BACKGROUND Takayasu arteritis is a rare but intractable chronic disease in young female patients. Percutaneous transluminal angioplasty of the involved renal arteries has been reported;however, few studies have report...BACKGROUND Takayasu arteritis is a rare but intractable chronic disease in young female patients. Percutaneous transluminal angioplasty of the involved renal arteries has been reported;however, few studies have reported the use of drug coated balloon angioplasty in the treatment of Takayasu arteritis. We aimed to demonstrate five young female patients who presented with a history of hypertension due to Takayasu arteritis. CASE SUMMARY From April 2017 to October 2018, five female patients were diagnosed with hypertension due to Takayasu arteritis by computed tomography angiography (CTA) and laboratory tests. Four patients had a complaint of headache with or without dizziness, and one patient showed no symptom. There was no significant family or past history of hypertension or kidney disease, and the physical examinations were almost normal on admission. We performed a treatment by drug coated balloon angioplasty. Blood pressure decreased dramatically in all patients after balloon angioplasty, and the patency of treated renal artery was demonstrated with CTA over 5 months after the angioplasty procedure. CONCLUSION Drug coated balloon angioplasty is safe and effective for renal artery stenosis due to Takayasu arteritis. A prospective study with a larger sample size is necessary to further demonstrate the effectiveness of the treatment.展开更多
Transplant renal artery stenosis(TRAS) is a relatively rare complication after renal transplantation. The site of the surgical anastomosis is most commonly involved, but sites both proximal and distal to the anastomos...Transplant renal artery stenosis(TRAS) is a relatively rare complication after renal transplantation. The site of the surgical anastomosis is most commonly involved, but sites both proximal and distal to the anastomosis may occur, as well. Angioplasty is the gold standard for the treatment of the stenosis, especially for intrarenal lesions. We report two cases of intrarenal TRAS and successful management with angioplasty without stent placement. Both patients were male, 44 and 55 years old respectively, and they presented with elevated blood pressure or serum creatinine within three months after transplantation. Subsequently, they have undergone angioplasty balloon dilatation with normalization of blood pressure and serum creatinine returning to baseline level. Percutaneous transluminal balloon renal angioplasty is a safe and effective method for the treatment of the intrarenal TRAS.展开更多
The effects of the renal artery stenosis(RAS) on the blood flow and vesselwalls are investigated.The pulsatile blood flow through an anatomically realistic model ofthe abdominal aorta and renal arteries reconstructed ...The effects of the renal artery stenosis(RAS) on the blood flow and vesselwalls are investigated.The pulsatile blood flow through an anatomically realistic model ofthe abdominal aorta and renal arteries reconstructed from CT-scan images is simulated,which incorporates the fluid-structure interaction(FSI).In addition to the investigationof the RAS effects on the wall shear stress and the displacement of the vessel wall,it isdetermined that the RAS leads to decrease in the renal mass flow.This may cause theactivation of the renin-angiotension system and results in severe hypertension.展开更多
Saphenous vein graft (SVG) bypass of the renal artery from the aorta has been well documented, though bypass of the internal iliac artery to the individual renal arteries is not yet described. We herewith present a ca...Saphenous vein graft (SVG) bypass of the renal artery from the aorta has been well documented, though bypass of the internal iliac artery to the individual renal arteries is not yet described. We herewith present a case of early TRAS detected 6 hours after a successful renal transplant. Renal angiography showed complete stenosis of the internal iliac to renal artery anastomosis. Percutaneous transplant artery angioplasty was attempted, but was not successful;hence the surgical correction of the same was done. This is to demonstrate the use of saphenous vein bypass of anastomotic obstruction of the previous anastomosis, in case of short renal artery.展开更多
Background:Transplant renal artery stenosis(TRAS)is a vascular complication after kidney transplantation associated with poor outcomes.This study aimed to analyze the efficacy and safety of low-dose aspirin for preven...Background:Transplant renal artery stenosis(TRAS)is a vascular complication after kidney transplantation associated with poor outcomes.This study aimed to analyze the efficacy and safety of low-dose aspirin for preventing TRAS.Methods:After kidney transplantation,patients were enrolled from January 2018 to December 2020 in Henan Provincial People’s Hospital.A total of 351 enrolled recipients were randomized to an aspirin group with low-dose intake of aspirin in addition to standard treatment(n=178),or a control group with only standard treatment(n=173).The patients was initially diagnosed as TRAS(id-TRAS)by Doppler ultrasound,and confirmed cases were diagnosed by DSA(c-TRAS).Results:In the aspirin and control groups,15.7%(28/178)and 22.0%(38/173)of the recipients developed id-TRAS,respectively,with no statistical difference.However,for c-TRAS,the difference of incidence and cumulative incidence was statistically significant.The incidence of c-TRAS was lower in the aspirin group compared with the control group(2.8%[5/178]vs.11.6%[20/173],P=0.001).Kaplan–Meier estimates and Cox regression model identified the cumulative incidence and hazard ratio(HR)of TRAS over time in two groups,showing that recipients treated with aspirin had a significantly lower risk of c-TRAS than those who were not treated(log-rank P=0.001,HR=0.23,95%confidence interval[CI]:0.09–0.62).The levels of platelet aggregation rate(P<0.001),cholesterol(P=0.028),and low-density lipoprotein cholesterol(P=0.003)in the aspirin group were decreased compared with the control group in the third-month post-transplantation.For the incidence of adverse events,there was no statistical difference.Conclusion:Clinical application of low-dose aspirin after renal transplant could prevent the development of TRAS with no significant increase in adverse effects.Trial Registration:Clinicaltrials.gov,NCT04260828.展开更多
