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。     

肾血管性高血压的介入治疗

我们评价经皮肾动脉腔内成形术（PTRA）及内支架植入术治疗肾血管性高血压（RVH）的疗效。 一、对象和方法 1．对象：肾动脉狭窄19例，其中男5例，女14例，平均年龄39．3岁（21～73岁），均符合血管成形术适应证，并排除了禁忌证。单侧肾动脉狭窄12例，双肾动脉狭窄7例。肾动脉开口病变4例，非开口病变15例。动脉粥样硬化性狭窄18例，多发性大动脉炎1例，其中4例患者合并肾功能不全。     

经皮血管成形术治疗移植肾动脉狭窄的临床研究

目的 评估经皮血管成形术在治疗移植肾动脉狭窄(TRAS)导致的移植肾功能损害和(或)高血压中的效果.方法 回顾性分析1998年7月至2007年1月经皮肾动脉造影明确诊断为移植肾动脉狭窄的16例患者的临床资料.在16例患者被确诊前先行多普勒超声检查,有13例被发现TRAS,3例阴性,假阴性率为18.75%.对16例TRAS患者均采取经皮血管成形术治疗.术后对患者进行了3年的随访,分别在术后1周、6个月、1年、2年和3年时评估肾功能和高血压改善状况.以平均动脉压较术前下降至少15%定义为高血压改善;以血清肌酐降低至少20%定义为移植肾功能改善.结果 经皮血管成形术成功率100%,16例患者经治疗后均获临床治愈.术后1周、6个月、1年、2年和3年时,肾功能改善率分别为81.25%、68.75%、62.5%、56.25%和50%,高血压改善率分别为62.5%、75%、75%、56.25%和50%,所有患者服用降血压药物的种类和用量均减少.结论 经皮血管成形术对TRAS导致的肾功能损害和高血压有明显的改善作用,是安全和有效的治疗方法 .     

移植肾动脉狭窄的DSA动脉造影和PTA治疗

移植肾动脉狭窄的ＤＳＡ动脉造影和ＰＴＡ治疗齐隽，闵志廉，何长民，朱有华我们对９例肾移植后有高血压并发症的病人进行了ＤＳＡ动脉造影，并对其中一例移植肾动脉狭窄（ＴＲＡＳ）病人进行了经皮穿刺腔内血管成形术（ＰＴＡ），效果满意。资料与方法９例病人因慢性肾炎...     

介入诊疗技术在肾移植临床上的应用(附14例报告)

目的：探讨介入诊疗技术在肾移植临床上的应用。方法：回顾性分析14例肾移植术后患者接受介入诊疗的临床资料．其中肾移植术后肾功能丧失8例。移植肾动脉血栓形成2例．移植肾动脉狭窄2例。假性动脉瘤和术后并发重症高血压各1例。结果：对8例移植肾失功能者进行动脉造影。3例显示血管堵塞未予处置，另5例进行移植。肾动脉栓塞。其中3例栓塞术后完全停用免疫抑制剂．1例用小剂量激素维持．1例手术切除移植肾。1例重症高血压者经自体肾动脉栓塞．血压得到很好控制。接受肾动脉栓塞术患者均出现“栓塞后综合征”。2例移植肾动脉血栓形成患者溶栓成功．但。肾功能未恢复。2例移植肾动脉狭窄患者．1例放置支架失败。仅进行球囊扩张，术后血压控制良好。肾功能恢复。但6个月后血压再次升高、肾功能严重受损而行栓塞治疗，1例未处置。术后高血压得到控制。1例移植肾假性动脉瘤者经动脉造影证实后手术切除。结论：移植肾或自体肾动脉栓塞可替代手术切除移植肾和治疗肾移植术后重症高血压；移植肾动脉血栓形成可作溶栓治疗；移植肾动脉狭窄进行球囊扩张远期效果不佳。     

移植肾动脉狭窄的DSA动脉造影和经皮穿刺腔内血管成形术治疗

移植肾动脉狭窄的ＤＳＡ动脉造影和经皮穿刺腔内血管成形术治疗齐隽，闵志廉，何长民，朱有华，孟钢，王卓伟，王立明，郑军华，徐丹枫，余加仁，贾志斌，欧阳强同种尸体肾移植后约有１０％的患者发生肾动脉狭窄（ＴＲＡＳ）。ＴＲＡＳ的存在可产生继发性高血压，从而导致...     

