Percutaneous Transluminal Renal Artery Stenting In The Treatment Of Atherosclerotic Renal Artery Stenosis

Objective:To investigate the effectiveness of percutaneous transluminal renalartery stenting (PTRAS) in the treatment of atherosclerotic renal artery stenosis(ARAS).Methods: We retrospectively analysed28patients with severe ARAS, whichtreated by PTRAS from January2005to March2012in our hospital. The cases included18male and10female, and the mean age was66.2years. There were20cases ofunilateral ARAS (right kidney,9case; left kideny,11case) and8cases of bilateralARAS. All patients were performed renal angiography, and the results revealed that thelevel of renal artery stenosis was over50%in all cases. Concomitant diseases includedhypertension (23cases), Urinary protein>150mg/d (5cases). Twenty-eight patientswere divided into group A (50%to70%of renal artery stenosis, n=10) and group B(≥70%of renal artery stenosis, n=18) according to the serious level of renal arterystenosis. The patients who had bilateral ARAS added into group B.Results: PTRAS was successfully performed in27of the28patients. Thetechnical success rate was96.43%. During the follow-up period, each group has onedeath because of cardiovascular and cerebrovascular diseases. In group B,1case wassuffered left lower extremity amputation (atherosclerosis obliterans); five cases withproteinuria before PTRAS, had no improvement or worsening after the procedure.Compared with the preoperative blood pressure(BP), the BP decreased significantly at12months after PTRAS.[Group A,systolic blood pressure:(121.44±17.88) mm Hgvs(131.28±10.44)mmHg, P<0.05; diastolic blood pressure:(68.44±7.18)mmHgvs(78.11±7.32)mmHg, P<0.05; Group B,systolic blood pressure:(137.22±13.47)mmHg vs(154.67±14.11) mmHg, P>0.05; diastolic blood pressure:(75.11±7.54)mmHgvs (89.56±8.37)mmHg, P>0.05]. After PTRAS, the overall benefit rate of hypertension was85.71%in Group A and56.25%in Group B, respectively. The renal benefit ratiowas100%in group A and81.25%in group B. During follow-up period, it wasdemonstrated by color Doppler ultrasound that the renal arteries remained patent, andPSV of main renal arteries significantly decreased after PTRAS [(103±17)cm/svs(148.76±67.89)cm/s; P<0.05]. The differences had statistical significance.Conclusion: To control the indications of ARAS intervention strictly, to avoidkidney damage by practised skill, and to improve the success rate of surgery are the keypoint of PTRAS. PTRAS is minimally invasive, and is one of the effective method ofrevascularization in ARAS patients.