ObjectiveTo retrospective summarize the experience of endovascular repair and open surgery in the treatment of renal aneurysms in our single center.MethodsClinical data of 24 patients with renal aneurysm treated in our hospital from August 2012 to May 2018 were analyzed retrospectively. Nine patients undergoing surgical intervention were categorized as the open operation group, and ten patients who received endovascular repair were classified as the endovascular repair group. To compare and analyze the results of the two groups. Five patients who had refused surgery therapy will be analyzed separately.ResultsTwenty-four patients with seventeen females (70.8%) and seven males (29.2%) were enrolled in this study and nineteen patients with twenty-three aneurysms got repaired successfully. The endovascular repair group had shorter hospital stay compared with the open operation group [median: 10.5 (P25 6.3, P75 15.0) d vs. 21.0 (P25 17.0, P75 27.5) d］. One patient in the open operation group developed renal artery stenosis at 11 months after surgery and underwent reoperation by repair by successful stent placement. There were no other significant postoperative complications occurred in the two groups. No abnormal enlargement or rupture of the aneurysms were observed during the follow-up period in 5 unoperated patients.ConclusionsBoth open surgery and endovascular repair are effective means of treating renal artery aneurysms. Once the renal aneurysm ruptures, serious consequences will occur. Once a renal aneurysm is diagnosed, regardless of the size of the aneurysm, active surgical treatment is recommend.
Objective To investigate the effectiveness of percutaneous transluminal renal artery stenting (PTRAS) in treating atherosclerotic renal artery stenosis (ARAS). Methods A total of 69 patients with severe ARAS were treated with PTRAS between January 2002 and December 2008. There were 47 males and 22 females with an average age of 66.2 years(range, 42-88 years), including 66 cases of unilateral ARAS (single functional kidney, 1 case) and 3 cases of bilateral ARAS. Renal angiography revealed that the degree of renal artery stenosis was 70%-99%. Concomitant diseases included hypertension (67 cases), atherosclerosis obl iterans (69 cases), coronary heart disease (34 cases), diabetes (44 cases), and hyperl ipidemia (36 cases). Blood pressure, serum creatinine (sCr), and patency of the renal artery were measured to assess the effectiveness of PTRAS after 12 months. Results The renal artery stent was successfully implanted in 68 patients and the technical success rate was 98.6%. One patient was converted to il io-renal bypass because of intra-operative acute renal artery occlusion. One patient died of heart failure at 6 months after PTRAS, and 1 patient was lost at 3 months after PTRAS. The other 66 patients were followed up 32 months on average (range, 13-60 months). The blood pressure decreased significantly at 1 month and gained a further decrease at 12 months after PTRAS when compared with the preoperative ones [systol ic blood pressure: (132 ± 24) mm Hg vs (163 ± 34) mm Hg, P lt; 0.05; diastol ic blood pressure: (78 ± 11) mm Hg vs (89 ± 17) mm Hg, P lt; 0.05; 1 mm Hg=0.133 kPa]. Hypertension was cured in 4 cases (6.3%), improved in 52 cases (81.2%), failure in 8 cases (12.5%), and the overall benefit rate was87.5%. The sCr level was stable after 12 months of PTRAS, showing no significant difference when compared with preoperative basel ine [(107.8 ± 35.4) μmol/L vs (104.1 ± 33.8) μmol/L, P gt; 0.05]. Renal function was improved in 9 cases (13.6%), stable in 48 cases (72.8%), deterioration in 9 cases (13.6%), and the overall benefit rate was 86.4%. Instent restenosis found in 2 patients (3.0%) at 12 months after operation. Conclusion PTRAS is a safe and effective method to treat ARAS. It can control the blood pressure and stabil ize the renal function in most ARAS patients. Long-term efficacy needs further investigation.