Background:This study aims to observe the dynamic changes of renal artery(RA)disease and cortical blood perfusion(CBP)evaluated by contrast-enhanced ultrasound(CEUS)after percutaneous transluminal renal artery stentin...Background:This study aims to observe the dynamic changes of renal artery(RA)disease and cortical blood perfusion(CBP)evaluated by contrast-enhanced ultrasound(CEUS)after percutaneous transluminal renal artery stenting(PTRAS)in patients with severe atherosclerotic renal artery stenosis(ARAS)and to analyze the relationship between CBP and prognosis.Methods:This was a single-center retrospective cohort study.A total of 98 patients with unilateral severe ARAS after successful PTRAS in Beijing Hospital from September 2017 to September 2020 were included.According to renal glomerular filtration rate(GFR)detected by radionuclide imaging at 12 months after PTRAS,all patients were divided into the poor prognosis group(n=21,GFR decreased by≥20%compared with baseline)and the control group(n=77,GFR decreased by<20%or improved compared with baseline).Renal artery stenosis was diagnosed by digital subtraction angiography,and renal CBP was evaluated by CEUS using TomTec Imaging Systems(Germany)before PTRAS,at 6 months and 12 months after discharge.The receiver operating characteristic(ROC)curve with area under the curve(AUC)was used to analyze the predictive value of CBP parameters,including area under ascending curve(AUC1),area under the descending curve(AUC2),rising time(RT),time to peak intensity(TTP),maximum intensity(IMAX),and mean transit time(MTT)for poor prognosis.Results:Among the 98 patients,there were 52 males(53.1%),aged 55–74 years old,with an average age of 62.1±8.7 years,and an average artery stenosis of 82.3±12.9%.The poor prognosis group was associated with significantly increased incidence of diabetes(76.2%vs.41.6%),and lower levels of GFR of the stenotic kidney(21.8 mL/min vs.25.0 mL/min)and total GFR(57.6 mL/min vs.63.7 mL/min)(all P<0.05),compared with the control group(P<0.05).In addition,the rate of RA restenosis was significantly higher in the poor prognosis group than in the control group(9.5%vs.0,χ^(2)=9.462,P=0.002).Compared with the control group,the poor prognosis group was associated with significantly decreased baseline AUC1 and AUC2,and extended duration of TTP and MTT(P<0.05).At 6 months and 12 months of follow-up,patients in the control group were associated with markedly increased AUC1,AUC2,and IMAX,and shorter duration of RT and MTT(P<0.05).The ROC curve showed that the predictive values of AUC1,AUC2,RT,TTP,IMAX,and MTT for poor prognosis were 0.812(95%CI:0.698–0.945),0.752(95%CI:0.591–0.957),0.724(95%CI:0.569–0.961),0.720(95%CI:0.522–0.993),0.693(95%CI:0.507–0.947),and 0.786(95%CI:0.631–0.979),respectively.Conclusions:Preoperative renal CBP in severe ARAS patients with poor prognosis is significantly reduced,and does not show significant improvement after stent treatment over the first year of follow-up.The parameter AUC1 may be a good predictor for renal dysfunction after PTRAS in severe ARAS patients.Trial Registration:ChiCTR.org.cn,ChiCTR1800016252.展开更多
Background:Renal artery stenosis (RAS) is always associated with abnormalities in renal microvascular perfusion (RMP).However,few imaging methods can simultaneously evaluate the degree of luminal stenosis and RMP.Thus...Background:Renal artery stenosis (RAS) is always associated with abnormalities in renal microvascular perfusion (RMP).However,few imaging methods can simultaneously evaluate the degree of luminal stenosis and RMP.Thus,this study will aim to evaluate the feasibility of using contrast-enhanced ultrasound (CEUS) for assessing both RAS and RMP to achieve a one-stop assessment of patients with suspected renovascular hypertension. Methods:This will be a single-center diagnostic study with a sample size of 440.Patients with chronic kidney disease (CKD) and suspected of having resistant hypertension will be eligible.Patients with Stages 1–3 CKD will undergo CEUS and computed tomography (CT) angiography (CTA).Values obtained by CEUS and CTA for diagnosing low-grade (lumen reduced by <60%) and high-grade (lumen reduced by ≥60%) RAS will be compared.Moreover,all patients will also undergo radionuclide imaging.The diagnostic value for RAS will be assessed by the receiver operating characteristic curve,including the accuracy,sensitivity,specificity,positive predictive values,negative predictive values,and area under the ROC.Pearson correlation analysis will be performed to assess the association between CEUS findings for RMP and glomerular filtration rate measured by a radionuclide imaging method. Conclusion:The data gathered from this study will be used to evaluate the feasibility of expanding clinical applications of CEUS for evaluation of patients with suspected renovascular hypertension.展开更多
Background： The decrease ofglomenllar filtration rate has been theoretically supposed to be the result of low perfusion in renal artery stenosis （RAS）. But the gap between artery stenosis and the glomerular filtrat...Background： The decrease ofglomenllar filtration rate has been theoretically supposed to be the result of low perfusion in renal artery stenosis （RAS）. But the gap between artery stenosis and the glomerular filtration ability is still unclear. Methods： Patients with selective renal artery angiogram were divided by the degree of renal artery narrowing, level of estimated glomerular filtration rate （eGFR）, respectively. The different levels ofeGFR, renal microcirculation markers, and RAS severity were compared with each other, to determine the relationships among them. Results： A total of 215 consecutive patients were enrolled in the prospective cohort study. Concentrations of microcirculation markers had no significant difference between RAS group （RAS ≥ 50%） and no RAS group （RAS 〈 50%） or did not change correspondingly to RAS severity. The value ofeGFR in RAS group was lower than that in the no RAS group, but it did not decline parallel to the progressive severity of RAS. The microcirculation markers presented integral difference if grouped by different eGFR level with negative tendency, especially that plasma cystatin C （cysC） and urinary microalbumin to creatinine ratio （mACR） increased with the deterioration ofeGFR, with strong （r= -0.713, P 〈 0.001 ） and moderate （r = -0.580, P 〈 0.001 ） correlations. In the subgroup analysis of severe RAS （RAS 〉 80%）, the levels of plasma cysC and urinary mACR demonstrated stronger negative associations with eGFR, （r = -0.827, P 〈 0.001） and （r= -0.672, P 〈 0.001 ） correlations, respectively. Conclusions： Severity of RAS could not accurately predict the value of eGFR, whereas microcirculation impairment may substantially contribute to the glomerular filtration loss in patients with RAS.