摘要目的 评价非动脉硬化性肾动脉狭窄引起继发性高血压行血管内治疗的中期临床效果.方法 选择2005年7月至2012年7月收治15例非动脉硬化性肾动脉狭窄患者,其中大动脉炎5例,肾动脉纤维肌发育不良10例,其中经皮肾动脉、成形术(PTRA)10例,肾动脉支架植入术8例,行第2次PTRA6例,术后1、3、6、9、12个月和每年随诊血压,服用降压药情况以及血肌酐,术后3个月、半年、1年行肾动脉CT血管成像检查明确肾动脉再狭窄率.结果 第1次PTRA或肾动脉支架植入术的技术成功率是94％(17/18),并发症发生率是11％(2/18).术后4周随诊的患者中血压改善的占100％(15/15),在平均随诊35.6个月期间血压最后治愈或改善达87％(13/15).在随诊期间有35％(6/17)的肾动脉再狭窄率,所有这些患者均再次行第2次PTRA,且没有并发症发生,所有行第2次PTRA的患者的血压均得到改善.结论 非动脉硬化性肾动脉狭窄行血管腔内治疗的技术是安全的,对继发性高血压的中期疗效是肯定的.

abstractsObjective To evaluate mid-term outcome of endovascular treatment for nonatherosclerotic renal artery disease (NARAD).Methods Between July 2005and July 2012,15 consecutive patients with NARAD for poorly controlled hypertension.Underlying disease included Takayasu arteritis in 5 cases and fibromuscular dysplasia in 10 cases.Twenty-four renal artery interventions were performed,including 10primary and 6 secondary pereutaneous renal artery angioplasty (PTRA) and 8 stent placement.Follow-up monitoring of blood pressure,use of antihypertensive medication,and the serum creatinine level after PTRA or stenting were assessed at 1,3,6,9,12 months,and each following year.The degree of restenosis was evaluated with computed tomographic angiography (CTA) after PTRA or stenting at 3,6,12 months,and every year if possible.Technical and clinical success rates for the treatment of NARAD,and restenosis rates for the renal artery were evaluated.Results The technical success rate for primary PTRA or stenting was 94％ (17/18) and the complication rate was 11％ (2/18).Hypertension improved in 100％ (15/15) of the patients after four weeks follow-up,and was finally cured or improved in 87％ (13/15) during the mean follow-up period of 35.6 months.There was a cumulative 35％ (6/17) restenosis rate during the follow-up.All of the patients were treated with a second PTRA without complications and all of the patients were improved of hypertension after the second PTRA.Conclusions Endovascular treatment for nonatherosclerotic renal artery disease is technically and clinically successful and safe to perform endovascular treatment for NARAD confers mid-term benefit for blood pressure,renal artery patency.