移植肾动脉狭窄病因及介入治疗疗效分析

目的探讨移植肾动脉狭窄(TRAS)的病因、介入治疗的疗效及安全性。方法对2000年至2005年经移植肾动脉造影确诊为TRAS的23例患者的临床资料进行回顾性分析。男19例,女4例。年龄23～62岁,平均44岁。23例术后均采用环孢素(CsA)或他克莫司(FK506)加吗替麦考酚酯(MMF)加泼尼松(Pred)三联免疫抑制治疗,其中以CsA治疗为主者14例(60.9%),以FK506治疗为主者9例(39.1%)。结果23例TRAS患者中发生急性排斥反应(AR)者13例(56.5%);移植肾功能延迟恢复(DGF)者4例(17.4%);吻合技术原因致吻合口狭窄者1例(4.3%),移植术后1周切除移植肾,再次移植成功;TRAS原因不明者5例(21.7%)。经造影确诊为移植肾动脉狭窄时间为移植术后1周～4年,平均(12±11)个月。单纯吻合口狭窄12例,单纯主干狭窄9例,吻合口并主干狭窄1例,吻合口并受体髂动脉狭窄1例。22例经介入治疗,13例(59.1%)肾功能于1周内恢复,8例(36.4%)2～3周内恢复,1例(4.5%)随访3个月肾功能无变化;造影剂肾毒性导致血肌酐一过性升高者5例,发生移植肾动脉血栓和腹股沟血肿各1例。结论同种异体肾移植术后TRAS与移植肾血管吻合技术、AR及DGF有关。移植肾动脉造影是确诊金标准,一经确诊应立即行球囊扩张或血管内支架治疗,注意并发症的发生。     

血管内支架成形术治疗移植肾动脉狭窄

一、资料和方法肾移植患者3例,男性2例,女性1例。3例均为供肾动脉同受者髂动脉端端吻合。移植时间0.5～9年。临床主要症状为进行性高血压,且用降压药效果不佳;肾功能受损,表现为血尿素氮,肌酐逐渐升高,尿量减少伴双下肢浮肿。3例均采用对侧股动脉穿刺Ｓｅｌｄｉｎｇｅｒ技术行移植肾动脉造影证实移植肾动脉狭窄的部位和程度。然后用4～6ｍｍ球囊导管,直径选择以邻近正常血管直径为标准。在透视下将球囊导管置入狭窄动脉处,反复扩张球囊至球囊壁上切迹消失,再放置内径6ｍｍ的Ｓｔｒｅａｋｅｒ支架(Ｂｏｓｔｏｎ公司,美国),造影复查了解血管成…     

介入治疗移植肾动脉狭窄一例

我院收治1例。肾移植后并发移植肾动脉狭窄（TRAS）者，采用经皮血管腔内成形术（PTA）及留置支架治疗后痊愈，现报告如下。     

儿童移植肾动脉狭窄的处理及临床疗效分析

目的探讨血管介入治疗在儿童移植肾动脉狭窄(transplantation renal artery stenosis, TRAS)中应用的临床疗效。方法回顾性分析2013年1月至2021年9月在郑州大学第一附属医院肾移植科诊断为移植肾动脉狭窄的儿童受者的临床资料, 比较血管介入治疗前后及末次随访时的血肌酐水平及移植肾动脉收缩期峰值(peak systolic velocity, PSV)、叶间动脉PSV和峰值流速后比值变化。结果 238例儿童肾移植受者中6例诊断为TRAS, 发生率2.5%, 手术时的中位年龄为12岁(9～17岁), 确诊TRAS时的中位时间为术后4个月(1.7～18.0个月), 随访中位时间6.6年(2.5～8.0年)。6例TRAS的儿童受者均经血管介入治疗, 其中经皮腔内血管成形(percutaneous transluminal angioplasty, PTA)治疗5例, 经皮血管内支架成形(PTAS)治疗1例。肌酐基础值为(75.2±27.9)μmol/L, 确诊TRAS时为(200.8±88.5)μmol/L, 较基础值显著升高(P=0.025), 而经血管...     