目的 探讨大动脉炎所致肾动脉上腹主动脉闭塞的手术治疗方法。方法 回顾性分析1例肾动脉上腹主动脉闭塞行腹主动脉-双股动脉人工血管搭桥手术治疗的患者的临床资料,并进行文献复习。结果 术后患者头痛明显好转，血压由术前的220/110 mm Hg(1 mm Hg=0.133 kPa)降至160/100 mm Hg,双下肢踝肱指数由0.50升至1.19。术后2周复查CTA示人工血管通畅，术后3个月复查彩超示人工血管通畅，血压在(140～150)/(80～95) mm Hg间波动，双眼视力1.0左右，已恢复正常生活。结论 大动脉炎所致肾动脉上腹主动脉闭塞常会影响多个重要脏器的供血，病变复杂，手术时机及方法的正确选择及长期抗炎治疗可以提高患者的治疗效果。
Objective To investigate the ultrasonographic characteristics of acute Stanford type A aortic dissection (ATAAD) involving the renal arteries and their relationship with renal function. Methods Patients with ATAAD admitted to Deyang People's Hospital from February 2013 to May 2023 were selected for the study. Based on whether the renal arteries were involved in the dissection, the patients were divided into two groups: a renal artery involvement group and a renal artery non-involvement group. General data and ultrasound characteristics of the two groups were compared. Logistic regression analysis and model correction were performed to analyze the relationship between ultrasound characteristics and renal function involvement in ATAAD patients. Receiver operating characteristic (ROC) curves were used to evaluate the predictive value of ultrasound characteristics for renal artery involvement in ATAAD patients. Additionally, patients in the renal artery involvement group were divided into normal renal function and abnormal renal function subgroups based on serum blood urea nitrogen (BUN) and serum creatinine (Scr) levels. Clinical data of the two subgroups were compared, and a log-binomial model was used to analyze the risk effects of ultrasound characteristics for abnormal renal function. Pearson correlation analysis was performed to assess the correlation between ultrasound characteristics of renal artery involvement and renal function indicators. Results A total of 163 patients were included, consisting of 106 males and 57 females, with a mean age of (50.06±10.46) years (ranging from 20 to 85 years). Significant differences in gender, Scr, and BUN were observed between the renal artery involvement group and the renal artery non-involvement group (P<0.001). Compared to the renal artery non-involvement group, the renal artery involvement group had an increased ascending aorta diameter, a greater proportion of ascending aortic dilation and poor renal perfusion (P<0.05). Logistic regression analysis indicated that ascending aorta diameter, ascending aortic dilation, and poor renal perfusion were independent factors for renal artery involvement (P<0.05). Ultrasonographic characteristics showed good predictive ability for renal artery involvement in ATAAD patients. Furthermore, the combination of the three characteristics yielded a higher predictive value for renal artery involvement. Compared to the normal renal function group, the abnormal renal function group had higher BUN and Scr levels, increased ascending aortic diameter, a greater proportion of ascending aortic dilation and poor renal perfusion (P<0.05). The log-binomial model analysis revealed that the risk ratios for ascending aortic diameter, ascending aortic dilation, and poor renal perfusion were statistically significant both before and after adjustment (P<0.05). Pearson correlation analysis revealed that ascending aortic diameter, ascending aortic dilation, and poor renal perfusion were strongly correlated with renal function parameters (P<0.05). ConclusionUltrasound characteristics of ATAAD involving the renal arteries are associated with renal function. Ascending aorta diameter, ascending aortic dilation, and poor renal perfusion are independent risk factors for abnormal renal function.
自1934年Goldblatt 发现肾动脉狭窄与高血压的关系以及1978年Gruntzig首次报道1例经皮腔内肾血管成形术（percutaneous transluminal renal angioplasty, PTRA）以来，肾动脉狭窄可导致肾血管性高血压和缺血性肾病已形成共识。目前，肾动脉狭窄的治疗方式包括药物治疗、手术治疗及腔内治疗，合理治疗仍存在争议。但不可否认，腔内治疗是目前多数医疗机构普遍采用的治疗方法。......
ObjectiveTo systematically evaluate the effectiveness and safety of fenestrated endovascular aortic repair (F-EVAR) and chimney endovascular aortic repair (Ch-EVAR) in treatment of juxtarenal abdominal aortic aneurysm (JRAAA).MethodsThe databases including the PubMed, Cochrane Library, CNKI, etc. were searched to collect the randomized controlled trails (RCTs) and non-RCTs about the F-EVAR versus Ch-EVAR for the JRAAA. The retrieval time was from inception to November 2019. The studies were screened according to the inclusion and exclusion criteria, the data were extracted and the quality was evaluated by 2 reviewers independently. Then the meta-analysis was conducted using the RevMan 5.1 software.ResultsA total of 9 non-RCTs involving 536 patients were included, 315 of whom were in the F-EVAR group, 221 of whom were in the Ch-EVARF group. The results of meta-analysis showed that: Compared with the F-EVAR group, the Ch-EVAR group had a higher incidence of type Ⅰ endoleak [OR=0.31, 95%CI (0.12, 0.85), P=0.02] and a lower incidence of target organ injury [OR=2.96, 95%CI (1.30, 6.72), P=0.010]. But there were no differences in the technical success rate, vascular restenosis, re-intervention rate, and 30 d mortality between the 2 groups (P>0.05).ConclusionsBoth F-EVAR and Ch-EVAR are safe and effective treatments for JRAAA. F-EVAR has a relative low incidence of type Ⅰ endoleak, but a relatively high incidence of target organ damage. However, for the limitation of quantity and quality of the included studies, this conclusion still requires to be further proved by performing large scale and high quality RCTs. It suggests that doctors should choose a best therapy for patients with JRAAA according to an integrative disease assessment.
