ObjectiveTo evaluate the involvement of renal artery in acute Stanford type A aortic dissection (TAAD) using CT angiography (CTA) and to analyze the difference of renal function among different types of renal artery involvement.MethodsFrom January 2016 to November 2017, 151 patients of acute TAAD with renal artery involvement were included in the study. There were 118 males and 33 females, with an average age of 47.93±10.53 years. All patients underwent aortic CTA to confirm the TAAD. According to CTA, involvement of one side of renal artery can be divided into four types: type A, large tear near renal artery orifice, difficult to distinguish true or false lumen; type B, the orifice of the renal artery originates entirely from the false lumen; type C, the orifice of the renal artery originates entirely from the true lumen; type D, renal artery dissection is observed, renal artery intima can be seen. The levels of serum creatinine (sCr) and creatinine clearance (CC) in all groups were analyzed and compared. ResultsThe results of one-way ANOVA analysis showed that there was no significant difference in sCr or CC among the groups (P>0.05). There was no significant difference in age, sex, proportion of hypertension history and onset time among the above groups (P>0.05).ConclusionThe three most common types of renal artery involvement were BC type, CC type, and AC type. The types of renal artery involvement do not affect renal function.
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。
目的 探讨64排螺旋CT血管探针技术在评价肾动脉狭窄中的价值。 方法 回顾分析2010年4月－2012年1月51例行64排螺旋CT肾动脉血管成像且肾动脉狭窄患者的临床资料，对双侧肾动脉行血管探针重组，分析血管狭窄的原因，以及累及范围、狭窄程度。 结果 51例患者双侧肾动脉共105支（3支副肾动脉），其中管腔正常肾动脉27支，管腔有狭窄肾动脉78支。管腔狭窄者中，肾动脉斑块血管共65支，累及范围主要为局限性，以混合性及轻度狭窄为主；肾动脉夹层4支，累及范围主要为节段性，假腔内无对比剂，真腔轻中度狭窄为主；肾动脉肿瘤包绕共有9支，累及范围主要为节段性，腔轻度狭窄为主。 结论 64排螺旋CT血管成像清晰显示肾动脉，血管探针技术分析血管快速、可靠，能准确评价肾动脉狭窄，对指导临床治疗具有重要的意义。
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.