严重肾动脉狭窄

Jose D. Tafur, C. White
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引用次数: 0

摘要

肾血管性高血压、缺血性肾病和心脏不稳定综合征患者,尽管有最大的药物治疗,但有血流动力学阻塞性肾动脉狭窄的患者可能从肾动脉支架置入中获益。肾动脉狭窄的筛查可以通过多普勒超声、计算机断层血管造影和磁共振血管造影来完成。目前,肾支架置入术的技术成功率(>97%)超过了从该手术中受益的患者的百分比(类似于70%)。生理测量,如充血/静息横切梯度,有助于确认肾灌注不足的严重程度,从而改善可能对肾动脉重建术有反应的患者的选择。经验丰富的手术人员应进行肾脏干预,以尽量减少并发症。首选桡骨入路以避免入路相关并发症。放置良好的裸金属支架5年的初级通畅率超过80%,可以通过定期的临床、实验室和影像学随访来监测支架内再狭窄。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Severe Renal Artery Stenosis
Patients with uncontrolled renovascular hypertension despite maximal medical therapy, ischemic nephropathy, and cardiac destabilization syndromes who have hemodynamically obstructive renal artery stenosis are likely to benefit from renal artery stenting. Screening for renal artery stenosis can be done with Doppler ultrasonography, computed tomographic angiography, and magnetic resonance angiography. Currently the technical success for renal stenting (>97%) exceeds the percentage (similar to 70%) of patients benefitting from the procedure. Physiologic measurements such as hyperemic/resting translesional gradients are useful to confirm the severity of renal hypoperfusion and therefore improve the selection of patients likely to respond to renal artery revascularization. Experienced operators should perform renal interventions in order to minimize complications. Radial access should be preferred to avoid access related complications. Primary patency of well-placed bare metal stents exceeds 80% at five years and surveillance for in-stent restenosis can be done with periodic clinical, laboratory, and imaging follow-up.
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