展开更多
Objective:Early detection of atherosclerotic renal artery stenosis (ARAS) is clinically important with respect to blood pressure control, prevention of renal insufficiency, and even improving survival. We investigated...Objective:Early detection of atherosclerotic renal artery stenosis (ARAS) is clinically important with respect to blood pressure control, prevention of renal insufficiency, and even improving survival. We investigated whether the presence of significant ARAS (luminal diameter narrowing ≥70%) could be predicted using a logistic regression model before coronary angiography/intervention. Methods:Initially, we developed a logistic regression model for detecting significant ARAS based upon clinical and angiographic features and biochemical measurements in a cohort of 1 813 patients undergoing transfemoral coronary and renal angiography. This model was then prospectively applied to an additional 495 patients who received transradial renal angiography to ascertain its predictive accuracy for the presence of significant ARAS. Results:Multivariate regression analysis revealed that older age (≥65 years), resistant hypertension, type 2 diabetes, creatinine clearance (Ccr) ≤60 ml/min, and multivessel coronary disease were independent predictors for significant ARAS. A logistic regression model for detecting ARAS by incorporating conventional risk factors and multivessel coronary disease was generated as:P/(1 P)=exp( 2.618+1.112[age≥65 years]+1.891[resistant hypertension]+0.453[type 2 diabetes]+0.587[Ccr≤60 ml/min]+2.254[multivessel coronary disease]). When this regression model was prospectively applied to the additional 495 patients undergoing transradial coronary and renal angiography, significant ARAS could be detected with a sensitivity of 81.2%, specificity of 88.9%, and positive and negative predictive accuracies of 53.8% and 96.7%, respectively. Conclusions:The logistic regression model generated in this study may be useful for screening for significant ARAS in patients undergoing transradial coronary angiography/intervention.展开更多
Background:The assessment of renal function is important to the prognosis of patients needing Fontan palliation due to the reconstructed compromised circulation.To know the relationship between the kidney perfusion an...Background:The assessment of renal function is important to the prognosis of patients needing Fontan palliation due to the reconstructed compromised circulation.To know the relationship between the kidney perfusion and hemodynamic characteristics during surgical design could reduce the risk of acute kidney injury(AKI)and the postoperative complications.However,the issue is still unsolved because the current clinical evaluation methods are unable to predict the hemodynamic changes in renal artery(RA).Methods:We reconstructed a three-dimensional(3D)vascular model of a patient requiring Fontan palliation.The technique of computational fluid dynamics(CFD)was utilized to explore the changes of RA hemodynamics under different possible blood flow rates.The relationship between the kidney perfusion and hemodynamic characteristics was investigated.Results:The calculated results indicated the declined tendency of the pressure and pressure drop as the flow rate decreased.When the flow rate decreased to two-thirds of its baseline,both the pressure of left renal artery(LRA)and the pressure of right renal artery(RRA)dipped below 50%,and the pressure of RRA fell more quickly than that of LRA.Uneven distribution of WSS was observed on the trunk of RA,and the lowest WSS was found at the distal of RA.The average WSS in RA dropped to around 50%as the flow rate reached one-third of its baseline.Conclusions:As a promising approach,CFD can be utilized to quantitatively evaluate the hemodynamic characteristics of RA and contribute to offsetting the drawbacks of clinical assessments of renal function,to help realize better prognosis for the patients with Fontan palliation.展开更多
BACKGROUND Digital subtraction angiography(DSA),the gold standard of cerebrovascular disease diagnosis,is limited in its diagnostic ability to evaluate arterial diameter.Intravascular ultrasonography(IVUS)has advantag...BACKGROUND Digital subtraction angiography(DSA),the gold standard of cerebrovascular disease diagnosis,is limited in its diagnostic ability to evaluate arterial diameter.Intravascular ultrasonography(IVUS)has advantages in assessing stenosis and plaque nature and improves the evaluation and effectiveness of carotid artery sten-ting(CAS).CASE SUMMARY Case 1:A 65-year-old man presented with a five-year history of bilateral lower limb weakness due to stroke.Physical examination showed decreased strength(5-/5)in both lower limbs.Carotid artery ultrasound,magnetic resonance angiography,and computed tomography angiography(CTA)showed a right proximal internal carotid artery(ICA)stenosis(70%-99%),acute cerebral infarction,and severe right ICA stenosis,respectively.We performed IVUS-assisted CAS to measure the stenosis and detected a low-risk plaque at the site of stenosis prior to stent implantation.Post-stent balloon dilatation was performed and postoperative IVUS demonstrated successful expansion and adherence.CTA six months postoperatively showed no significant increase in in-stent stenosis.Case 2:A 36-year-old man was admitted with a right common carotid artery(CCA)dissection detected by ultrasound.Physical examination showed no positive neurological signs.Carotid ultrasound and CTA showed lumen dilation in the proximal CCA with an intima-like structure and bulging in the proximal segment of the right CCA with strip-like low-density shadow(dissection or carotid web).IVUS-assisted DSA confirmed right CCA dissection.CAS was performed and intraoperative IVUS suggested a large residual false lumen.Post-stent balloon dilatation was performed reducing the false lumen.DSA three months postoperatively indicated good stent expansion with mild stenosis.CONCLUSION IVUS aids decision-making during CAS by accurately assessing carotid artery wall lesions and plaque nature preoperatively,dissection and stenosis morphology intraoperatively,and visualizing and confirming CAS postoperatively.展开更多
