Evaluation Of Percutaneous Transluminal Renal Artery Revascularization For The Treatment Of Renal Artery Stenosis

Objective: Observe the safety of percutaneous renal artery revascularization(PTRAR)in treating renal artery stenosis(RAS)patients and the clinical efficacy in the short and medium-term.Method: 120 consecutive RAS patients treated with PTRAR from July 01,2015 to June 30,2018 in Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology were selected as subjects for retrospective study.There were 72 males(60%)and 48 females(40%)with an average age of 51 ±17(1.08-79)years.The causes of RAS were atherosclerotic renal artery stenosis(ARAS)in 91 cases(75.8%),FMD-RAS in 17 cases(14.2%),TA-RAS in 6 cases(5%),renal artery aneurysm(RAAs)in 2 cases(1.7%),renal artery thrombosis(RAE)(1.7%)in 2 cases,nodular PAN-RAS(0.8%)in 1 case and NF1-RAS(0.8%)in 1 case.Collect the clinical data(including past medical history,renal function,RAS etiology,complications,risk factors,surgery way and surgical approach)and postoperative follow-up results of all of these patients during hospitalization;evaluate the safety and clinical efficacy of patients after PTRAR.Result: The success rate of PTRAR was 95.5%.The operation-related complications were occurred in 7 cases(5.8%).The mean follow-up time of PTRAR was 24(1-36)months.During the follow-up period of 1-36 months,the mean systolic blood pressure and diastolic blood pressure were significantly lower than those before PTRAR(P < 0.05);The types of antihypertensive drugs were less than those before PTRAR;There was no significant difference in serum creatinine(P > 0.05).Restenosis occurred in 11 cases of 114 patients with successful operation.The cure rates of hypertension in FMD-RAS group were 47.1%,47.1%,50%,50% and 25% respectively,at 1 month,6 months,12 months,24 months and 36 months of postoperative follow-up,and the cure rate decreased after 24 months.In a case a patient with FMD-RAS who was operatively unsuccessful due to severe residual stenosis received renal autotransplantation at 24 months after operation.After 12 months of follow-up,all antihypertensive drugs were discontinued and blood pressure returned to normal.During the follow-up period,9 cases were lost,15 cases(12.7%)had cardiovascular and cerebrovascular events,5 cases(4.2%)died,5 cases(4.2%)had renal events,4 cases(3.5%)had non-fatal cardiac events,and 1 case(0.8%)had stroke.Conclusion:1.PTRAR is a safe and effective method for treating renal artery stenosis(RAS)of different causes and ages.It can reduce the types of antihypertensive drugs;improve the blood pressure control rate;delay the deterioration of renal function.Long-term clinical efficacy requires further observation.2.Percutaneous renal artery stenting(PTRAS)can make patients with myofibrillary dysplasia renal artery stenosis(FMD-RAS)enter the remission period of normal blood pressure without any antihypertensive drugs for months or even years.But after remission period,the incidence of restenosis was significantly higher than that of atherosclerotic renal artery stenosis(ARAS).3.Compared with percutaneous renal artery stenting(PTRAS),percutaneous renal artery angioplasty(PTRA)has no significant difference in blood pressure control and renal function improvement in patients with FMD-RAS,but it has a high patency rate and a low incidence of restenosis,so it should be the preferred treatment for FMD-RAS.For FMD-RAS patients with severe residual stenosis,some patients still have blood pressure benefit from surgical treatment.