自发性肾动脉夹层的治疗策略

目的:探讨自发性肾动脉夹层(SRAD)的治疗策略。方法:回顾分析2007~2019年3个医疗中心收治的SRAD患者的临床资料,包括人口学特征、临床表现、辅助检查、治疗方案和结果等。结果:共纳入22例患者,其中男性18例,女性4例;平均发病年龄47岁。20例患者就诊时有高血压,近期新发患者占80%。突发腰肋部疼痛是最常见的症状。22例患者共有24条肾动脉受累(2例为双侧病变)。6例患者(7条肾动脉)接受保守治疗;1例(单侧)因术中夹层破裂行腔内栓塞术,15例(15条肾动脉成功,1条未成功)行腔内支架修复术,技术成功率为88.2%(15/17)。腔内修复明显减少口服降压药数量,降低血压,恢复肾功能(P均<0.05)。腔内修复控制血压的有效率(治愈或改善)为80%。平均随访时间44.5月,期间支架通畅,无闭塞。结论:SRAD的治疗需要根据患者病情选择合适的方法。腔内修复是首选的血管重建方法,有助于控制血压和改善肾功能。

Therapeutic strategy for spontaneous renal artery dissection

Objective:Spontaneous renal artery dissection(SRAD)is a rare clinical entity,and there is no consensus regarding optimal treatment.This study aimed to investigate therapeutic strategy of SRAD.Methods:A retrospective review was performed for SRAD patients between 2007 and 2019 in three hospitals.Clinical data were collected and analyzed.Results:Twenty-two patients(18 men and 4 women)were included with a mean age of 47 years.Twenty patients(90.9%)had hypertension,either new onset(80%)or preexistent.The most common symptom was sudden flank or lumbar pain.Twenty patients had 24 affected renal arteries.Of these patients,6(7 diseased renal arteries)were managed conservatively,1 underwent endovascular coil embolization due to intraoperative rupture,and 15 successfully underwent endovascular repair in 16 diseased arteries.The technical success rate was 88.2%for endovascular repair(15/17).Endovascular repair significantly improved hypertension and restored renal function,and these changes continued during the follow-up(all P<0.05).The effective rate of endovascular repair was 80%for improving/curing hypertension.The stents were patent within a mean follow-up of 44.5 months.Conclusion:SRAD should be treated according to patient situations.Endovascular stent repair may be the first choice of vascular revascularization for SRAD.It is benefit to control blood pressure and restore renal function.