Renal artery stenosis(RAS) with a bifurcation lesion is a challenge for interventional therapy.The aim of this study is to summarize our experience in RAS with a bifurcation lesion.Five patients with RAS involving bif...Renal artery stenosis(RAS) with a bifurcation lesion is a challenge for interventional therapy.The aim of this study is to summarize our experience in RAS with a bifurcation lesion.Five patients with RAS involving bifurcation lesion are described.In cases 1 to 3,a single-stent strategy was first adopted.However,these three patients were converted to a two-stent strategy for bailout stent implantation in the side branches.In cases 4 and 5,a simultaneous kissing stent technique was performed.Angiography showed that the reference vascular diameter of the main branch was much larger than those of the side branches.Although obvious residual stenosis existed in cases 1 to 3 after stent implantation,no obvious residual stenosis was seen in cases 4 and 5.Renal artery duplex sonography was performed in cases 1 through 5 at 6,7,7,8,and 6 months,respectively,after the procedures.No evidence of restenosis or occlusion was seen.In conclusion,stent implantation with the simultaneous kissing stent technique may result in more simple and more satisfactory immediate angiographic results.展开更多
Objective:To investigate the effect of Huanshuai Recipe Oral Liquid(缓衰口服液,HSR) on retarding the progression of renal dysfunction in patients with atherosclerotic renal artery stenosis(ARAS).Methods:A total of 52 ...Objective:To investigate the effect of Huanshuai Recipe Oral Liquid(缓衰口服液,HSR) on retarding the progression of renal dysfunction in patients with atherosclerotic renal artery stenosis(ARAS).Methods:A total of 52 ARAS patients with the Chinese medicine(CM) syndrome of qi deficiency and blood stasis,phlegm and dampness retention were recruited and randomly assigned into the treatment group(36 cases) and the control group(16 cases).Both groups received a basic treatment(high-quality low-protein diet,blood pressure control,lipid-lowering,correcting the acidosis,etc.).In addition,the treatment group received 20 mL HSR and the control group received placebo,3 times a day for 6 months.Renal function(serum creatinine,blood urea nitrogen and uric acid) and blood lipids(cholesterol,triglycerides and low density lipoprotein) were examined monthly.The estimated glomerular filtration rate(eGFR) and CM syndrome score were compared between groups.Results:After treatment,compared with the control group,the serum creatinine level,uric acid level and CM syndrome score of the treatment group were significantly decreased(P<0.05 or P<0.01),and the eGFR in the treatment group were significantly increased(P<0.05).Conclusion:HSR can effectively improve the renal function and clinical symptoms of ARAS patients.展开更多
Together with an increasingly aging world populationthere is also an increasing prevalence ofatherosclerosis. Renal artery stenosis (RAS) is one of thesystemic manifestations of atherosclerosis. Its incidenceis about ...Together with an increasingly aging world populationthere is also an increasing prevalence ofatherosclerosis. Renal artery stenosis (RAS) is one of thesystemic manifestations of atherosclerosis. Its incidenceis about 15%-35%. RAS accounts for 5%-27% of allpatients with end-stage renal disease (ESRD).2 Patientswith renal dysfunction resulting from RAS are at risk ofdeath from cardiovascular disease and ESRD.展开更多
BACKGROUND Intracranial and extracranial artery stenosis is associated with cerebral infarction.Vascular calcification and atherosclerosis are the main causes of stenosis and major risk factors for cardiovascular and ...BACKGROUND Intracranial and extracranial artery stenosis is associated with cerebral infarction.Vascular calcification and atherosclerosis are the main causes of stenosis and major risk factors for cardiovascular and cerebrovascular events in patients with type 2 diabetes mellitus(T2DM).Bone turnover biomarkers(BTMs)are associated with vascular calcification,atherosclerosis,glucose,and lipid metabolism.AIM To investigate the association of circulating BTM levels with severe intracranial and extracranial artery stenosis in patients with T2DM.METHODS For this cross-sectional study including 257 T2DM patients,levels of the BTMs serum osteocalcin(OC),C-terminal cross-linked telopeptide of type I collagen(CTX),and procollagen type I N-peptide were measured by electrical chemiluminescent immunoassay,and artery stenosis was assessed by color Doppler and transcranial Doppler.Patients were grouped according to the existence and location(intracranial vs.extracranial)of artery stenosis.Correlations between BTM levels,previous stroke,stenosis location,and glucose and lipid metabolism were analyzed.RESULTS T2DM patients with severe artery stenosis had a higher frequency of previous stroke and levels of all three tested BTMs(all P<0.05)than patients without.Some differences in OC and CTX levels were observed according to the location of artery stenosis.Significant associations were also observed between BTM levels and some glucose and lipid homeostasis parameters.On multivariate logistic regression analysis,all BTMs were significant predictors of artery stenosis in T2DM patients with and without adjustment for confounding factors(all P<0.001),and receiver operating characteristic curve analysis demonstrated the ability of BTM levels to predict artery stenosis in T2DM patients.CONCLUSION BTM levels were found to be independent risk factors for severe intracranial and extracranial artery stenosis and were differentially associated with glucose and lipid metabolism in patients with T2DM.Therefore,BTMs may be promising biomarkers and potential therapeutic targets for artery stenosis.展开更多
