A Clinical Study Of Renal Artery Fibromuscular Dysplasia In Chinese

Objective:To investigate the clinical and angiographic characteristics in Chinese patients with renal artery fibromuscular dysplasia(RA-FMD)in the National Cardiovascular Center for consecutive 18-years.Methods:The medical data of patients with RA-FMD diagnosed in Fuwai Hospital from November 1,2000 to October 31,2018 were collected continuously.And the demographic,clinical and renal arteriographic data were analyzed retrospectively.Results:For 18 years,one hundred and forty-two patients included 76 males and 66 females at the ratio of 6:5.The age of diagnosis was 28±9.8(10-55)years,and the onset age of hypertension was 23.9 ± 9.1(6-54)years.All patients suffered from hypertension at admission.Systolic blood pressure was 157.6 ± 17.5 mmHg,diastolic blood pressure was 102.3±14.2 mmHg,and the number of antihypertensive drugs was 2.0±1.2.More than half(53.5%)patients had dizziness or headache.Serious complications included 13(9.2%)stroke,5(3.5%)heart failure and 7(4.9%)renal insufficiency.Renal damage included 25(17.6%)urinary protein,45(31.7%)renal atrophy,6(4.2%)renal infarction and 4(2.8%)nephrectomy.A total of 179 renal arteries were involved,36(25.4%),69(48.6%)and 37 cases(26.1%)had single left,single right and bilateral lesions,respectively.Multifocal and focal types were 36(25.4%)and 106(74.6%)cases respectively,while unifocal and tubular types were 63(44.3%)and 43(30.3%)cases respectively.Renal artery stenosis was 85.2±12.7%,included twenty-four cases(16.9%)of renal artery occlusion.Twenty(14.1%),53(37.3%)and 57(40.1%)had renal artery stenosis mainly in the proximal,the middle and the distal trunk.However,10(7.0%)of the first branch and 2(1.4%)of the second branch were less.Forty-four cases(31.0%)had renal aneurysm,and 38(86.4%)had only one aneurysm.Twenty-eight(63.6%),12(27.3%)and 4(9.1%)had single left,single right and bilateral aneurysms.The stenosis of the coronary artery,abdominal aorta,intracranial artery and subclavian artery as well as splenic aneurysm was in 1 case(0.7%)respectively.Iliac artery dissection,vertebral artery stenosis and superior mesenteric artery stenosis was in 2 cases(1.4%)respectively.Conclusion:This study indicated that the clinical and angiographic characteristics in Chinese patients with RA-FMD are significantly different from the latest international consensus on FMD,and more large sample multicenter studies are needed.Background and Objectives:Endovascular data of patients with RAS caused by FMD are scarce in China.This study aimed to evaluate the safety and efficiency of percutaneous transluminal angioplasty(PTA)with selective stenting treating Chinese patients with renal artery stenosis(RAS)due to fibromuscular dysplasia(FMD).Methods:Clinical data of 105 hypertensive patients with RAS caused by FMD underwent endovascular therapy at a single-site between June 2001 and October 2018 were analyzed retrospectively.Baseline blood pressure,use of antihypertensive medications,renal function,and adverse events at a one-year follow-up were evaluated.Results:The patients were aged between 10 and 64 years(mean age 26.7±8.2 years)and 52(49.5%)were female.In total,105 patients undergoing endovascular therapy involving 124 RASs.Thirty(24.2%),64(51.6%)and 30(24.2%)RASs were multifocal,unifocal and tubular types,respectively.Ninety-four(89.5%)and 11(10.5%)patients underwent PTA alone and PTA plus stenting,respectively.The technical success rate for endovascular therapy was 95.2%(100/105)without severe complications.During one-year follow-up(n=100),the mean systolic and diastolic blood pressure decreased from 157.6±17.5 and 102.3±14.2 mmHg to 129.6±12.3 and 81.3±11.1 mmHg,respectively,and the number of antihypertensive medications reduced from 2.2±1.2 to 0.8±1.0(all P<0.001).The cure rate and improved rate of blood pressure was 49.0%and 40.0%,respectively.The serum creatinine levels remained stable.The primary and secondary restenosis rate was 13.4%and 5.8%,respectively.Conclusion:Endovascular therapy for treating RAS caused by FMD was technically safe and effective for reducing blood pressure in Chinese patients.