功的施行PTRAS治疗肾动脉狭窄,采用彩色多普勒超声、CTA、定期门诊检查及肾动脉造影随访12～60月。全部病例均根据临床血压进行疗效评价。结果:支架植入术技术成功率100%。近期疗效(≤3月):42例患者高血压治愈者24例(57.14%)、改善者13例(30.95%)、无效者5例(11.90%)。中期疗效(4～12月):42例患者高血压治愈者17例(40.5%)、改善者19例(45.2%)、无效者6例(14.3%)。远期疗效(≥13月):42例患者高血压治愈者16例(38.1%)、改善者17例(40.5%)、无效者9例(21.4%)。≥3年疗效:24例高血压患者治愈者16例、改善者6例、2例无效。随访中有10例发生支架内再狭窄,行经皮腔内肾动脉成形术(PTRA)后,有6例血压改善。结论:PTRAS治疗肾血管性高血压中远期临床疗效肯定,支架内再次狭窄,大部分病例行PTRA可取得满意的疗效。     

Percutaneous angioplasty for renovascular hypertension due to fibromuscular dysplasia.

Because the cause of hypertension is reversible in only 5 percent of patients, extensive initial work-up should only be considered in selected cases. Secondary causes should be suspected in patients whose hypertension begins before age 30 or after age 50 and in patients whose hypertension suddenly worsens after a long period of good control, becomes severe or malignant, or remains refractory to maximal medical therapy. A sudden reduction in renal function in a hypertensive patient and the discovery of a unilateral small kidney may also raise suspicion of a secondary cause. Renovascular disease, one of the most common secondary causes of hypertension, is usually the result of atherosclerosis in older patients and the result of fibromuscular dysplasia in younger patients. Physical examination seldom contributes to the diagnosis. The classic upper abdominal or flank bruit occurs in only 30 to 50 percent of patients with renovascular disease, and is not uncommon in patients with essential hypertension. The gold standard for diagnosis of renovascular disease remains the arteriogram. Transluminal renal angioplasty may be performed during arteriography if a high-grade stenosis is identified. Other management options include medical therapy and surgical revascularization with grafts.     

Percutaneous transluminal angioplasty for atheromatous renal artery stenosis--blood pressure response and discriminant analysis of outcome predictors

Percutaneous transluminal angioplasty was performed in 39 consecutive patients with atheromatous renal artery stenosis associated with hypertension. The mean blood pressure before angioplasty was 191/107 mmHg and this had dropped to a mean of 167/90 mmHg at the patient's most recent visit, representing a significant fall in both systolic (p less than 0.01) and diastolic pressures (p less than 0.001). The mean serum creatinine was 166.7 mumol/l before percutaneous transluminal angioplasty and 155.3 mumol/l at the most recent visit (not statistically significant). The mean number of anti-hypertensive drugs fell from 2.4 to 1.9 after percutaneous transluminal angioplasty (p less than 0.05). Three patients (eight per cent) were 'cured' (diastolic blood pressure less than 90 mmHg without medication), 25 (64 per cent) had 'improved' (diastolic blood pressure less than 109 mmHg, with a fall of more than 15 per cent) and 11 (28 per cent) had not improved. Logistic discriminant analysis showed that pre-percutaneous transluminal angioplasty diastolic blood pressure, age, serum creatinine and smoking habit together correctly predicted the outcome of percutaneous transluminal angioplasty in 90 per cent of patients, with four 'false positives' and no 'false negatives'. Ten patients suffered a total of 12 serious complications related to the procedure: one death in acute renal failure, one myocardial infarction, one severe hypotension just after the procedure, one deep vein thrombosis, one episode of transient ischaemia of the toes and seven groin haematomas. Thus percutaneous transluminal angioplasty for atheromatous renal artery stenosis rarely 'cures' hypertension, but improved blood pressure control is often achieved, albeit at the expense of troublesome complications. A prospective, randomized trial is needed to establish whether or not the improvement is due directly to percutaneous transluminal angioplasty.     

Percutaneous transluminal angioplasty following endarterectomy

Prior to the introduction of percutaneous transluminal angioplasty (PTA), bypass grafting or endarterectomy was the treatment of choice for aortoiliofemoral atherosclerotic occlusive disease. Currently, PTA is a well-established procedure for the treatment of aortoiliofemoral atherosclerotic occlusive disease. PTA is as effective as, and safer than, surgery in these cases. Percutaneous transluminal angioplasty and endarterectomy cause similar trauma to the arterial wall, i.e., intimal denudation, plaque disruption and splitting, and medial disruption, splitting, and overstretching. Both PTA and endarterectomy heal in a similar manner, i.e., neointima formation and scarring. Both PTA and endarterectomy can be repeated. Therefore, PTA can be performed after endarterectomy or vice versa. Several patients with recurrent occlusive disease after endarterectomy have been safely treated with PTA. Our results obtained with PTA in patients who had a prior endarterectomy are comparable to the results obtained in patients who did not have a prior endarterectomy. No complications have been encountered. A previous endarterectomy does not preclude a subsequent PTA, or vice versa, in patients with recurrent occlusive disease.     

