支架置入术联合自体肾移植术治疗双侧肾动脉狭窄1例并文献复习

目的:评估支架置入术联合自体肾移植术治疗肾血管性高血压的疗效。方法:顽固性高血压患者1例,经血管造影证实为双侧肾动脉显著狭窄,左肾动脉起始部70%~80%狭窄,行肾动脉支架置入术(PTRAS),右肾动脉起始部90%狭窄,因狭窄部紧靠右肾动脉起始部,而且伴有显著的狭窄后扩张,故未行PTRAS,而采用自体肾移植术。结果:经左肾动脉行支架置入术后,血压控制仍不满意,继而行右侧自体肾移植术,术后停服所有降压药物,血压能维持在正常水平。结论:在双侧肾动脉显著狭窄时,采用支架置入术联合自体肾移植术是合理及有效的治疗手段。

Treatment of renal artery stenosis with stent placement and kidney autotransplantation: one case report and literature review

Objective: To evaluate the efficacy and safety of revascularization and kidney autotransplantation as treatment for renal artery stenosis. Method:An elderly patient with poorly controlled hypertension was found marked stenosis of bilateral renal artery in renal arteriography. Percutaneous transluminal renal angioplasty with stent (PTRAS) was performed in beginning section of left renal artery with 70~80% stenosis. Renal arteriography also found 90% stenosis in beginning section of right renal artery. Because the stenosis abuted against the ostium of right renal artery and there was marked dilation after stenosis. So kidney autotransplantation rather than PTRAS was performed. Result:Control of the hypertension in this patient was not satisfactory after PTRAS. And then kidney autotransplantation was performed. After the operation, the patient stopped all antihypertensive drugs and blood pressure maintained normal level. Conclusion:Respective PTRAS and kidney autotransplantation were reasonable and efficacious measure for the treatment of marked stenosis of bilateral renal artery.