Search

Refractory hypertension and renal insufficiency caused by Takayasu arteritis with renal arteries involved are difficult to treat with medicines.Instead,surgery is often recommended for refractory renovascular hypertension with renal artery stenosis of ≥70%.Although both open surgery and endovascular surgery have been applied,the preferred surgical strategy remains undetermined.This article reviews the clinical effectiveness,long-term patency,and complications of open surgery,percutaneous balloon angioplasty,and stenting in patients with Takayasu arteritis-associated renal artery stenosis.

Objective: To explore the prevalence and risk factors of atherosclerotic renal artery stenosis (ARAS) in patients undergoing coronary angiography., Methods: A total of 2506 patients with suspected and known coronary heart disease (CAD) at our hospital underwent simultaneous coronary and renal angiography. Renal artery stenosis was defined as at least one of renal artery stenosis ≥ 50% narrowing of luminal diameter. The prevalence of ARAS was summarized from the results of angiography. And single- and multi-variable logistic regression analysis was used to assess the relationship between clinical characteristics and ARAS., Results: Among them, there were 1479 males and 1027 females with a mean age of 62.7 ± 11.4 years. ARAS was detected in 409 patients (16.3%), including 214 (8.5%) with significant stenosis (≥ 75%); Bilateral ARAS was detected in 98 patients (3.9%), including 27 (1.1%) with significant stenosis (≥ 75%). Left and right ARAS were detected in 162 patients (6.5%) and 148 patients (5.9%) respectively, including 84 patients (3.4%) with significant stenosis (≥ 75%) in left ARAS and 72 patients (2.9%) in right ARAS. Univariate analysis indicated that age, females, diabetes, hypertension, stroke, peripheral artery disease, coronary heart disease, renal insufficiency, dyslipidemia and hyperuricemia were the predictor for ARAS (P < 0.05 or 0.01). Multivariate regression analysis demonstrated that age ≥ 65 years (P = 0.025, OR = 1.358), females (P < 0.01, OR = 1.678), hypertension (P < 0.01, OR = 1.650), peripheral artery disease (P < 0.01, OR = 14.678), renal insufficiency (P < 0.01, OR = 1.835), coronary heart disease including 3-vessel (P < 0.01, OR = 1.746) and left main coronary (P < 0.01, OR = 3.416)disease were independent risk factors for ARAS., Conclusion: Renal angiography should be routinely performed in female patients aged ≥ 65 years with hypertension, peripheral artery disease, elevated creatinine and coronary heart disease, especially for 3-vessel and left main coronary disease to identify ARAS in time.

Objective: To clarify the outcome of surgical reconstruction for renal artery in Takayasu arteritis-induced renal artery stenosis (TARAS)., Methods: A retrospective chart review was conducted on 33 consecutive patients with TARAS, who underwent aortorenal bypass (ARB) with autologous saphenous vein graft. There were 9 male and 24 female patients, with a mean age of (25 ± 11) years. The effects on blood pressure and renal function were analyzed. Primary, primary assisted, and secondary patency rates were determined. The effects of various factors on primary patency rate were analyzed. All patients showed hypertension. The mean blood pressure was (175 ± 26)/(100 ± 19) mmHg (1 mmHg = 0.133 kPa). The mean antihypertensive dosage was (2.1 ± 0.6) defined daily dose (DDD). Seventeen patients showed intractable hypertension. Mean estimated glomerular filtration rate was (78 ± 5) ml/min. One patient was dialysis-dependent, and 3 patients were combined with congestive heart failure., Results: ARB was performed for the 39 renal arteries, including 27 unilateral and 6 bilateral bypasses. Postoperative morbidity was 15.2%. All patients survived. During follow-up of mean (56 ± 18) months, two graft occlusions and four graft restenoses occurred. All graft restenoses were eliminated successfully with percutaneous angioplasty, but one patient experienced restenosis again six months later. At 1, 3, and 5 years of follow-up, primary patency was 92%, 89%, and 79%, respectively, primary assisted patency was 95%, 95%, and 91%, respectively, and secondary patency was 95%, 95%, and 91%, respectively. ARB resulted in a decrease in mean blood pressure to 139/85 mmHg (one month post-ARB, P = 0.000) and 136/80 mmHg (last follow-up, P = 0.000), and a reduction in mean antihypertensive dosage to 1.4 DDD (one month post-ARB, P = 0.084) and 0.6 DDD (last follow-up, P = 0.000). Mean estimated glomerular filtration rate increased to 82 ml/min (P = 0.458) one month post-ARB, and 91 ml/min (P = 0.044) at last follow-up, respectively. The dialysis-dependent patient no longer required hemodialysis, and left ventricular dysfunction resolved in all of the three patients., Conclusion: ARB using the autologous saphenous vein graft is safe, effective and durable for treating TARAS.

