Publication: Renal arter darlıklarının stent ile endovasküler tedavisi: Teknik ve klinik sonuçlar
Abstract
AMAÇ Renal arter darlıklarının tedavisinde stent yerleştirilmesinin, primer başarı oranı ve takip sonuçları ile, renovasküler hipertansiyonu ve böbrek fonksiyonları bozuk olan hastalarda, klinik sonuçlarını değerlendirmektir. GEREÇ VE YÖNTEM Otuz beş (16 erkek, 19 kadın; yaş ortalaması 60,1) hastada toplam 40 renal artere balon ile genişleyen stent yerleştirildi. On bir hastada kontrol edilemeyen hipertansiyon, 12 hastada ilerleyici böbrek yetmezliği ve 8 hastada da her iki bulgu birden bulunmaktaydı. Dört olgu ise insidental olarak, periferik arter hastalığı için yapılan anjiyografilerde tanı aldı. Hastalar tedavinin etkinliğini belirlemek için, işlem öncesi ve sonrası kan basıncı ve serum kreatinin düzeyleri ile takip edildiler. Primer teknik başarı oranı %100 idi. Stenoz oranları %50-90 (ort. %81) arasında değişmekte idi. Yirmi sekiz renal arterde ostial lezyon, 10 tanesinde proksimal ve 2 olguda distal lezyon vardı. En az bir yıllık kontrolü yapılan olgularda, bir yıllık primer açık kalma oranı %93 (14/15) idi. Yedi (%20) hastanın hipertansiyonunda tam iyileşme, 17 (%48,5) hastada düzelme izlenirken, 11 (%31,5) hastada ise yanıt alınmadı. Renal fonksiyonu bozuk olan 21 hastanın 12 (%57,2)'sinde düzelme, 3 (%14,3)'ünde kötüleşme saptanırken, 6 (%28,5) hastada ise deği- şiklik izlenmedi. SONUÇ Renal arter darlıklarının stent ile revaskülarizasyonu, primer teknik başarı şansı yüksek, restenoz oranı düşük, komplikasyon oranı kabul edilebilir sınırlar içerisinde olan, basit etkin ve güvenilir bir tedavi yöntemidir. Kontrol edilemeyen hipertansiyonu ve ilerleyici böbrek yetmezliği olan önemli bir hasta grubunda, klinik fayda sağlamaktadır.
PURPOSE: To determine the primary success rate and follow-up results of renal artery stenting in controlling renovascular hypertension and renal failure in patients with renal artery stenosis. MATERIALS AND METHODS: Balloon expandable stents were placed in 40 renal arteries of 35 patients (16 men, 19 women; mean age 60,1). Indications for treatment were hypertension alone in 11 patients, disturbed renal functions alone in 12 patients and hypertension associated with renal failure in eight patients. Four of the patients were diagnosed during angiography due to peripheral arterial diseases. Blood pressures and serum creatinine levels were measured before the operation and after stenting. RESULTS: The primary technical success rate was 100%. Mean percent stenosis was 81%. The lesions were ostial in 28 patients, proximal in 10 patients and distal in 2 patients. In those patients having at least one year of follow up, the primary patency at one year was 93% (14/15). Hypertension was cured in 7 (20%) patients, improved in 17 (48.5%) patients and did not respond in 11 (31.5%) patients. Of 21 patients with disturbed renal function, 12 (57.2%) patients improved, 3 (14.3%) patients deteriorated and 6 (28.5%) patients were stabilized. CONCLUSION: Revascularization of renal artery stenosis is a simple, efficient and safe procedure with high primary technical results, low restenosis rates and acceptable complication rates. It has a beneficial effect on blood pressure control and a nondeleterious effect on renal function.
PURPOSE: To determine the primary success rate and follow-up results of renal artery stenting in controlling renovascular hypertension and renal failure in patients with renal artery stenosis. MATERIALS AND METHODS: Balloon expandable stents were placed in 40 renal arteries of 35 patients (16 men, 19 women; mean age 60,1). Indications for treatment were hypertension alone in 11 patients, disturbed renal functions alone in 12 patients and hypertension associated with renal failure in eight patients. Four of the patients were diagnosed during angiography due to peripheral arterial diseases. Blood pressures and serum creatinine levels were measured before the operation and after stenting. RESULTS: The primary technical success rate was 100%. Mean percent stenosis was 81%. The lesions were ostial in 28 patients, proximal in 10 patients and distal in 2 patients. In those patients having at least one year of follow up, the primary patency at one year was 93% (14/15). Hypertension was cured in 7 (20%) patients, improved in 17 (48.5%) patients and did not respond in 11 (31.5%) patients. Of 21 patients with disturbed renal function, 12 (57.2%) patients improved, 3 (14.3%) patients deteriorated and 6 (28.5%) patients were stabilized. CONCLUSION: Revascularization of renal artery stenosis is a simple, efficient and safe procedure with high primary technical results, low restenosis rates and acceptable complication rates. It has a beneficial effect on blood pressure control and a nondeleterious effect on renal function.