肾动脉原位切开扩张术治疗肾血管性高血压三例报告

肾动脉原位切开扩张术治疗肾血管性高血压三例报告亓天伟史本康陈钦忠近年来，多采用经皮腔内血管成形术（ＰＴＡ）治疗肾动脉狭窄所致的肾血管性高血压。由于此类病人常伴有腹主动脉严重病变使肾动脉狭窄处病变复杂，或因肾动脉多段狭窄等情况，在行经皮肾动脉扩张术选择...     

肾血管性高血压的介入治疗

目的：研究经皮腔内血管成形术加内支架植入术治疗肾动脉狭窄致致肾血管性高山压的临床效果。方法：选用Palmaz支架,对7例大动脉炎、2例动脉弱样硬化,3例纤维肌性发育不良所致肾动脉病变先行经皮腔内血管成形术,然后放置支架,术后患者行常规抗凝治疗,结果：12例患者,经皮腔内血管成形术加支架植入术技术成功率为100％,血压下降60－120／35－100mmHg近期随访－32个月未见复发,结论：经皮腔内血管成形术加支架植入术治疗肾血管性管高血压效果满意,创伤小,患者痛苦少,为肾动脉狭窄所致肾血管性高血压较理想的治疗方法。     

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.     

经皮血管成形术治疗肌纤维发育不良型肾动脉狭窄的临床疗效

目的评价经皮血管腔内血管成形术(PTA)治疗肾动脉肌纤维性发育不良的疗效及安全性。方法选择肌纤维发育不良型肾动脉狭窄患者32例(均合并2~3级高血压或难治性高血压),行经皮肾动脉成形术治疗。术后随访观察患者血压、药物治疗种类、术后再狭窄、生存率和并发症等。结果 PTA技术成功率93.94%(31/33)。术前、术后收缩压分别为(189.6±26.0)mmHg、(136.6±8.0)mmHg(t=9.117,P0.001),舒张压分别为(121.6±21.7)mmHg、(81.1±11.5)mmHg(t=7.745,P0.001)。无肾动脉破裂、夹层、分支堵塞及血栓形成等相关并发症和术后不良事件发生。术后随访时间5~100个月,平均(40.4±26.1)个月,患者生存率100%(32/32)。结论经皮血管成形术治疗肌纤维发育不良肾动脉狭窄安全、有效。     

Percutaneous transluminal angioplasty for renovascular hypertension in children

Percutaneous transluminal angioplasty (PTA) has been developed over the past 8 years as an alternative to reconstructive surgery for renovascular hypertension. We report three cases and review the use of PTA in children with renal artery stenosis. At least 37 cases of PTA have been reported in patients whose ages ranged from 1.3 to 17 years (mean 10 years). Of these, 10 had fibromuscular dysplasia; 13 unspecified unilateral renal artery stenosis; 4 bilateral stenosis; 4 neurofibromatosis; 4 renal transplant; 1 atherosclerosis; and 1 postsurgical stenosis. Nine of 10 patients with fibromuscular dysplasia were cured and 3 of 4 with renal transplant arterial stenosis were cured or improved. There were 11 failures of PTA, including all 4 patients with neurofibromatosis and 1 with transplant arterial stenosis. We conclude that PTA is the treatment of choice for children with hypertension due to fibromuscular dysplasia and should be attempted for stenosis of the transplanted renal artery. Other lesions resulting in renal artery stenosis may not be as amenable to dilation and should be considered on an individual basis.R. L. Chevalier is an Established Investigator of the American Heart Association     

Percutaneous transluminal angioplasty in transplant renal artery stenosis: experience and review of the literature

Percutaneous transluminal angioplasty (PTA) was performed in five instances of renal transplant artery stenosis (RTAS) in four patients. Hypertension was present in all cases and improved after angioplasty together with reduction in medicine requirements. Abnormal renal function in four instances also improved after PTA. This reflects the current literature in which 76 of 90 patients were successfully treated by PTA (follow-up to 24 months), with two cases of recurrent stenosis, no mortality, and only a single case of graft loss. Vascular surgical repair succeeded in 130 to 180 patients, but graft loss occurred in 20 cases and recurrent stenosis in 11. Mortality was reported in five cases. Our review of the literature and experience suggests that PTA may be preferred in the treatment of RTAS.     