Objective: To investigate the effectiveness of percutaneous transluminal renal artery stenting (PTRAS) in treating atherosclerotic renal artery stenosis (ARAS)., Methods: A total of 69 patients with severe ARAS were treated with PTRAS between January 2002 and December 2008. There were 47 males and 22 females with an average age of 66.2 years (range, 42-88 years), including 66 cases of unilateral ARAS (single functional kidney, 1 case) and 3 cases of bilateral ARAS. Renal angiography revealed that the degree of renal artery stenosis was 70%-99%. Concomitant diseases included hypertension (67 cases), atherosclerosis obliterans (69 cases), coronary heart disease (34 cases), diabetes (44 cases), and hyperlipidemia (36 cases). Blood pressure, serum creatinine (sCr), and patency of the renal artery were measured to assess the effectiveness of PTRAS after 12 months., Results: The renal artery stent was successfully implanted in 68 patients and the technical success rate was 98.6%. One patient was converted to ilio-renal bypass because of intra-operative acute renal artery occlusion. One patient died of heart failure at 6 months after PTRAS, and 1 patient was lost at 3 months after PTRAS. The other 66 patients were followed up 32 months on average (range, 13-60 months). The blood pressure decreased significantly at 1 month and gained a further decrease at 12 months after PTRAS when compared with the preoperative ones [systolic blood pressure: (132 +/- 24) mm Hg vs (163 +/- 34) mm Hg, P < 0.05; diastolic blood pressure: (78 +/- 11) mm Hg vs. (89 +/- 17) mm Hg, P < 0.05; 1 mm Hg = 0.133 kPa]. Hypertension was cured in 4 cases (6.3%), improved in 52 cases (81.2%), failure in 8 cases (12.5%), and the overall benefit rate was 87.5%. The sCr level was stable after 12 months of PTRAS, showing no significant difference when compared with preoperative baseline [(107.8 +/- 35.4) micromol/L vs (104.1 +/- 33.8) micromol/L, P > 0.05]. Renal function was improved in 9 cases (13.6%), stable in 48 cases (72.8%), deterioration in 9 cases (13.6%), and the overall benefit rate was 86.4%. Instant restenosis found in 2 patients (3.0%) at 12 months after operation., Conclusion: PTRAS is a safe and effective method to treat ARAS. It can control the blood pressure and stabilize the renal function in most ARAS patients. Long-term efficacy needs further investigation.

Objective: To investigate the diagnosis and management of transplant renal artery stenosis (TRAS) caused by early stage acute allograft rejection., Method: A retrospective study was conducted in 3 cases with diagnoses of TRAS and early stage acute allograft rejection confirmed by color Doppler ultrasonography, renal artery angiography, and renal graft biopsy., Results: Antirejection therapy was carried on subsequently rather than percutaneous transluminal angioplasty or percutaneous transluminal angioplasty and stenting. The blood pressure and creatinine level which were abnormal at the time of diagnosis of TRAS and acute allograft rejection returned to normal after antirejection treatment in those patients. Moreover, TRAS was not detected any more by color Doppler ultrasonography during the follow-up period., Conclusion: TRAS is associated with early stage acute allograft rejection episodes. Color Doppler ultrasonography is useful in screening and follow-up of TRAS. Transplant renal arteriography is the gold standard for diagnosis. Antirejection therapy is an effective therapeutic modality other than percutaneous transluminal angioplasty or angioplasty and stenting for TRAS.