经皮穿剌血管盛开术治疗移植肾动脉狭窄

为了观察血管成形术在移植肾动脉狭窄的治疗作用。我们将１８例移植肾动脉狭窄并高血压的患者进行了血管成形术治疗。疗效以临床随访、血管造影和超声迫踪为评价。结果１８例患者手术均成功，成形术后，所有患者均治愈。认为血管成形术是移植肾动脉狭窄所致长期高血压和肾功能减退的有效的和首选的治疗方法。     

同种异体肾移植术后移植肾动脉狭窄 介入治疗的临床疗效分析

目的探讨同种异体肾移植术后移植肾动脉狭窄（TRAS）介入治疗的临床疗效。方法介入治疗同种异体肾移植术后TRAS患者22例,其中单纯球囊扩张治疗10例（球囊组）,内支架治疗12例（支架组）。对所有患者术前及术后2年内血压、肾功能以及生活质量进行评估,并与同期接受单纯药物治疗的6例TRAS患者（药物组）进行比较。结果球囊组技术成功率90.00%,支架组技术成功率100%。术后在血压及肾功能改善方面,球囊组和支架组均取得显著疗效,两组近期疗效未见明显差异,药物组疗效不满意。术后随访6个月～2年,支架组再狭窄率16.67%,除1例不明原因治疗无效外,其余11例均能比较健康的生活和工作。球囊组手术失败1例,再狭窄率达40.00%。结论内支架植入术可作为TRAS特别是I型及Ⅱ型狭窄的首选治疗方法。     

供肾动脉带主动脉袖口预防移植肾动脉狭窄

目的:探讨供肾动脉带主动脉袖口预防移植肾动脉狭窄的效果。方法:对955例(1030例次)行肾移植患者的肾移植供肾动脉,全部采用主动脉袖口与受者髂内动脉吻合。应用彩色多普勒血流B超及移植肾动脉血管造影排除移植肾动脉狭窄。结果:955例(1030例次)肾移植无一例出现移植肾动脉狭窄。结论:供肾动脉带腹主动脉袖口可以防止移植后肾动脉狭窄发生。     

经皮穿刺血管成形术治疗移植肾动脉狭窄

为了观察血管成形术在移植肾动脉狭窄的治疗作用。我们将18例移植肾动脉狭窄并高血压的患者进行了血管成形术治疗。疗效以临床随访、血管造影和超声追踪为评价。结果18例患者手术均成功，成形术后，所有患者均治愈。认为血管成形术是移植肾动脉狭窄所致长期高血压和肾功能减退的有效的和首选的治疗方法。     

成人移植婴幼儿供肾术后移植肾动脉狭窄

目的探讨成人受者接受小儿供肾移植术后发生的移植肾动脉狭窄临床特点、病因、诊断及治疗。方法回顾性分析2014年7月至2019年3月在华中科技大学同济医学院附属协和医院泌尿外科进行的25例小儿供者整块双肾移植和27例小儿供者单肾移植的临床资料(受者均≥18岁)。结果其中1例双肾移植成人受者(4.0%)和2例单肾移植受者(7.4%)在移植术后13～23个月诊断为移植肾动脉狭窄, 高于同期接受成人供肾的成人受者移植肾动脉狭窄率(1.1%)。移植肾动脉狭窄成人受者与非狭窄组比较, 其供者年龄更小(P<0.05), 但是供者、受者体重差异均无统计学意义(P>0.05)。狭窄部位内径1.40～1.63 mm, 均为移植肾动脉自供者腹主动脉起始部而非吻合口本身。肾动脉非狭窄段内径2.31～4.93 mm, 与相应年龄小儿正常肾动脉一致。3例移植肾动脉狭窄受者行经皮腔内血管成形及支架置入术后均得到有效治疗。结论移植肾动脉狭窄的原因可能与过度剥离肾动脉周围组织, 影响其术后继续发育相关。谨慎选择成人受者接受婴儿单供肾, 保留肾动脉周围组织可能有助于预防移植肾动脉狭窄。     