肾动脉球囊成形术或支架置入治疗肾血管性高血压

目的　评估球囊成形术或支架置入治疗肾血管性高血压的安全性和疗效。方法　对 2 1例患者共 2 7条肾动脉狭窄 ,应用单纯高压球囊扩张或置入球囊扩张支架治疗。结果　 2 7条病变动脉 ,2 0条扩张满意 ,7条狭窄肾动脉预扩张支架置入后 ,1例病变残余狭窄 11% ,其余 6条无残余狭窄。 2 1例患者血压均有明显下降 ,收缩压从 172± 11mmHg降至 12 6± 8mmHg ;舒张压从 115± 7mmHg降至 79± 6mmHg。 15例停用降压药血压仍正常。另 6例降压药从 4种减至 1种 ,血压仍能满意控制。结论　肾动脉扩张或支架置入是治疗肾血管性高血压简便、安全、有效的方法     

Short-term blood pressure variability in renovascular hypertension and in severe and mild essential hypertension

This study was designed to examine short-term blood pressure variability (BPV) in patients with different severity and forms of chronic medically treated hypertension. Power spectral analysis of BPV was performed from continuous finger blood pressure (Finapres) recordings. Ten patients with renovascular hypertension (RVHT), 34 with severe essential hypertension (SEHT) and 29 with mild essential hypertension (MEHT) as well as healthy age- and sex-matched control subjects were studied. The RVHT group was characterized by reduced low frequency (LF) power of both systolic and diastolic BPV (P =0.004 and P =0.003 respectively) when compared with the control group. There was also a tendency to lower total power of diastolic BPV (P =0.094). On the contrary, the SEHT group had increased total power of diastolic BPV (P =0.044). However, in the SEHT group, we found no differences in the LF and high frequency power of systolic and diastolic BPV when compared with controls. The MEHT group presented with lower LF power of systolic and diastolic BPV (P =0.028 and P =0.003 respectively) and, in addition, high frequency power of diastolic BPV was lower than in the control group (P =0.020). When the hypertensive groups were compared with each other, total power and LF power of diastolic BPV (P =0.043 and P =0.039 respectively) were lower in the RVHT group than in the SEHT group. In addition, total power of diastolic BPV was lower (P =0.030) in the MEHT group than in the SEHT group. No differences were observed in BPV between the RVHT and MEHT groups. The results show that BPV in hypertensive patients groups behaved differently. This suggests that both the aetiology and severity of hypertension have a significant influence on short-term BPV measured in laboratory conditions and that different control mechanisms are operating in these clinically distinctly different hypertension groups.     

Pressor-depressor factors in renal vein blood in patients with renovascular hypertension

Development of renovascular hypertension was investigated in 68 patients. Interrelated defects found in components of renal pressor-depressor system may be a contributing factor in the disease onset. Contralateral pressor-depressor system is the first to start regulating deranged regional and general hemodynamics in functional failure of the kidneys. In organic lesion occurring in the affected kidney later than in the contralateral one, there is compensatory depressor activation upon the distress of the pressor function. This may be aimed at maintenance of adequate microcirculatory blood flow and metabolism.     

Percutaneous transluminal angioplasty of the abdominal aortic bifurcation

Percutaneous transluminal angioplasty (PTA) of the abdominal aortic bifurcation was performed in three patients with atherosclerotic disease. All three patients had experienced severe claudication on exertion. The dilatations were performed with Gruntzig balloon catheters after determination of a significant pressure gradient (greater than 20 mm Hg) across the stenotic lesions. Follow-up at 9, 12, and 23 months revealed no recurrent symptoms. Balloon dilatation of the distal abdominal aorta is safe and effective and eliminates the risk of impotence that is common after vascular reconstruction.     

经皮腘下动脉腔内血管成形术初步经验分析

目的观察了解经皮腔内血管成形术(PTA)在治疗下肢动脉闭塞症腘下段病变中的可行性和短期效果。方法选取4例下肢动脉硬化闭塞症患者,对其7支腘下动脉的15处病变进行PTA治疗,观察术中及术后患者的临床和血管造影表现,并对其中3例患者进行短期(<12个月)随访。结果PTA技术成功率60%(9/15),PTA后放置支架6枚;术后1例出现骨筋膜室综合征而截肢;术后6个月的血管通畅率50%(3/6),血管病变复发率38.5%(5/13);1例于术后9个月余截除第一趾。结论在明确病变远侧流出道情况下,经皮腘下动脉腔内血管成形术对于严重下肢缺血的患者具有肯定的近期疗效。     

Percutaneous transluminal angioplasty of the subclavian arteries.

