Evaluation Of The Effect Of Endovascular Treatment And Preoperative Assessment Analysis For Atherosclerotic Renal Artery Stenosi

Objective:To evaluate the efficacy of PTRAS in patients with ARAS and analyze the factors affecting the efficacy of PTRAS to explore the effect of PTRAS and its reasonable preoperative evaluation index.Methods:The clinical data of patients with atherosclerotic renal artery stenosis who underwent endovascular treatment in our hospital from December 2010 to October 2020were retrospectively analyzed.The changes of blood pressure and renal function were followed up.Results:PTRAS was successfully performed in all 42 patients.A total of 52balloon-expandable stents were implanted.The follow-up time was 6-18 months.The follow-up results showed that the systolic blood pressure of all 42 patients decreased from(151.41±21.33)mm Hg to(134.57±12.86)mm Hg(P<0.05),the diastolic blood pressure decreased from(84.64±11.01)mm Hg to(78.95±9.48)mm Hg(P=0.028),and the pulse pressure difference decreased from(68.77±15.30)mm Hg to(55.98±10.47)mm Hg(P<0.05).The postoperative blood pressure was significantly improved compared with that before operation,and the differences were statistically significant(P<0.05).The creatinine level of 42 patients was(91.80±31.70)μmol/L before operation and(83.18±21.12)μmol/L at follow-up(P=0.019).The estimated glomerular filtration rate of 42 patients was(92.74±44.26)[ml/(min·1.73 m ~2)]before operation and(79.22±42.28)[ml/(min·1.73 m ~2)]at follow-up(P=0.009).There was no significant difference in postoperative efficacy between unilateral group(group A)and bilateral group(group B).The 32 patients with improved renal function and hypertension were cured or improved,and no complications such as cardiovascular and cerebrovascular accidents during the follow-up period were defined as the benefit group,and the remaining patients were defined as the non-benefit group.The preoperative age,gender,systolic blood pressure,diastolic blood pressure,pulse pressure,urea nitrogen,serum creatinine,triglyceride,cholesterol,albumin,homocysteine,estimated glomerular filtration rate and other indicators were compared between the two groups.The results showed that gender,smoking,systolic blood pressure,pulse pressure difference and albumin were related risk factors for renal artery stenosis.Renal function was improved and hypertension was cured or improved,and there was no cardiovascular and cerebrovascular accident during the follow-up period.Conclusion:PTRA or PTRAS treatment can effectively alleviate the symptoms of hypertension in patients with hemodynamic significance and clinical symptoms.However,the choice of indications for patients should be particularly cautious.Gender,smoking,preoperative systolic blood pressure,pulse pressure difference and albumin are good predictors of blood pressure control and renal function benefit after revascularization.Strict screening should be performed before PTRA or PTRAS treatment.