经皮血管成形术治疗移植肾动脉狭窄的临床分析

目的 探讨经皮血管成形术(PTA)治疗移植肾动脉狭窄(TRAS)的效果及预后.方法 回顾性分析白2002年4月至2008年12月经肾动脉造影检查证实为TRAS的10例患者临床资料.术前患者均接受血液透析治疗;术后采用三联免疫抑制治疗方案;初步诊断TRAS采用彩超检查方法,确诊应用移植肾动脉造影方式;采用PTA治疗10例移植肾动脉狭窄患者,观察治疗效果及患者预后.结果 10例患者经PTA治疗后均获临床治愈,其中8例术后血压及移植肾功能显著改善,2例术后发生肾功能延迟恢复(DGF),经血液透析治疗后肾功能恢复良女子.结论 PTA是治疗TRAS的安全、有效的方法,PTA治疗后出现的DGF是可以治愈的.     

The efficacy of hemodialysis in interventional therapy in coronary artery disease patients with chronic renal insufficiency

The aim of this study was to explore the efficacy and safety of hemodialysis in interventional therapy for patients with coronary artery disease combined with chronic renal insufficiency. With the aging and social development, the number of coronary artery disease patients with chronic renal insufficiency gradually increased. Total 58 coronary heart disease patients with chronic renal dysfunction were selected. These patients were characterized with typical angina symptoms and typical electrocardiogram (ECG) changes of onset angina. Continuous oral administration of sodium bicarbonate tablets 1?g 3/day?×?3 days and slow intravenous input sodium chloride 1000 ～1500 mL 3–12?h before operation were given. By this way, all patients were treated by hydration and alkalization. After percutaneous coronary intervention (PCI) treatment, patients were immediately transferred to undergo 4?h of dialysis treatment without removing indwelling of femoral artery puncture sheath tube to protect renal function. Changes in renal function including serum creatinine, glomerular filtration rate, and urine were observed and recorded. All patients were successfully underwent PCI treatment. Within one month after PCI, there were no obvious complication and no stent thrombosis occurred. Among of 58 patients, 56 cases showed no significant increase in serum creatinine levels compared with those before operation. However, serum creatinine level of one patient increased to 251?umol/L and one patient still required permanent dialysis. Using hemodialysis in interventional therapy in coronary artery disease patients with chronic renal insufficiency could significantly improve the prognosis of the patients.     

移植肾动脉狭窄的诊治(附3例报告)

目的探讨移植肾动脉狭窄的诊治方法. 方法回顾性分析253例肾移植术后发生的3例移植肾动脉狭窄(transplant renal artery stenosis, TRAS)的诊治经过. 结果 3例TRAS均发生于肾移植术后半年内,经彩超和肾动脉造影确诊.3例均行经皮穿刺移植肾动脉球囊扩张成形(percutaneous transluminal renal angioplasty, PTRA)和血管内支架置入,获临床治愈.随访15～24个月,无TRAS复发,移植肾功能正常. 结论彩超是筛选TRAS的首选检查方法,肾动脉造影是TRAS的确诊手段.PTRA/血管内支架置入是治疗TRAS的安全、有效和首选方法.     

