摘要
目的探讨移植肾动脉狭窄(TRAS)的介入治疗。方法35例TRAS患者从肾移植到出现肾动脉狭窄症状平均6.9个月(3～18个月),记录经皮血管成形术(PTA)前后血压变化和血肌酐水平。经对侧股动脉或左肱动脉入路,使用普通球囊导管(5F,直径4～6mm,长度20～30mm)和微球囊导管(2.6F,直径3mm,长度36mm)分别对35例TRAS行PTA术,其中11例放置支架。结果35例TRAS患者共行46次PTA(行1次PTA20例,2次12例,3次3例),其中26次经对侧股动脉,20次经左肱动脉穿刺插管。PTA治疗前肾动脉狭窄率为75%～98%,PTA后狭窄率降为10%～30%。PTA前收缩压150～210mmHg(1mmHg=0.133kPa),平均170mmHg,舒张压90～145mmHg,平均120mmHg;PTA后收缩压降为100～190mmHS,平均135mmHg,舒张压降为80～125mmHg,平均85mmHg。首次PTA后再狭窄率39%,再次PTA后狭窄率15%。46次PTA共使用普通球囊导管26个,微球囊导管20个。11枚支架8枚为自膨式支架,3枚为球囊扩张式。术后随访3～60个月(平均23个月)。35例中最终治愈11例,改善15例,好转7例,无效2例。除1例肱动脉入路发生术后穿刺点血肿外无其他并发症。结论TRAS的PTA治疗安全有效,配合肱动脉入路和微球囊导管有助于提高手术成功率;合理选用支架能降低再狭窄率。
Objective To analyze the treatment of transplant renal artery stenosis （TRAS） by percutaneous transluminal angioplasty （PTA） and stenting. Methods The average time duration from transplantation to the on set symptom of TRAS was 6.9 months （3 - 18 months） in 35 TRAS patients. BP and creatinine level were recorded before and after the procedure. PTA was performed through contralateral femoral or left brachial approach with ordinary balloon （5 F, length 20 - 30 mm） and/or small balloon catheters （2. 6 F, length 36 mm） in all patients, and stents were embedded in 11 of them. Results A total of 46 PTA were successfully performed （1 time, 20 cases; 2 times, 12 cases, and 3 times, 3 cases） via contralateral femoral approach （26） and left brachial approach （15）. Stenosis were significantly decreased from 75% - 98% pre-PTA to 10% - 30% post-PTA.Systolic pressure decreased from 170 mmHg （150 - 210 mmHg） pre-PTA to 135 mmHg （100 - 190 mmHg） post-PTA and diastolic pressure decreased from 120 mmHg （90 - 145 mmHg） to 85 mmHg （80 - 125 mmHg） respectively. Restenosis rates were 39% after first PTA and 15% after the second time. All 46 times of PTA used 26 ordinary balloon catheters and 20 mieroballoon catheters. 8 self-expandable stents （Wallstent） and 3 balloon-dilatation stents （Palmaz） were released in 11 cases. There were healed case （n = 11） , melioration （n = 15）, improvement （n = 7）, and inefficiency （n = 2） after follow - up of 23 months （3 - 60 month）. No complication occured except puncture site hematoma via the braehial artery approach in 1 case. Conclusions PTA is safe and effective in the treatment of TRAS and high rate of procedure success may be achieved with the help of brachial approach and micro-balloon catheter.Reasonable use of stents is beneficial in decreasing the restenosis.
出处
《介入放射学杂志》
CSCD
2008年第12期853-857,共5页
Journal of Interventional Radiology
关键词
血管成形术
肾动脉梗阻
肾移植
治疗结果
Angioplasty
Renal artery obstruction
Kidney transplantation
Treatment Outcome
