| BackgroundRenal artery fibromusclar dysplasia(RAFMD)is the most common non-atherosclerotic,noninflammatory cause of renal artery stenosis(RAS)mainly affect young and middle-aged patients.In recent years,percutaneous transluminal angioplasty(PTA)has become an important treatment of FMD-RAS,but there are few reports on the clinical characteristics,treatment and long-term prognosis of these patients in our population.In order to provide guidance for clinical work,this study reviewed the clinical features,treatment and prognosis of patients with FMD-RAS in the center,and evaluated the therapeutic effect and influencing factors of PTA in FMD-RAS patients.Materials and MethodsA total of 77 patients who were diagnosed with FMD-RAS were enrolled in Fuwai Hospital from November 2003 to February 2017.The clinical and interventional data were collected and all patients were followed by outpatient follow-up and telephone follow-up.The data were analysed by SPSS software.Results1.Seventy-seven patients with FMD-RAS were enrolled in this study.There were 44 females,33 females and the ratio of male/female was 3:4,with an average age of 27.1 ± 9.0 and the age of onset of symptoms was 23.1 ± 7.9 years.Hypertension is the most common clinical manifestation(56 cases,72.7%),and 17 patients had a history of smoking.2.There were 37 cases(48%)of the right renal artery involvement alone,20 cases(26%)of the left renal artery involvement alone,and 20 cases(26%)of bilateral renal artery involvement;12 cases of patients had multifocal lesions("string of bead" stenosis),and focal stenosis occurred in 51 cases,of which 22 cases of localized stenosis and 29 cases of tubular stenosis;There were also 30 cases(39%)of patients with branch artery involvement,and 12 cases(15.6%)patients with renal artery distal aneurysm formation.3.One hundred and six interventional procedures were performed on 91 renal arteries in 77 patients,the technical success rate was 80.5%.Sixty patients underwent PTA and 9(11.7%)patients required stent implantation.There were 6 patients with restenosis(3 cases of PTA and 3 cases of stent implantation)who received PTA.PTA failed in two patients because the guidewire could not pass through the occlusive lesions.4.The mean follow-up was 45.5 months(3-161 months)and 15 patients(19.5%)were lost.Follow-up information in 62 patients(80.5%)was collected.Forty-five patients(77.6%)achieved significant benefits in terms of hypertension after initial and re-revascularization,of which 33(56.9%)patients were cured,12(20.7%)patients were improved.Systolic blood pressure decreased from 148.3 ± 20.0 mmHg to 132,9 ± 10.9 mmHg(p<0.001).Diastolic blood pressure decreased from 98.6 ±15.1 mmHg to 84.1 ± 9.1 mmHg(p<0.001).The number of daily antihypertensive drugs decreased from 1.7 ± 1.2 to 0.7 ± 1.0(p<0.001).5.PTA in the right renal artery had better response in blood pressure(p=0.046)and simple PTA also has better blood pressure improvement than stent implantation(p=0.018).Patients with restenosis had poor blood pressure improvement(p<0.001).6.Fifteen patients(27.3%,15/55)who were referred to Fuwai hospital for the initial renal artery interventional therapy were diagnosed with restenosis,including 14 patients confirmed by angiography and 1 case by CTA.Thirteen patients received another PTA with or without stent implantation.Among them,after longterm follow-up,3 cases were lost,10 patients received another or three revascularization intervention,2 cases of hypertension cured,2 patients with improved blood pressure,6 patients had no significant change in blood pressure.Conclusion1.Renal artery FMD is more common in young women,especially before 30 years old.Hypertension is the most common clinical manifestations.2.The right renal artery has a higher rate of involving with FMD than the left side,and bilateral renal artery involvement are not uncommon.Unifocal lesions are more common than multifocal stenosis.Some patients are also diagnosed with branch artery involvement and aneurysm formation.3.Most of the patients(45 patients,77.6%)benefited from PTA with or without stent implantation with 33(56.9%)patients "cured" and 12(20.7%)patients"improved" in terms of hypertension.4.Simple PTA for FMD-RAS can be safety and effective.Simple PTA has a better efficacy than PTA with stent implantation.5.For patients with restenosis,some patients still have blood pressure benefit from another PTA.6.Surgical treatment was recommended for patients with huge aneurysm or complex anatomical structures. |
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