Minimally invasive salvage therapy for transplanted renal allografts

Abstract

Purpose: To evaluate the effectiveness of interventional therapy for complications of transplanted renal allografts. Materials and methods: Between January 2009 and March 2014, 14 patients underwent interventional therapy for complications of renal allografts. Complications included transplant renal artery stenosis (TRAS), TRAS combined with pseudoaneurysms, transplant renal venous kinking and ureteral obstruction (UO). Serum creatinine (S.Cr) levels were evaluated before and after procedure. The characteristics and procedure outcomes of these patients with vascular and nonvascular complications were also analyzed. Results: All primary procedures were successfully performed, which included percutaneous transluminal angioplasty (PTA) for TRAS (n?=?4), stenting and coil embolization for TRAS combined with pseudoaneurysms (n?=?1), stenting for renal vein kinking (n?=?2), and percutaneous nephrostomy (PCN) for UO (n?=?7) and secondary antegrade stent placement in six UO patients after 1 week of PCN. No major procedure related complications occurred. S.Cr level subsequently improved from 6.0?±?3.6 to 2.6?±?2.1?mg/dL (p?<?0.001), as well as patients’ clinical features within 1 week after procedure. In our study, the onset time of vascular complications was earlier (<6 months) than nonvascular complications with significant difference (p?<?0.001). During follow-up, the patient with TRAS and pseudoaneurysms suffered acute rejection 1 month after treatment and received transplant renal artery embolization. One patient with TRAS showed restenosis 4 months after procedure, and was retreated successfully with stenting. Thirteen cases reserved their transplanted renal allografts. Conclusion: Interventional therapy could be prior considered for transplanted renal allograft complications as its effectiveness and minimal invasiveness in saving the transplanted renal grafts.     

Interventional therapy of vascular complications following renal transplantation

Abstract:  Renal transplantation is accepted as the preferred treatment for most cases of end-stage renal disease. Postoperative vascular complications include stenosis or thrombosis of the transplant renal artery or arteriovenous fistulas after biopsy. Impaired arterial perfusion of the transplant may be the leading cause for graft dysfunction or refractory hypertension. Therefore, non-invasive imaging modalities are required to detect and locate vascular complications with high accuracy. Doppler ultrasound is suited as a screening method for the detection of impaired graft perfusion. Magnetic resonance imaging (MRI) is used for an accurate diagnosis of vascular complications and to support decision for appropriate surgical or interventional treatment. Minimal invasive techniques like percutaneous transluminal angioplasty and stent placement have evolved as safe procedures with a high technical success rate reducing substantial morbidity. They can be considered as an alternative to surgical treatment of transplant renal artery stenosis (TRAS). Embolization of severe arteriovenous fistulas is the method of choice if the feeding artery can be occluded through a microcatheter. In selected cases, even catheter-guided fibrinolytic treatment of arterial thrombosis might be considered, if instantaneous surgery is considered a high-risk procedure. This article reviews the imaging features of common vascular complications after renal transplantation with focus on MRI. In addition, interventional radiological techniques are described for the treatment of TRAS, acute thrombotic occlusion, and arteriovenous fistulas.     

介入治疗肾血管平滑肌脂肪瘤进展

肾脏血管平滑肌脂肪瘤（RAML）是常见的肾脏良性肿瘤,其发病隐匿,发生率较低;主要并发症包括腰痛和肾积水等,严重并发症为肿瘤破裂,出血凶险,预后不良。介入方法,包括动脉栓塞术、经皮消融术等现已成为治疗RAML的重要手段。本文对介入治疗RAML的研究进展进行综述。     

Prevalence of atherosclerotic renal artery stenosis in patients starting dialysis.

BACKGROUND: Atherosclerotic renal artery stenosis (ARAS) can lead to end-stage renal failure (ESRF). We determined the prevalence of ARAS in patients 45 years of age or older starting renal replacement therapy. METHODS: Forty-nine of 80 consecutive patients (37 males, 12 females) starting renal replacement therapy in our centre gave informed consent and underwent spiral computed tomographic angiography of their renal arteries. A renal artery diameter reduction of 50% or more assessed by two radiologists was considered as a significant stenosis. RESULTS: Twenty of 49 patients (41%) had an ARAS, and in eight cases (16%) this was bilateral or unilateral with a single kidney. Women were more likely to have an ARAS than men; 75 (9/12) vs 30% (11/37, P<0.01). However, relatively more women declined participation. Non-participants and participants did not differ in respect to other relevant clinical data. Nonetheless, findings in these patients would be negative, the prevalence of ARAS would still be 31% in women and 22% in men (NS). In 13 patients with ARAS the registered diagnosis of ESRF either was hypertension, renovascular disease or unknown. Assuming that in these patients atherosclerotic renovascular disease was the cause of renal failure, a total of 13 patients (13/49, 27%) entered the dialysis programme because of this problem. CONCLUSIONS: These results suggest that ARAS is an important cause of ESRF.     

