直接動脈支架置放血管整型術治療移植腎動脈狹窄後的立即效果及長期追蹤 – 一個單一醫學中心的經驗

Immediate efficacy and long term follow-up of pimary endoluminal stenting of transplant renal artery stenosis – a single center experience

蘇峻弘(Chun-Hung Su)

指導教授 ： 翁國昌

中山醫學大學/醫學院/醫學研究所/碩士(2008年)

https://doi.org/10.6834/CSMU.2008.00070

摘要

背景資料
傳統血管整型術對於移植腎動脈狹窄的治療常有再狹窄的問題，患者需再次接受血管整型術或手術治療。研究顯示直接動脈支架置放血管整型術可明顯減少再狹窄的問題，短期追蹤亦顯示明顯改善血壓控制及腎功能，但至今無長期追蹤的報告可參考。
研究材料及方法
我們以病例回溯的方法進行研究，收集西元2001年9月至2003年8月在本院9位接受直接動脈支架置放血管整型術的移植腎動脈狹窄患者的資料，包括術前至術後的血壓、腎功能指數(肌酸酐)及降血壓藥物的數量。術後資料包含48小時內及第一至四年的紀錄，並且計算測量的腎絲球過濾率及平均動脈壓作為評估預後的參考指標。其中一位患者因腎臟切片證實因急性排斥造成腎功能快速惡化而排除在後續分析之外，我們使用重複變異數分析的方法分析剩餘8位術後資料與術前的比較。
結果
所有患者均成功完成直接動脈支架置放血管整型術，在追蹤期間沒有出現任何血管再狹窄的臨床表現，患者難以控制的血壓能有立即的改善及維持長期穩定的效果，另外術前患者普遍不良的腎功能也能立即獲得改善且長期追蹤期間無再度惡化的情形。
結論
這是第一篇直接動脈支架置放血管整型術治療移植腎動脈狹窄後的長期追蹤報告，結果顯示直接動脈支架置放不但能減少血管再狹窄，也降低再次接受侵入性治療與併發症的機會，並且有良好的長期預後。

關鍵字

移植腎動脈狹窄 ； 直接動脈支架置放

並列摘要

Background
The main problem of percutaneous transluminal angioplasty of transplant renal artery stenosis(TRAS) is recurrent TRAS soon after the procedure. Repeating PTA and metabolic stents deployment or surgical treatment were recommended for recurrent TRAS. The use of primary stenting in stenotic lesions may slow or prevent recurrence of TRAS. The experience of primary endoluminal stenting of TRAS was reported but still limited in short term follow-up
Materials and methods
This is a retrospective case controlled study and consisted of 9 kidney recipients transplanted with TRAS that received primary endoluminal stenting between September 2001 and August 2003 and all these were from cadavers. The data we collected including arterial pressure, creatinine and the numbers of anti-hypertensive medications before and after procedure. We calculated eGFR(estimated glomerular filtration rate) and MAP(mean arterial pressure) for further outcome evaluation. The data collection after procedure included within 48 hours, 1 year, 2 year, 3 year and 4 year. Repeated measurement ANOVA was used to analysis and comparison. At each interval, the patient’s follow-up value compared with the baseline value (Pre-stent).
Result
The technical success rate was 100%. One of these patients was excluded in the further statistical analysis because the deterioration of graft function was due to acute
rejection and polyomavirus nephropathy, which was confirmed by graft biopsy.
Primary stenting resulted in immediate improvement of blood pressure control and remained stable during 4 years follow-up with comparison to baseline MAP(ANOVA: p = 0.002). It also led to immediate significant improvement of graft dysfunction and remained stable persistently during 4 years follow-up according the eGFR analysis (ANOVA p=0.002). No any clinical evidence of recurrent stenosis was recorded.
Conclusion
As far as we know, this is the first report of long-term follow-up after primary endoluminal stenting of TRAS. This method reduce rcurrent stenosis and the risk of procedural complications. It’s good efficacy and safety were also confirmed by this study.

並列關鍵字

transplant renal artery stenosis ； primary endoluminal stenting

參考文獻

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