| Background:Atherosclerotic renal artery stenosis(ARAS). is a manifestation of generalized atherosclerosis. Because of the aging of the general population, atherosclerotic renal artery stenosis is anticipated to become increasingly prevalent over the coming decades. The stenosis decreases renal per-fusion pressure, which activates Renin-angiotensin-aldosterone system, causing hypertension and renal insufficiency. ARAS has been reported to be a leading cause of end-stage renal disease in the elderly.Percutaneous transluminal renal artery stenting(PTRAS) can rectify the pathophysiology of ARAS, being believed to cure hypertension and renal insufficiency. However, reports from recent trials indicate little additional benefit from PTRAS in patients with atherosclerotic renal artery stenosis. The efficacy of PTRAS remains to be controversial.Premier retrospective study usually focus on the correlation of all-cause mortality and deterioration of renal function with PTRAS. However all-cause mortality and renal function is not comprehensive. The final purpose of PTRAS is to prevent cardiovascular and renal adverse events. Little study has analyzed the risk factors for cardiovascular and renal adverse events after PTRAS. Charlson comorbidities index (Charlson-comorbidity index, CCI), is the most commonly used comorbidities index tools, commonly used in the tumor, death and life expectancy in critically ill patients with evaluation, and assessment of the risks of adverse events after surgery, but the value of CCI for the forecast cardiovascular adverse events after PTRAS is still unclear.Transfemoral approach and transradial approach are common approaches of percutaneous transluminal intervention. Clinic trials reveals that transradial approach for percutaneous coronary intervention is feasible and safe. Transfemoral approach is the routine approach for percutaneous renal artery intervention, the feasibility and safety of transradial approach for percutaneous renal artery intervention needs farther assessment.Purpose:Evaluate the clinical curative effect of PTRAS. Analyze the risk factors for cardiovascular and renal adverse events after PTRAS. Evaluate the safety and effectiveness of two different approaches of femoral artery and radial artery to perform renal arteriography.Method:The patients with renal artery stenosis from January 2008 to April 2015 in Chinese PLA General Hospital were included. Renal arteriography was performed Renal arteriography through femoral artery or radial artery. X-ray irradiation time, operation time, dose of contrast agent, success rate comfort level, time in bed and complication rate were recorded among. Success rate of stenting and restenosis rate were recorded for patients with renal artery stenting. Renal artery stenting was performed with 232 cases, for whom the occurrence of adverse cardiovascular and renal events, blood pressure, drugs and renal function were observed in 36 months follow up. According to the occurrence of adverse events,232 cases were divided into two group and risk factors for adverse events were analyzed.Results:1. Blood pressure:both the blood pressure of patients with ARAS 24h (147± 18/88 ±7mmHg) and 36m (138±17/84±8 mmHg) after PTRAS were significantly lower than that of preoperative stage (163±19/93±12 mmHg) (P< 0.05).2. After PTRAS, kinds of antihypertensive drugs used were significantly less (2.0± 0.4 VS 2.7±1.3) than preoperative (P< 0.05).3. After PTRAS, patients’serum creatinine,24h (124.8±62.4μmol/L) and 36m (123.5±62.8μmol/L) was not significantly changed compared with baseline (121.3±60.5μmol/L) (p>0.05). And the eGFR 24h(68.5±20.3 ml/(min□1.73m2)) and 36m (69.2±18.9 ml/(min□1.73m2)) were not significantly changed compared with baseline (70.5±18.8ml/(min□1.73m2)) (P>0.05).4. GFR assessed by renography:GFR of stenting-lateral was not significantly changed (27.1±13.3 VS 25.9±13.0 ml/min) 1 year after PTRAS (p>0.05), GFR of non-stenting-lateral was lowered (40.3±15.7 VS 44.9±15.2 ml/min)significantly (p<0.05)5.Results of univariable and multivariable logistic regression analysis showed that occurrence of cardiovascular or renal adverse events was associated with higher CCI score (≥3), advanced age (>65), diabetes and congestive heart failure (P<0.05).6. X-ray irradiation time ((2.08±0.16) min VS (4.14±0.23) min), and operation time((5.37±1.78)min VS (9.06±2.58)min) of femoral artery group were shorter than those of radial artery group (P<0.05). The dose of contrast agent ((14.27±3.65) ml VS (15.09±3.48) ml), success rate (99.84% VS 99.35%) of angiography and complication rate (3.65% VS 4.10%) between two groups did not differ significantly (P>0.05). Anxiety scale (34.6±6.1 VS 57.2±11.3) of radial artery group was lower than that of femoral artery group (P<0.05). Time in bed ((1.5±0.42) h VS (23.2 ±1.65) h) of radial artery group was shorter than that of femoral artery group (P<0.05). Stenting success rate (97.02 VS 98.83) between two groups did not differ significantly.Conclusions:1. PTRAS can make hypertension caused by ARAS effectively controlled.2. PTRAS can reduce the kinds of antihypertensive drugs.3. PTRAS can prevent renal insufficiency caused by ARAS from being progressive, but can not improve renal function significantly.4. Higher CCI score (≥3), advanced age (≥65), diabetes and congestive heart failure are risk factors for cardiovascular or renal adverse events after PTRAS.5. It is safe and feasible to perform renal arteriography or threat renal artery stenosis with stenting through the approach of radial artery which has the equal success rate to the approach of femoral artery. Furthermore patients suffer less trauma and adverse reaction. |
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