经皮血管成形术治疗肾动脉纤维肌性发育不良的临床疗效

目的评价经皮血管成形术（PTA）治疗肾动脉纤维肌性发育不良（FMD）的疗效及安全性。方法连续入选我院近6年来因严重高血压入院,经肾动脉造影确诊为肾动脉FMD并行PTA的患者。回顾性分析其临床特点,并随访血压、降压药使用情况和PTA治疗效果。结果共入选20例患者,年龄13～47岁（平均24.5±7.8岁）,其中女性12例（60.0%）。肾动脉造影显示共23条肾动脉受累,其中21条肾动脉直径狭窄〉60%的患者行肾动脉成形术,包括单纯球囊扩张17例（80.9%）,球囊扩张加支架置入4例（19.1%）,技术成功率为95.2%（20/21）。经过1～6年随访,改为肾动脉逐年累积再狭窄发生率为15.0%,20.7%,26.3%,33.7%,33.7%,33.7%。结论 PTA治疗肾动脉FMD安全有效。

Clinical outcomes of percutaneous transluminal angioplasty as treatment for renal artery fibromuscular dysplasia.

Purpose To evaluate the safety and efficiency of percutaneous transluminal angioplasty(PTA)as treatment for symptomatic renal artery fibromuscular dysplasia(FMD).Method Twenty consecutive patients with FMD in the past 6 years who underwent PTA for severe hypertension were enrolled in the retrospective study.Clinical characteristic were analyzed,and blood pressure,use of antihypertensive medications and the effect of PTA were followed up.Results In 20 patients,aged 13～47 years(24.5±7.8),female 12(60.0%),23 renal arteries were involved angiographically.21 of 23 had diameter reduction more than 60%which were performed PTA,17 of 21(80.9%)underwent plain balloon dilation,and the other 4(19.1%)with balloon dilation plus stent.The technical success rate for primary PTA was 95.2%(20/21)without severe procedure related complications.During 6-72 month follow-up,blood pressure and the number of antihypertensive medications were significantly decreased.The restenosis rate at 1st,2nd,3rd,4th,5th,and 6th year was 15.0%,20.7%,26.3%,33.7%,33.7%,33.7%,respectively.Conclusion PTA for symptomatic renal artery FMD is technically successful,safe and durable,and effective on the blood pressure control in most of patients.