基金Supported by the National Natural Science Foundation of China,No.81501569
文摘BACKGROUND Takayasu arteritis is a rare but intractable chronic disease in young female patients. Percutaneous transluminal angioplasty of the involved renal arteries has been reported;however, few studies have reported the use of drug coated balloon angioplasty in the treatment of Takayasu arteritis. We aimed to demonstrate five young female patients who presented with a history of hypertension due to Takayasu arteritis. CASE SUMMARY From April 2017 to October 2018, five female patients were diagnosed with hypertension due to Takayasu arteritis by computed tomography angiography (CTA) and laboratory tests. Four patients had a complaint of headache with or without dizziness, and one patient showed no symptom. There was no significant family or past history of hypertension or kidney disease, and the physical examinations were almost normal on admission. We performed a treatment by drug coated balloon angioplasty. Blood pressure decreased dramatically in all patients after balloon angioplasty, and the patency of treated renal artery was demonstrated with CTA over 5 months after the angioplasty procedure. CONCLUSION Drug coated balloon angioplasty is safe and effective for renal artery stenosis due to Takayasu arteritis. A prospective study with a larger sample size is necessary to further demonstrate the effectiveness of the treatment.
文摘Transplant renal artery stenosis(TRAS) is a relatively rare complication after renal transplantation. The site of the surgical anastomosis is most commonly involved, but sites both proximal and distal to the anastomosis may occur, as well. Angioplasty is the gold standard for the treatment of the stenosis, especially for intrarenal lesions. We report two cases of intrarenal TRAS and successful management with angioplasty without stent placement. Both patients were male, 44 and 55 years old respectively, and they presented with elevated blood pressure or serum creatinine within three months after transplantation. Subsequently, they have undergone angioplasty balloon dilatation with normalization of blood pressure and serum creatinine returning to baseline level. Percutaneous transluminal balloon renal angioplasty is a safe and effective method for the treatment of the intrarenal TRAS.
文摘The effects of the renal artery stenosis(RAS) on the blood flow and vesselwalls are investigated.The pulsatile blood flow through an anatomically realistic model ofthe abdominal aorta and renal arteries reconstructed from CT-scan images is simulated,which incorporates the fluid-structure interaction(FSI).In addition to the investigationof the RAS effects on the wall shear stress and the displacement of the vessel wall,it isdetermined that the RAS leads to decrease in the renal mass flow.This may cause theactivation of the renin-angiotension system and results in severe hypertension.
文摘Saphenous vein graft (SVG) bypass of the renal artery from the aorta has been well documented, though bypass of the internal iliac artery to the individual renal arteries is not yet described. We herewith present a case of early TRAS detected 6 hours after a successful renal transplant. Renal angiography showed complete stenosis of the internal iliac to renal artery anastomosis. Percutaneous transplant artery angioplasty was attempted, but was not successful;hence the surgical correction of the same was done. This is to demonstrate the use of saphenous vein bypass of anastomotic obstruction of the previous anastomosis, in case of short renal artery.
基金Project of Science and Technology of Henan Province(No.202102310438)Joint construction project of Henan Medical Science and Technology Research Plan(No.LHGJ20210042)Foundation of Henan Educational Committee(No.22A320012)
文摘Background:Transplant renal artery stenosis(TRAS)is a vascular complication after kidney transplantation associated with poor outcomes.This study aimed to analyze the efficacy and safety of low-dose aspirin for preventing TRAS.Methods:After kidney transplantation,patients were enrolled from January 2018 to December 2020 in Henan Provincial People’s Hospital.A total of 351 enrolled recipients were randomized to an aspirin group with low-dose intake of aspirin in addition to standard treatment(n=178),or a control group with only standard treatment(n=173).The patients was initially diagnosed as TRAS(id-TRAS)by Doppler ultrasound,and confirmed cases were diagnosed by DSA(c-TRAS).Results:In the aspirin and control groups,15.7%(28/178)and 22.0%(38/173)of the recipients developed id-TRAS,respectively,with no statistical difference.However,for c-TRAS,the difference of incidence and cumulative incidence was statistically significant.The incidence of c-TRAS was lower in the aspirin group compared with the control group(2.8%[5/178]vs.11.6%[20/173],P=0.001).Kaplan–Meier estimates and Cox regression model identified the cumulative incidence and hazard ratio(HR)of TRAS over time in two groups,showing that recipients treated with aspirin had a significantly lower risk of c-TRAS than those who were not treated(log-rank P=0.001,HR=0.23,95%confidence interval[CI]:0.09–0.62).The levels of platelet aggregation rate(P<0.001),cholesterol(P=0.028),and low-density lipoprotein cholesterol(P=0.003)in the aspirin group were decreased compared with the control group in the third-month post-transplantation.For the incidence of adverse events,there was no statistical difference.Conclusion:Clinical application of low-dose aspirin after renal transplant could prevent the development of TRAS with no significant increase in adverse effects.Trial Registration:Clinicaltrials.gov,NCT04260828.