Ultrasound evaluation and interventional therapy for peripheral vascular access stenosis in dialysis patients

Objective To investigate the patency rate and restenosis after percutaneous transluminal angioplasty (PTA) for the treatment of arteriovenous fistula (AVF) and arteriovenous graft (AVG) stenosis in dialysis patients. Methods The patients who were successfully treated by PTA for the first time in the blood purification center of the 2nd Affiliated Hospital of Nanjing Medical University from January 2016 to June 2017, including 71 cases of AVF in the forearm, 52 cases of AVF in the upper arm and 59 cases of AVG were recorded. The data of different stenosis parts were analyzed before and after treatment and followed up for 12 months. The initial patency rate and assisted-PTA patency rate were observed at 3 months, 6 months, 9 months, and 12 months after ultrasound interventional therapy, and the initial patency time for patients who needed to reintervention among all types of pathways were recorded. Results The initial patency rates at 3 months, 6 months, 9 months and 12 months after ultrasound interventional therapy were 98.59%, 90.14%, 71.93%, 54.93% respectively in forearm AVF, 90.38%, 65.38%, 42.31%, 32.69% respectively in upper arm AVF, 91.53%, 32.20%, 6.78%, 1.69% respectively in AVG, and the PTA-assisted patency rates were 98.59%, 97.18%, 95.77%, 94.37% respectively in forearm AVF, 92.31%, 86.54%, 84.62%, 80.77% respectively in upper arm AVF, 100.00%, 98.31%, 96.61%, 93.22% respectively in AVG, while the initial patency time was (8.99±3.54) months in forearm AVF, (6.33±3.01) months in upper arm AVF, (4.80±1.40) months in AVG respectively. Conclusions Ultrasound can comprehensively evaluate the function of peripheral vascular access, guide PTA treatment, and evaluate treatment outcomes. Ultrasound intervention therapy has best initial patency rate for forearm AVF stenosis. The prognosis of upper arm AVF stenosis PTA is relatively poor due to the easy cephalic stenosis. Although AVG has a short interval of restenosis, it can achieve a better long-term patency rate through regular intervention with ultrasound intervention.     

超声造影在移植肾血管并发症中的应用价值

目的  评价超声造影(CEUS)在移植肾血管并发症中的应用价值。方法  回顾性分析临床怀疑有移植肾血管并发症的28例肾移植患者的普通超声和CEUS图像资料, 以CT血管造影(CTA)或数字减影血管造影(DSA)为诊断标准, 分析CEUS在移植肾血管并发症中的诊断价值。结果  28例患者均未发生造影剂相关不良反应。22例确诊发生血管并发症。CEUS正确诊断血管并发症17例, 漏诊5例移植肾动脉狭窄, 误诊1例移植肾局灶性梗死。CEUS诊断移植肾血管并发症的灵敏度、特异度、阳性预测值、阴性预测值及准确度分别为0.77、1.00、1.00、0.55及0.82。普通超声及CEUS诊断移植肾动脉狭窄的灵敏度、特异度、阳性预测值、阴性预测值及准确度分别为0.37和0.74, 0.89和1.00, 0.88和1.00, 0.40和0.64, 0.54和0.82。两者灵敏度、准确度比较差异均有统计学意义(均为P < 0.05)。结论  CEUS是诊断移植肾血管并发症的有效手段。