Percutaneous transluminal angioplasty for hepatic artery stenosis after living donor liver transplantation.

The purpose of this study was to evaluate the efficacy of percutaneous transluminal angioplasty (PTA) for treatment of hepatic artery stenosis after living donor liver transplantation. Eighteen patients with hepatic artery stenosis after living donor liver transplantation were included in this study. The success rate and complications of PTA and recurrent stenosis of the hepatic artery were evaluated. Seventeen of 18 patients (94.4%) were successfully treated without complication by a first PTA procedure. Recurrence of hepatic artery stenosis occurred in 6 patients (33.3%). Repeated PTA was performed 12 times for the 6 patients. Two complications occurred as arterial dissection and perforation. As a consequence, the complication rate was 6.7%, involving 2 of 30 procedures in total. In conclusion, PTA is effective for treatment of hepatic artery stenosis after living donor liver transplantation without an increase in the complication rate.     

移植肾动脉狭窄腔内治疗的中期结果

目的探讨移植肾动脉狭窄经皮血管腔内成形(PTA)及支架置入的安全性及中远期结果。方法回顾性分析2011年1月至2018年12月解放军总医院血管外科收治的18例移植肾动脉狭窄患者的临床资料。结果3例经同侧股动脉,15例经对侧股动脉人路治疗。4例单纯PTA治疗,8例PTA后置入支架,6例直接置入支架。共置入14枚支架,均为球扩式支架,其中2枚为药涂支架,技术成功率100%。平均造影剂用量64ml,治疗前肾动脉狭窄率为50%〜99%,腔内治疗后狭窄率降为10%〜30%。收缩压由术前的(157.2±43.0)mmHg降至术后的(129.8±8.6)mmHg;血清肌酐(SCr)水平由术前的(258.8±214.7)μmol/L降至术后的(176.3±101.1)μmol/L,尿素氮由术前的(15.7±1.6)mmol/L降至术后(10.6±1.1)mmol/L(均P<0.05)。术后中位随访42.4个月(3~93个月),治愈17例,无效1例,1例单纯球囊扩张后术后30 d出现再狭窄,予以置入支架。除1例移植肾动脉出血外无其他并发症。结论移植肾动脉狭窄是导致移植肾失功的常见血管因素,腔内治疗安全、有效。     

High-grade renal transplant artery stenosis after suboptimal angioplasty: favourable long-term outcome

The purpose of our report is to present the long-term outcomes of three renal transplant recipients with high-grade stenosis and suboptimal percutaneous angioplasty (PTA) because of technical difficulties. Two men and one woman of age 67, 53, and 54 years, who maintained functional cadaveric graft for 17, 9, and 13 years, and had diagnosed significant renal transplant artery stenosis at 2, 1, and 2 years after renal transplantation, respectively, were studied. Stenoses were diagnosed angiographically in the first patient and by Doppler in other two patients, then confirmed by angiography. All three patients had difficult-to-treat hypertension with deterioration of graft function in the presence of or after introducing ACE-inhibitor therapy. PTA was performed in all patients with suboptimal or unsuccessful results as assessed by angiography or control Doppler examination--the residual stenosis was significant and practically unchanged. Surgery was not performed because of high risk, so patients were further treated conservatively. Hypertension was treated avoiding ACE inhibitors. Twelve, 7, and 7 years after angioplasty the serum creatinine is stable in all patients, even decreased compared to pre-PTA and early post-PTA levels, namely, 134, 102, and 75 micromol/L, respectively. Control Doppler examinations revealed a residual stenotic jet in all patients, with slightly decreased peak systolic velocity over time, indicating a slightly decreased grade of stenosis. These observations suggest that renal transplant artery stenosis, even of high grade, can be stable, or even regress with time with excellent long-term graft survival. Randomized studies comparing conservative treatment versus revascularization are warranted.     