基金supported by grants from the National High Level Hospital Clinical Research Funding(No.BJ2018-198)Basic Research Project of the Central Academy of Medical Sciences of China(No.2019PT320012)+1 种基金Beijing Science and Technology Project(No.Z211100002921011)National Key R&D Program of China(No.2020YFC2008100).
文摘Background:This study aims to observe the dynamic changes of renal artery(RA)disease and cortical blood perfusion(CBP)evaluated by contrast-enhanced ultrasound(CEUS)after percutaneous transluminal renal artery stenting(PTRAS)in patients with severe atherosclerotic renal artery stenosis(ARAS)and to analyze the relationship between CBP and prognosis.Methods:This was a single-center retrospective cohort study.A total of 98 patients with unilateral severe ARAS after successful PTRAS in Beijing Hospital from September 2017 to September 2020 were included.According to renal glomerular filtration rate(GFR)detected by radionuclide imaging at 12 months after PTRAS,all patients were divided into the poor prognosis group(n=21,GFR decreased by≥20%compared with baseline)and the control group(n=77,GFR decreased by<20%or improved compared with baseline).Renal artery stenosis was diagnosed by digital subtraction angiography,and renal CBP was evaluated by CEUS using TomTec Imaging Systems(Germany)before PTRAS,at 6 months and 12 months after discharge.The receiver operating characteristic(ROC)curve with area under the curve(AUC)was used to analyze the predictive value of CBP parameters,including area under ascending curve(AUC1),area under the descending curve(AUC2),rising time(RT),time to peak intensity(TTP),maximum intensity(IMAX),and mean transit time(MTT)for poor prognosis.Results:Among the 98 patients,there were 52 males(53.1%),aged 55–74 years old,with an average age of 62.1±8.7 years,and an average artery stenosis of 82.3±12.9%.The poor prognosis group was associated with significantly increased incidence of diabetes(76.2%vs.41.6%),and lower levels of GFR of the stenotic kidney(21.8 mL/min vs.25.0 mL/min)and total GFR(57.6 mL/min vs.63.7 mL/min)(all P<0.05),compared with the control group(P<0.05).In addition,the rate of RA restenosis was significantly higher in the poor prognosis group than in the control group(9.5%vs.0,χ^(2)=9.462,P=0.002).Compared with the control group,the poor prognosis group was associated with significantly decreased baseline AUC1 and AUC2,and extended duration of TTP and MTT(P<0.05).At 6 months and 12 months of follow-up,patients in the control group were associated with markedly increased AUC1,AUC2,and IMAX,and shorter duration of RT and MTT(P<0.05).The ROC curve showed that the predictive values of AUC1,AUC2,RT,TTP,IMAX,and MTT for poor prognosis were 0.812(95%CI:0.698–0.945),0.752(95%CI:0.591–0.957),0.724(95%CI:0.569–0.961),0.720(95%CI:0.522–0.993),0.693(95%CI:0.507–0.947),and 0.786(95%CI:0.631–0.979),respectively.Conclusions:Preoperative renal CBP in severe ARAS patients with poor prognosis is significantly reduced,and does not show significant improvement after stent treatment over the first year of follow-up.The parameter AUC1 may be a good predictor for renal dysfunction after PTRAS in severe ARAS patients.Trial Registration:ChiCTR.org.cn,ChiCTR1800016252.
文摘Background:Renal artery stenosis (RAS) is always associated with abnormalities in renal microvascular perfusion (RMP).However,few imaging methods can simultaneously evaluate the degree of luminal stenosis and RMP.Thus,this study will aim to evaluate the feasibility of using contrast-enhanced ultrasound (CEUS) for assessing both RAS and RMP to achieve a one-stop assessment of patients with suspected renovascular hypertension. Methods:This will be a single-center diagnostic study with a sample size of 440.Patients with chronic kidney disease (CKD) and suspected of having resistant hypertension will be eligible.Patients with Stages 1–3 CKD will undergo CEUS and computed tomography (CT) angiography (CTA).Values obtained by CEUS and CTA for diagnosing low-grade (lumen reduced by <60%) and high-grade (lumen reduced by ≥60%) RAS will be compared.Moreover,all patients will also undergo radionuclide imaging.The diagnostic value for RAS will be assessed by the receiver operating characteristic curve,including the accuracy,sensitivity,specificity,positive predictive values,negative predictive values,and area under the ROC.Pearson correlation analysis will be performed to assess the association between CEUS findings for RMP and glomerular filtration rate measured by a radionuclide imaging method. Conclusion:The data gathered from this study will be used to evaluate the feasibility of expanding clinical applications of CEUS for evaluation of patients with suspected renovascular hypertension.
