Clinical Study Of Endovascular Intervention In The Treatment Of Atherosclerotic Renal Artery Stenosis

Objective: With the rapid development of interventional scientific technology and the improvement of clinicians’ surgical level,endovascular interventional therapy has become more and more widely used in the treatment of atherosclerotic renal artery stenosis,and Some scholars believe that it can be the first choice for renal artery stenosis.Now,the results of some randomized clinical trials show that endovascular intervention can not benefit all patients or not better than the best drug treatment.Therefore,it is controversial whether the treatment of renal artery stenosis is the first choice for endovascular intervention.In this study,we were analyzed the clinical data of patients undergoing endovascular intervention in our hospital in recent years and evaluated the early clinical outcomes of endovascular interventional therapy in patients with atherosclerotic renal artery stenosis.Methods: Retrospective analysis of clinical data of 41 patients undergoing endovascular intervention for atherosclerotic renal artery stenosis between January 2015 and December 2018 of Department of Vascular Surgery in Tianjin Medical University Second Hospital.All patients were observed the change of blood pressure,serum creatinine,urea nitrogen,glomerular filtration rate and blood pressure-lowering drug type or amount at the time of admission,1 day before surgery,1 day after surgery,5 days after surgery,and 3 or 6 months after operation,analysis and evaluation of the effectiveness and safety of endovascular interventional treatment of renal artery stenosis.Results: In this group,40 patients successfully completed endovascular intervention,the technical success rate was 97.56%.Among them,8 patients underwent renal balloon angioplasty(19.51%)and 30 patients underwent renal artery stenting(73.17%).2 patients with renal artery Anjiojet thrombectomy system thrombolysis、 thrombectomy combined with catheter thrombolysis(4.88%),1 patient converted to open aortic-renal artery artificial blood vessel bypass surgery due to failed interventional surgery(2.44)%).The total incidence of postoperative complications was 14.63%,of which the perioperative incidence was 4.88% and the rate of long-term in-stent restenosis was 9.75%.The results of this study is showed:The patient’s blood pressure at admission was(161.80±25.47/84.76±14.35)mm Hg and 1 day before surgery was(159.32±26.45/83.39±12.20)mm Hg.There was no statistically significant difference between the two groups(P>0.05).The blood pressure was significantly decreased at each time point after operation and the difference was statistically significant(P < 0.05).Among them,blood pressure was cured in 4cases(9.75%)and improved in 33 cases(80.49%).The average preoperative oral antihypertensive drug was(2.46±1.10)and 3 and 6 months after operation was(1.90±0.94)、(1.88±0.95),the difference was statistically significant(P< 0.05).Preoperative serum creatinine(108.65±42.98)μmol/L,serum creatinine increased to(122.67±104.70)μmol/L on the first postoperative day,and decreased to(101.89±34.68)mmol/L on 3 months and(102.50±32.76)μmol /L on 6 months after operation,there was no significant difference compared with preoperative(P>0.05).Preoperative urea nitrogen was(9.65±11.10)mmol/l and postoperative urea nitrogen at all time points were reduced,the difference was not statistically significant(P > 0.05).Bilateral glomerular filtration rate was significantly increased after endovascular intervention: [GFR of the surgical side(29.94±12.94)ml/min VS(36.18±12.85)ml/min;non-surgical side GFR(33.93±17.93)ml/min VS(39.48±16.64)ml/min],the difference was statistically significant(P<0.05).Conclusion: 1.The atherosclerotic renal artery stenosis endovascular interventional operation is Minimally,safely and effectively,with high technical success rate and low postoperative complications.It can be used as the first choice for the treatment of renal artery stenosis.2.Endovascular intervention can effectively relieve renal artery stenosis,promote renal blood flow recovery,and have positive significance in blood pressure control and improvement of renal function.3.The age of the patient,the etiology and severity of hypertension,and the degree of renal artery stenosis can affect the clinical outcome of endovascular interventional treatment of renal artery stenosis.