Angioplasty and stenting of arterial stenosis affecting renal transplant function

PURPOSE: To evaluate the efficacy of percutaneous angioplasty and stenting in cases of artery stenosis of the transplanted kidney or proximal iliac artery stenosis causing transplant dysfunction and/or increase of the arterial blood pressure. MATERIALS AND METHODS: Between January 1999 and June 2007, we evaluated 24 patients who had undergone renal transplantation and subsequently were diagnosed with refractory hypertension and transplant dysfunction for signs of possible renal transplant artery stenosis. Color Doppler ultrasonography and magnetic resonance angiography preceded the intrarterial angiographic investigation, with false-negative results in 18.2% and 13.6% of patients, respectively. In 2 of the 24 patients, angiography did not reveal arterial stenosis affecting the transplanted kidney. Two patients had severe ipsilateral iliac artery stenosis and the remaining 20 had transplant artery stenosis. Successful angioplasty and stenting were performed in these 22 patients. RESULTS: The method was technically feasible in 100%. The procedure-related morbidity was 0%. During the follow-up period (range: 3 to 104 months), two patients died with normal transplant function, two suffered transplant failure, and the remaining 18 still have normal transplant function and easily controlled hypertension. CONCLUSION: Percutaneous angioplasty and stenting in cases of arterial stenosis affecting the renal transplant function are safe and effective procedures. Even more, the strong clinical suspicion must lead to angiographic investigation regardless of the results of other imaging approaches.     

Transplant renal artery stenosis: experience and comparative results between surgery and angioplasty

Abstract. One hundred thirty-eight patients with transplant renal artery stenosis (TRAS) were identified among 1200 patients undergoing renal transplantation in our university hospital. Severe systemic hypertension was the main symptom leading to a diagnosis of TRAS. Only 88 TRAS patients were given interventional treatment consisting of percutaneous angioplasty (PTA; n = 49) or surgical repair (SR; n = 39). The immediate success rate was 92. 1% for SR and 69% for PTA. The long-term success rate was 81. 5% for SR and 40. 8% for PTA, with a follow-up period of 56. 722. 4 months (SR group) and 3228. 1 months (PTA group). PTA morbidity reached 28%, compared to 7. 6% in the SR group. In spite of these results, we still favor PTA as a first line interventional treatment when TRAS is recent, linear, and distal and primary SR in cases of kinking and proximal TRAS.     

Incidence and outcome of transplant renal artery stenosis: single center experience

Since the incidence of transplant renal artery stenosis (TRAS) in renal allografts varies from 1% to 23%, we sought to examine its incidence, to analyze treatment options, and to ascertain its outcomes. Retrospective analysis of 793 kidney allograft recipients transplanted between 1996 and 2004 revealed an incidence of 0.9% (n = 7). Time from kidney transplantation to the first symptoms varied from 1 week to 3 years (median, 4 months). Three patients experiences refractory hypertension and six patients developed allograft dysfunction. Screening color Doppler ultrasonography showed hemodynamic changes in six patients with the definitive diagnosis confirmed by angiography in all patients. One patient with an anastomotic stenosis was treated with a surgical operation and six patients, percutaneous transluminal angioplasty (PTA), with stenting in three cases. Both surgical as well as PTA treatment were successful in all but one patient, who underwent PTA alone, developed chronic renal insufficiency necessitating hemodialysis and finally lost his allograft. In the other patients all symptoms resolved after treatment and the patients are doing well with functioning allografts. Although TRAS was an uncommon complication, if recognized promptly it could be treated by surgery or PTA with a high success rate.     

Metal stents for the management of atherosclerotic renovascular disease.

PURPOSE: We report on our experience with the use of metal stents for the treatment of atherosclerotic renovascular disease. PATIENTS AND METHODS: Since 1996, 62 patients (mean age 67 years) with ostial atherosclerotic renal artery stenosis were treated successfully by placement of metal stents. All patients presented with renovascular hypertension, and eight had additionally impaired renal function. In 12 patients, stents were placed bilaterally. In 54 patients, the introduction of stents was performed as the primary mode of treatment, and in the remaining 8 patients, the positioning of the endoprosthesis was deemed necessary because of recurrence of stenosis previously treated by renal percutaneous transluminal angioplasty (PTA). The patients were followed for a mean period of 18 months (range 9-48 months). RESULTS: Positioning of the endoprosthesis was successful in all patients. No major complications were reported. The 18-month patency rate was 77.4% (48 patients). Hypertension resolved in 39 patients and showed a trend to improvement in 15 patients. We observed no improvement of renal function in the eight patients who had impaired function prior to the procedure. CONCLUSION: Implantation of metal stents is a safe and effective method for the treatment of atherosclerotic renal artery stenosis and certainly presents an important alternative to renal PTA.