文摘Background： The decrease ofglomenllar filtration rate has been theoretically supposed to be the result of low perfusion in renal artery stenosis （RAS）. But the gap between artery stenosis and the glomerular filtration ability is still unclear. Methods： Patients with selective renal artery angiogram were divided by the degree of renal artery narrowing, level of estimated glomerular filtration rate （eGFR）, respectively. The different levels ofeGFR, renal microcirculation markers, and RAS severity were compared with each other, to determine the relationships among them. Results： A total of 215 consecutive patients were enrolled in the prospective cohort study. Concentrations of microcirculation markers had no significant difference between RAS group （RAS ≥ 50%） and no RAS group （RAS 〈 50%） or did not change correspondingly to RAS severity. The value ofeGFR in RAS group was lower than that in the no RAS group, but it did not decline parallel to the progressive severity of RAS. The microcirculation markers presented integral difference if grouped by different eGFR level with negative tendency, especially that plasma cystatin C （cysC） and urinary microalbumin to creatinine ratio （mACR） increased with the deterioration ofeGFR, with strong （r= -0.713, P 〈 0.001 ） and moderate （r = -0.580, P 〈 0.001 ） correlations. In the subgroup analysis of severe RAS （RAS 〉 80%）, the levels of plasma cysC and urinary mACR demonstrated stronger negative associations with eGFR, （r = -0.827, P 〈 0.001） and （r= -0.672, P 〈 0.001 ） correlations, respectively. Conclusions： Severity of RAS could not accurately predict the value of eGFR, whereas microcirculation impairment may substantially contribute to the glomerular filtration loss in patients with RAS.
文摘Objective:Early detection of atherosclerotic renal artery stenosis (ARAS) is clinically important with respect to blood pressure control, prevention of renal insufficiency, and even improving survival. We investigated whether the presence of significant ARAS (luminal diameter narrowing ≥70%) could be predicted using a logistic regression model before coronary angiography/intervention. Methods:Initially, we developed a logistic regression model for detecting significant ARAS based upon clinical and angiographic features and biochemical measurements in a cohort of 1 813 patients undergoing transfemoral coronary and renal angiography. This model was then prospectively applied to an additional 495 patients who received transradial renal angiography to ascertain its predictive accuracy for the presence of significant ARAS. Results:Multivariate regression analysis revealed that older age (≥65 years), resistant hypertension, type 2 diabetes, creatinine clearance (Ccr) ≤60 ml/min, and multivessel coronary disease were independent predictors for significant ARAS. A logistic regression model for detecting ARAS by incorporating conventional risk factors and multivessel coronary disease was generated as:P/(1 P)=exp( 2.618+1.112[age≥65 years]+1.891[resistant hypertension]+0.453[type 2 diabetes]+0.587[Ccr≤60 ml/min]+2.254[multivessel coronary disease]). When this regression model was prospectively applied to the additional 495 patients undergoing transradial coronary and renal angiography, significant ARAS could be detected with a sensitivity of 81.2%, specificity of 88.9%, and positive and negative predictive accuracies of 53.8% and 96.7%, respectively. Conclusions:The logistic regression model generated in this study may be useful for screening for significant ARAS in patients undergoing transradial coronary angiography/intervention.
基金Funding Statement:This study was supported by National Natural Science Foundation of China(No.81970439)Natural Science Foundation of Shanghai(No.19ZR1432700)+1 种基金Fund of the Shanghai Committee of Science and Technology(Nos.19411965400,17DZ2253100)the Development Fund of Shanghai Talents(No.2020114).
文摘Background:The assessment of renal function is important to the prognosis of patients needing Fontan palliation due to the reconstructed compromised circulation.To know the relationship between the kidney perfusion and hemodynamic characteristics during surgical design could reduce the risk of acute kidney injury(AKI)and the postoperative complications.However,the issue is still unsolved because the current clinical evaluation methods are unable to predict the hemodynamic changes in renal artery(RA).Methods:We reconstructed a three-dimensional(3D)vascular model of a patient requiring Fontan palliation.The technique of computational fluid dynamics(CFD)was utilized to explore the changes of RA hemodynamics under different possible blood flow rates.The relationship between the kidney perfusion and hemodynamic characteristics was investigated.Results:The calculated results indicated the declined tendency of the pressure and pressure drop as the flow rate decreased.When the flow rate decreased to two-thirds of its baseline,both the pressure of left renal artery(LRA)and the pressure of right renal artery(RRA)dipped below 50%,and the pressure of RRA fell more quickly than that of LRA.Uneven distribution of WSS was observed on the trunk of RA,and the lowest WSS was found at the distal of RA.The average WSS in RA dropped to around 50%as the flow rate reached one-third of its baseline.Conclusions:As a promising approach,CFD can be utilized to quantitatively evaluate the hemodynamic characteristics of RA and contribute to offsetting the drawbacks of clinical assessments of renal function,to help realize better prognosis for the patients with Fontan palliation.
基金Supported by Shenzhen Second People’s Hospital Clinical Research Fund of the Shenzhen High-level Hospital Construction Project,No.20223357021 and 20223357030and Research Project of Teaching Reform in Shenzhen Second People’s Hospital,No.202209.
文摘BACKGROUND Digital subtraction angiography(DSA),the gold standard of cerebrovascular disease diagnosis,is limited in its diagnostic ability to evaluate arterial diameter.Intravascular ultrasonography(IVUS)has advantages in assessing stenosis and plaque nature and improves the evaluation and effectiveness of carotid artery sten-ting(CAS).CASE SUMMARY Case 1:A 65-year-old man presented with a five-year history of bilateral lower limb weakness due to stroke.Physical examination showed decreased strength(5-/5)in both lower limbs.Carotid artery ultrasound,magnetic resonance angiography,and computed tomography angiography(CTA)showed a right proximal internal carotid artery(ICA)stenosis(70%-99%),acute cerebral infarction,and severe right ICA stenosis,respectively.We performed IVUS-assisted CAS to measure the stenosis and detected a low-risk plaque at the site of stenosis prior to stent implantation.Post-stent balloon dilatation was performed and postoperative IVUS demonstrated successful expansion and adherence.CTA six months postoperatively showed no significant increase in in-stent stenosis.Case 2:A 36-year-old man was admitted with a right common carotid artery(CCA)dissection detected by ultrasound.Physical examination showed no positive neurological signs.Carotid ultrasound and CTA showed lumen dilation in the proximal CCA with an intima-like structure and bulging in the proximal segment of the right CCA with strip-like low-density shadow(dissection or carotid web).IVUS-assisted DSA confirmed right CCA dissection.CAS was performed and intraoperative IVUS suggested a large residual false lumen.Post-stent balloon dilatation was performed reducing the false lumen.DSA three months postoperatively indicated good stent expansion with mild stenosis.CONCLUSION IVUS aids decision-making during CAS by accurately assessing carotid artery wall lesions and plaque nature preoperatively,dissection and stenosis morphology intraoperatively,and visualizing and confirming CAS postoperatively.