【摘要】 目的 评价彩色多普勒超声对肾动脉狭窄（ARAS）的诊断指标及准确性。 方法 1999年10月-2008年12月对患有高血压病的58例共113根肾动脉进行彩色多普勒超声检查。每例患者均测量肾动脉峰值流速（PSV）与肾内段动脉的阻力指数及肾脏长轴。在双盲条件下，以患者肾动脉造影、MRI血管造影及CT血管造影为标准，评价彩色多普勒超声诊断ARAS的诊断指标及准确性。 结果 彩色多普勒超声诊断肾动脉狭窄的敏感性为60%，特异性为83%，阳性预测值为83%，阴性预测值为61%。患侧肾长轴小于健侧肾长轴，患侧肾峰值流速高于健侧肾峰值流速，患侧肾阻力指数低于健侧肾阻力指数。 结论 肾动脉彩色多普勒超声对于肾动脉狭窄初筛诊断以及评价肾动脉狭窄介入治疗后的近、远期疗效，是一种简便可靠的无创检查手段。【Abstract】 Objective To evaluate the accuracy and index of color Doppler ultrasonography (CDU) diagnosing renal artery stenosis (RAS).〖WTHZ〗Methods〖WTBZ〗A total of 113 renal arteries of 58 patients with hypertension from October 1999 to December 2008 were examined by CDU. The peak systolic velocity (PSV) of the renal artery, resistant index of interior artery of kidney,and long axis of kidney of each patient were obtained. Under the double-blind condition, accuracy and diagnostic index of CDU for diagnosing RAS were evaluated according to the standard of renal arteriography, magnetic resonance angiography or computerized tomography angiography. Results The sensitivity of CDU for diagnosing RAS was 60%, specificity was 83%, positive predictive value was 83%, and negative predictive value was 61%. Long axis of kidney in patients with RAS was shorter than that in the healthy ones. The PSV in patients with RAS was higher than that in the healthy ones, and the resistant index of section artery of kidney in patients with RAS was lower than that in the healthy ones. Conclusion CDU is an easy and reliable non-invasive examination for early diagnosis and screening of RAS and for evaluating a short-or long-term therapeutic effect.
ObjectiveTo summarize the diagnosis, surgical management, and outcomes of one case of complex unilateral renal artery aneurysm repaired by in situ open surgery. MethodThe clinical data of a patient with complex renal artery aneurysm admitted to the Department of General Surgery, West China Hospital of Sichuan University in December 2021 who underwent in situ open surgery were retrospectively analyzed. ResultsThe patient was a middle-aged (41 years old) female with a left renal artery aneurysm detected on physical examination. The renal artery three-dimensional CT imaging showed that the aneurysm was large in size and complex in anatomical structure; the aneurysm was located at the renal hilum, demonstrating multiple outflow tracts and close proximity to renal parenchyma and the ureter. Surgical management included in situ aneurysm resection combined with renal artery branch reconstruction and great saphenous vein bypass grafting. The operation duration was 5 h and the intraoperative urine output was 250 mL, and the intraoperative blood loss was about 400 mL. Four units of erythrocyte suspension, 200 mL of autologous recycled blood, and 400 mL of plasma were transfused during the operation. The results of the 36-month postoperative follow-up showed that the reconstructed renal arterial branches and the bridging vessel had satisfactory blood flow, and renal function was unaffected. ConclusionsThe results of this case suggest that in complex renal artery aneurysms involving multiple branches, in situ resection of the aneurysm followed by revascularization and main renal artery bypass grafting to restore flow is safe and feasible, and the long-term prognosis is good. However, it should be emphasized that the anatomy of renal artery aneurysms should be evaluated in detail preoperatively to determine the method of in situ revascularization. The results of the study also need to be further validated by larger samples and multicenter studies.
ObjectiveTo study the clinical safety and effectiveness of paclitaxel-drug coated balloon (DCB) in treatment of Takayasu’s arteritis (TA) of renal artery. MethodsThe retrospective analysis was made on the clinical data of the three patients with severe stenosis of renal artery, who were treated in our hospital from January 2019 to August 2023. The patients underwent paclitaxel-DCB dilation therapy. ResultsSuccessful treatment was accomplished in all the three patients. The patients were followed up for 17, 38, and 40 months respectively, follow-up examination of ultrasound showed that the blood flow in renal artery was unobstructed. The serum creatinine level was changed from preoperative 53, 64, 55 μmol/L to 43, 70, 59 μmol/L on postoperative day 1. The systolic blood pressure was decreased from preoperative 180, 220, 150 mmHg to 116, 120, 110 mmHg on postoperative day 1. The peak systolic velocity of renal artery was reduced from preoperative 350, 377, 293 cm/s to 120, 135, 94 cm/s on postoperative day 1. ConclusionPaclitaxel-DCB is safe and effective for patients with renal artery stenosis of TA, but further researches with large sample are still needed.