Objective: To investigate the risk factors of transplant renal artery stenosis (TRAS)., Methods: The clinical records of 26 patients undergoing renal transplantation in our hospital between 2000 and 2005 were retrospectively analyzed, whose final diagnosis of TRAS was established on the basis of arteriographic findings. A case-control group of 52 post-renal transplantation patients were sampled by stratified randomization, whose blood pressure and renal graft function were without complications of avascularity or urinary passage. The two groups were matched for the operation time, gender, age, primary diseases, blood type, PRA and HLA matching and use of immunosuppressants. Possible events related to TRAS such as cold ischemia time, acute rejection, delayed graft function and approaches of arterial anastomosis were compared., Results: Fifteen patients (57.7%) with TRAS had a history of acute rejection episode, 7 (26.9%) had delayed graft function, both rates of which were higher than those in the control group (P<0.05). The cold ischemic time and type of arterial anastomosis showed no significant effect on TRAS occurrence (P>0.05)., Conclusions: Post-transplant renal artery stenosis is closely associated with acute rejection and delayed graft function but not with the cold ischemic time or the type of arterial anastomosis.

Objective: To observe the changes of clinical characteristics and interventional methods of patients with renal artery stenosis in recent 17 years., Methods: Comparing the clinical characteristics and interventional treatment of patients diagnosed renal artery stenosis by the means of renal angiography in recent 17 years., Results: The numbers of renal artery stenosis were increasing year by year. the average ages before the year of 2000 was younger than that after 2000 (P < 0.05) and the main cause of renal artery stenosis was aorto-arteritis at that time, however, it turned to atherosclerosis after the year of 2000. Same patients indicated renal angiography due to plash pulmonary edema, unstable angina on abnormal serum creatinine. The interventional methods to renal artery stenosis shifted from balloon angioplasty only before the year of 2000 to stent implantation post-balloon dilatation after the year of 2000. The distal protective device was more used during the procedure., Conclusions: The numbers of patients indicated renal angiography had been increasing in the two decades. The main causes of renal artery stenosis had been considered arthro-sclerosis instead of aorta-arteritis before. The methods of treatment to renal artery stenosis had been changed to renal stenting post-balloon angioplasty after the year of 2000.

Objective: To determine whether the etiology of renal artery stenosis changed. To investigate the clinical characteristics and current therapeutic situation of atherosclerotic renal artery stenosis (ARAS)., Methods: Retrospective analysis was performed in 144 cases of renal artery stenosis diagnosed by angiography (> or = 50% luminal narrowing) from 1979 to 2003. Eighty-seven of them were diagnosed as ARAS by special characteristics of angiography and clinical features. The clinical data of ARAS was compared with RAS caused by other diseases., Results: The proportion of ARAS in all RAS was 60.4%. The proportion of ARAS was 28.9% during the period of 1980 to 1990 and 71.7% from the year of 1991 to 2003, respectively. The prevalence of hypertension was 90.8% among ARAS patients. Newly-progressive hypertension was more common among ARAS patients compared with RAS patients with other causes (37.9% vs 21.0%, P = 0.044). Renal dysfunction were more commonly seen among ARAS than non-ARAS patients in those with the same degree of stenosis (11.2% vs 6.9% for stenosis 50%-74%, P = 0.038; 35.8% vs 15.4% for stenosis > or = 75%, P = 0.046). Among ARAS cases, 60.9% were managed with antihypertensive agents only, 18.8% were managed by angioplasty with or without stents. After 1990, the improvement rate of blood pressure rose significantly but not for renal function. The improvement rate of blood pressure by angioplasty was similar with that by medication (84.1% vs 92.6% for stenosis 50%-74%, P = 0.39; 76.6% vs 80.1% for stenosis > or = 75%, P = 0.61). And the improvement or stable rate of renal function was not different (85.4% vs 85.7% for stenosis 50%-74%, P = 0.91; 77.8% vs 76.9% for stenosis > or = 75%, P = 0.83)., Conclusion: ARAS is the predominant cause of RAS nowadays in stead of Takayasu arteritis. Medication is the mostly used management for ARAS, though more angioplasty with or without stents appear. The effect of medication for ARAS has improved since 1990. Most cases of ARAS could achieve ideal blood pressure control and similar renal function protection with either rational medication or angioplasty.