文摘Renal artery stenosis(RAS) with a bifurcation lesion is a challenge for interventional therapy.The aim of this study is to summarize our experience in RAS with a bifurcation lesion.Five patients with RAS involving bifurcation lesion are described.In cases 1 to 3,a single-stent strategy was first adopted.However,these three patients were converted to a two-stent strategy for bailout stent implantation in the side branches.In cases 4 and 5,a simultaneous kissing stent technique was performed.Angiography showed that the reference vascular diameter of the main branch was much larger than those of the side branches.Although obvious residual stenosis existed in cases 1 to 3 after stent implantation,no obvious residual stenosis was seen in cases 4 and 5.Renal artery duplex sonography was performed in cases 1 through 5 at 6,7,7,8,and 6 months,respectively,after the procedures.No evidence of restenosis or occlusion was seen.In conclusion,stent implantation with the simultaneous kissing stent technique may result in more simple and more satisfactory immediate angiographic results.
基金Supported by the Project of State Administration of Traditional Chinese Medicine,China(No.06-07LB22)Capital Characteristic Clinical Application Research,China(No.Z121107001012013)
文摘Objective:To investigate the effect of Huanshuai Recipe Oral Liquid(缓衰口服液,HSR) on retarding the progression of renal dysfunction in patients with atherosclerotic renal artery stenosis(ARAS).Methods:A total of 52 ARAS patients with the Chinese medicine(CM) syndrome of qi deficiency and blood stasis,phlegm and dampness retention were recruited and randomly assigned into the treatment group(36 cases) and the control group(16 cases).Both groups received a basic treatment(high-quality low-protein diet,blood pressure control,lipid-lowering,correcting the acidosis,etc.).In addition,the treatment group received 20 mL HSR and the control group received placebo,3 times a day for 6 months.Renal function(serum creatinine,blood urea nitrogen and uric acid) and blood lipids(cholesterol,triglycerides and low density lipoprotein) were examined monthly.The estimated glomerular filtration rate(eGFR) and CM syndrome score were compared between groups.Results:After treatment,compared with the control group,the serum creatinine level,uric acid level and CM syndrome score of the treatment group were significantly decreased(P<0.05 or P<0.01),and the eGFR in the treatment group were significantly increased(P<0.05).Conclusion:HSR can effectively improve the renal function and clinical symptoms of ARAS patients.
文摘Together with an increasingly aging world populationthere is also an increasing prevalence ofatherosclerosis. Renal artery stenosis (RAS) is one of thesystemic manifestations of atherosclerosis. Its incidenceis about 15%-35%. RAS accounts for 5%-27% of allpatients with end-stage renal disease (ESRD).2 Patientswith renal dysfunction resulting from RAS are at risk ofdeath from cardiovascular disease and ESRD.
基金Supported by Beijing Municipal Hospital Management Center“Cultivation Plan”,No.PX2022032.
文摘BACKGROUND Intracranial and extracranial artery stenosis is associated with cerebral infarction.Vascular calcification and atherosclerosis are the main causes of stenosis and major risk factors for cardiovascular and cerebrovascular events in patients with type 2 diabetes mellitus(T2DM).Bone turnover biomarkers(BTMs)are associated with vascular calcification,atherosclerosis,glucose,and lipid metabolism.AIM To investigate the association of circulating BTM levels with severe intracranial and extracranial artery stenosis in patients with T2DM.METHODS For this cross-sectional study including 257 T2DM patients,levels of the BTMs serum osteocalcin(OC),C-terminal cross-linked telopeptide of type I collagen(CTX),and procollagen type I N-peptide were measured by electrical chemiluminescent immunoassay,and artery stenosis was assessed by color Doppler and transcranial Doppler.Patients were grouped according to the existence and location(intracranial vs.extracranial)of artery stenosis.Correlations between BTM levels,previous stroke,stenosis location,and glucose and lipid metabolism were analyzed.RESULTS T2DM patients with severe artery stenosis had a higher frequency of previous stroke and levels of all three tested BTMs(all P<0.05)than patients without.Some differences in OC and CTX levels were observed according to the location of artery stenosis.Significant associations were also observed between BTM levels and some glucose and lipid homeostasis parameters.On multivariate logistic regression analysis,all BTMs were significant predictors of artery stenosis in T2DM patients with and without adjustment for confounding factors(all P<0.001),and receiver operating characteristic curve analysis demonstrated the ability of BTM levels to predict artery stenosis in T2DM patients.CONCLUSION BTM levels were found to be independent risk factors for severe intracranial and extracranial artery stenosis and were differentially associated with glucose and lipid metabolism in patients with T2DM.Therefore,BTMs may be promising biomarkers and potential therapeutic targets for artery stenosis.
