肾动脉狭窄治疗现况课件.ppt

肾动脉狭窄治疗现况 Interrelation among Renal-Artery Stenosis, Hypertension, and Chronic Renal Failure occur alone (isolated anatomical renal-artery stenosis) in association with hypertension, in association with renal insufficiency (ischemic nephropathy), or both. Natural history and prevalence Fibromuscular dysplasia accounts for less than 10 percent of cases of renal-artery stenosis, and 90 percent of cases of fibromuscular dysplasia involve the media. frequently involves the distal two thirds of the renal artery and its branches, and is characterized by a beaded, aneurysmal appearance on angiography rarely leads to renal-artery occlusion Natural history and prevalence Atherosclerosis accounts for 90 percent of cases of renal-artery stenosis and usually involves the ostium and proximal third of the main renal artery and the perirenal aorta progressive stenosis was reported in 51 percent of renal arteries 5 years after diagnosis renal atrophy developed in 21 percent of patients with renal-artery stenosis of more than 60 percent. atherosclerosis. Surgery treatment unilateral aortorenal bypass surgery once was the most common surgical technique. extra-anatomical bypass now accounts for 80 percent of renal bypass operations Perioperative mortality rates range from 2.1 percent to 6.1 percent for extra-anatomical bypass and from 1 percent to 4.7 percent for renal endarterectomy Surgery treatment Early graft failure has been reported in 1.4 to 10 percent of patients late graft failure is usually due to the presence of organized thrombus, intimal proliferation, and progressive atherosclerosis. At 5 years, the rate of graft failure ranges from 6 to 18 percent, repeated operation or angioplasty is required in 5 to 15 percent of patients and the survival rate is 65 to 81 percent. Percutaneous Intervention conventional balloon angioplasty, with or without stenting. Conventional balloon angioplasty is considered the treatment of choice for patients with uncontrolled hy