PURPOSE: To review the feasibility, risks, and long-term results of subclavian artery angioplasty with and without Palmaz stent placement. METHODS: Over a 9-year period, 113 patients (67 males; mean age 63 +/- 13 years) underwent percutaneous balloon angioplasty of subclavian occlusive lesions for a variety of indications: vertebrobasilar insufficiency (n = 70), upper limb ischemia (n = 50), coronary steal syndrome (n = 6), or anticipated coronary artery bypass grafting using the internal mammary artery in 12 asymptomatic patients. There were 94 (83%) stenoses and 19 (17%) occlusions with a mean percent stenosis of 80.1% +/- 7.4% (range 70 to 100). Mean lesion length was 24 +/- 8 mm (range 10 to 50). Beginning in 1989, stents were implanted for suboptimal dilation; in 1995, stenting became routine. RESULTS: Overall, 103 (91%) of 113 lesions were successfully treated; 10 (53%) occlusions could not be recanalized. Fifty-one stents were implanted in 46 patients. There were 3 (2.6%) procedural complications: a transient ischemic attack, one major (fatal) stroke, and an arterial thrombosis 24 hours after the procedure (treated medically) (0.9% major stroke and death rate). During a mean 4.3-year follow-up (range to 10), 16 (15.5%) restenoses were treated with angioplasty (n = 4), stenting (n = 7), or surgery (n = 5). Primary and secondary patencies for all treated lesions (n = 113) at 8 years were 75% and 81%, respectively; in patients without initial stent placement, the rates were 69% and 76%, while in those with stents, the rates rose slightly to 87% and 94% at 2.5 years (NS). Patency rates for all 103 recanalized lesions were 83% and 90% at 8 years (81% and 90% without stent and 87% and 94% with stent at 2.5 years, respectively [NS]). CONCLUSIONS: Balloon angioplasty with or without stenting is safe and effective for treating subclavian artery occlusive diseases with good long-term patency. Recanalization of occlusions is more difficult to achieve. Stents (implanted only for suboptimal dilation) do not seem to improve long-term patency.     

血管成形术治疗透析用动静脉内瘘狭窄

目的 探讨血管成形术在治疗血液透析动静脉内瘘狭窄中的作用. 方法 选择2006年7月至2013年2月中国中医科学院西苑医院37例血液透析动静脉内瘘狭窄闭塞的患者进行经皮腔内血管成形术治疗经肱动脉顺行穿刺,行前臂动脉造影检查及动静脉内瘘狭窄血管段球囊扩张血管成形术.结果 37例患者中34例成功进行了血管成形治疗,术后造影显示血管狭窄消失,术后透析血流量大于250ml/min,满足血液透析需求,技术成功率及临床成功率均为91.9％,术后平均随访12.3个月,3、6和12个月初始通畅率分别为94.2％、88.5％和78.3％,术中未出现严重并发症.结论 血管成形术是治疗血液透析动静脉内瘘狭窄的有效方法,甚至可作为治疗血液透析动静脉内瘘狭窄的首选方法.     

老年高血压患者血压变异性对肾功能的影响

目的探讨老年人群中血压变异性与肾功能损害之间的关系。方法纳入123例老年高血压患者,计算入组患者的肾小球滤过率(GFR),以90 m L/min为临界值将其分为肾功能正常组和肾功能异常组,监测患者的24 h动态血压。结果 (1)肾功能正常组白天的收缩压变异性明显小于肾功能异常组,但是白天的平均血压肾功能正常组却显著高于肾功能异常组;(2)年龄、白天收缩压的变异性与GFR呈负相关,而全天的舒张压,白天的舒张压、平均血压,夜间的舒张压与GFR呈正相关。结论血压变异性尤其是收缩压的变异性与肾功能不全独立相关。     

球囊导管成形术加血管内支架治疗Budd-chiari综合征

目的 :探讨球囊导管成形术 (PTA)加放置血管内支架治疗Budd -chiari综合征 (BCS)的价值。方法 :对 12例BCS患者 ,其中下腔静脉闭塞型 8例 ,肝静脉闭塞型 3例 ,混合型 1例 ,先行PTA ,再放置血管内支架。结果 :所有患者均置管成功 ,术后下腔静脉和肝静脉狭窄部直径分别由 1 0 4± 0 .3 8mm增加至 14 5 9± 1 2 5mm ,平均静脉压由 3 0± 6cmH2 O( 1cmH2 O =0 .0 98kPa)降至 15± 1 4cmH2 O。主要症状体征除 1例死亡外 ,其余 11例消失或基本消失 9例 ( 81 8% ) ,明显改善或缓解 2例 ( 18 2 % )。随访 7例无 1例发生再闭塞。结论 :PTA加内支架具有损伤小、疗效显著、再闭塞发生率低等特点 ,因此 ,应作为BCS治疗的首选方法