Objectives: To evaluate the effects of stent revascularization on renal function of patients with atherosclerotic renal artery stenosis with renal insufficiency., Methods: Percutaneous transluminal renal angioplasty with stent (PTRAS) was performed on 27 consecutive patients with severe atherosclerotic renal artery stenosis for preservation of renal function, and follow-up was conducted for 6 approximately 48 months., Results: Technically PTRAS was successfully performed in all 27 patients. The creatinine value was 155 micromol/L +/- 31 micromol/L before operation, and increased to 189 micromol/L +/- 38 micromol/L (P < 0.001), then decreased to 145 micrommol/L +/- 22 micrommol/L, 143 micromol/L +/- 22 micromol/L, 143 micromol/L +/- 24 micromol/L, and 139 micromol/L +/- 10 micromol/L, 6, 12, 24, and 36 months after the PTRAS respectively (all P < 0.05). The severe complications related to the procedure mainly included 7 cases of acute renal failure, 4 cases being reversible. One case died of cardiac infarction with underlying coronary heart disease 9 months after and 1 case died heart failure due to valvular disease of heart 25 months after., Conclusion: Renal artery stent revascularization is effective for preservation of renal function in patients with ischaemic nephropathy effect on. However, complications related to the procedure frequently occurred. The long-term efficacy is to be investigated further.

Objective: To discuss the diagnostic methods of transplant renal artery stenosis (TRAS) and clinical outcome following percutaneous transluminal angioplasty., Methods: Of 24 patients with TRAS screened by color Doppler ultrasound and confirmed with digital subtraction angiography, balloon angioplasty was performed in 19 patients, and 5 patients received stent implantation, including 2 cases of recurrent stenosis., Results: Technical success was achieved in all procedures with no serious complications. The blood pressure and serum creatinine levels of all patients were remarkably decreased (P < 0.01). Renal functions of the two patients with restenosis were significantly improved after intra-arterial stenting., Conclusions: Doppler ultrasonography is useful in the screening and follow-up of TRAS and arteriography is still the definite diagnostic method. Percutaneous transluminal angioplasty and stenting are safe and effective procedures to treat TRAS.

Objective: To explore the possible causes of transplant renal artery stenosis (TRAS) in cadaveric transplant recipients., Method: We retrospectively analyzed multiple factors that may contribute to TRAS (including the patients' age, presence of diabetes, cold ischemic time, acute rejection episode, cytomegalovirus infection, serum cholesterol, LDL cholesterol, pre-operative dialysis, number of donor renal arteries, which side of donor kidney, type of surgical anastomosis, different protocols of inductive and maintenance drug therapy) in 18 recipients with transplant renal artery stenosis after cadveric renal transplantation from Jan. 2000 to Dec. 2001 in comparison with another 566 non-TRAS recipients who underwent the transplantation during the same period., Results: There was a higher incidence of acute rejection in the TRAS group than non-TRAS group (66.67% vs 5.48%, P<0.01), and no significant difference was noted between TRAS and non-TRAS cases in terms of the pre-operative dialysis, presence of diabetes, cold ischemic time, number of donor renal arteries, whith side of donor kidney, type of surgical anastomosis, different protocols of inductive and maintenance drug therapy, cytomegalovirus infections and serum and LDL cholesterols., Conclusion: The occurrence of TRAS in cadaveric allografts is associated with acute graft rejection episode, suggesting the importance of the treatment of acute graft rejection in the prevention of TRAS.

Objective: It is important to identify patients at risk for atherosclerotic renal artery stenosis because renal artery stenosis is a progressive disease and a potentially correctable problem. This study is to evaluate the prevalence of angiographically-determined renal artery stenosis in a patient population undergoing routine coronary angiography, and to identify the risk factors for renal artery stenosis., Methods: Before the procedure, demographic data, medical history, physical findings and laboratory data were obtained. After coronary angiography, abdominal aortography was performed to screen for the presence of renal artery stenosis over a 8-month period. In 370 patients (237 males, 133 females), mean age was 60.6 (29 to 81) years. And an univariate and multivariate Logistic regression analysis was made to explore the association of the clinical variables with renal stenosis., Results: Renal artery narrowing was identified in 106 (28.6%) patients. Significant renal artery stenosis, defined as a narrowing of the diameter by more than 50%, was found in 63 patients (17.0%) and insignificant (< 50% diameter narrowing) stenosis was found in 43 patients (11.6%). Significant unilateral stenosis was present in 41 (11.1%) patients and bilateral stenosis was present in 22 (5.9%) patients. By univariate and multivariate logistic regression analysis, the association of clinical variables with renal artery stenosis was assessed. Multivariable predictors included age (OR = 1.06, 95% CI: 1.03 approximately 1.10, P < 0.0001), severity of coronary artery disease (OR = 1.65, 95% CI: 1.34 approximately 2.03, P < 0.0001) and peripheral vascular disease (OR = 2.64, 95% CI: 1.27 approximately 5.47, P = 0.0095). The variables such as sex, body mass index, hypertension, smoking history, hyperlipidemia, myocardial infarction, congestive heart failure, renal insufficiency and diabetes mellitus were not associated., Conclusion: Renal artery stenosis is a frequent finding in patients undergoing coronary angiography, especially in older people with generalized atherosclerosis.

Objective: To understand the prevalence of renal artery stenosis(RAS) in patients with coronary artery disease(CAD) and the relations among coronary artery disease, renal artery stenosis, hypertension and renal insufficiency., Methods: 280 patients with coronary artery disease or suspected coronary disease were carried out renal artery angiography after coronary angiography over 1 year period., Results: Of the total patient cohort, 43(15.3%) had significant RAS (> or = 50%), 3(1.0%) were obstructed and 14 (5.0%) were bilateral. 36 (19.1%) were diagnosed as having significant RAS among 188 CAD patients. 7 patients with significant RAS were found among 92 patients without significant coronary artery stenosis, all of them were found in the group of 22 patients with mild coronary artery atheroscloresis. The prevalence of significant RAS was 19.6% and 7.9% as referred to with or without hypertension, P < 0.05. 10 patients (55.6%) had significant RAS in 18 patients with mild renal insufficiency as compared to 33 patients (12.6%) had significant RAS in 262 patients with normal renal function, P < 0.05. In the subgroup of CAD, the prevalence of significant RAS were 15.3%, 17.1%, 25.4% in single vessel disease, two vessel disease and triple vessel disease patients, P < 0.05. 35 patients (81.4%) had hypertension among these 43 patients with RAS with 24 (56.0%) patient's blood pressure difficult to control., Conclusions: RAS is a frequent finding in patients with CAD, especially in triple vessel disease patients. Hypertension is closely related to RAS, it should be the risk factor of RAS, and can be the clinical manifestation of RAS. CAD patients with renal insufficiency but without history of chronic glomerulonephritis may indicate RAS.

Objective: To observe the histopathological changes of obliterative arteriopathy (OBA) in human renal allografts, analyse OBA cellular components and probe its pathogenesis., Methods: 74 renal allografts removed due to acute vascular rejection and chronic rejection were studied by light microscopy, electron microscopy and immunohistochemistry methods., Results: OBA predominately affected the intima of interlobar, arcuate and interlobular arteries in all the 74 renal allografts. 29 cases developed OBA within 3 months post transplantation. 19 (25.7%) renal allografts showed early OBA with intimal arteritis, 55 (74.3%) cases had advanced OBA with intimal spindle-shaped smooth muscle cell (SMC) proliferation and intimal fibrosis. The cellular composition of OBA consisted of two origins, one from the host and the other from arterial wall intrinsic cells of renal allografts, including T lymphocytes; monocyte/macrophage cells; endothelial cells and different phenotypes--"contractile" or "synthetic" SMCs, "synthetic" SMCs secreted collagen types I, III., Conclusion: Our findings suggest that OBA is a post transplantation intrarenal arterial wall proliferative lesion. It is the result of a series of interactions between host immunocytes and allograft vascular wall cells. OBA is a type of immune reaction.