移植肾动脉狭窄直接支架长期疗效的前瞻性研究苏峻弘ppt课件.ppt

;Outline;Transplant renal artery stenosis (TRAS) is an increasingly recognized, potentially treatable, etiology of refractory hypertension and graft dysfunction following kidney transplantation. ;Its incidence varies from 1% to 23%. Clinically, TRAS usually presents from 3 months to 2 years after transplantation, but it can occur at any time ;Percutaneous transluminal balloon angioplasty (PTA) is widely accepted as treatment of TRAS. Also of importance is the clinical recurrence rate, in the face of acute success, of at least 10% to 33% when using PTA alone.;The deployment of metallic stents to maintain the patency of stenosed vascular segments has been used in cases of recurrent TRAS. Research has indicated that the use of primary endoluminal stenting (PES) in stenotic lesions may slow or prevent the recurrence of TRAS. ;The experience of PES for TRAS from different donor kidneys has been reported, but with limited short-term follow-up. To date, there has only been one retrospective long-term report. ;;;Aims of this study;Materials;Methods(1); MRA confirmed TRAS ?end to side anastomosis (external iliac artery) ;Ipsilateral femoral approach ; Final result of PES ; MRA confirmed TRAS ?end to end anastmosis (internal iliac artery) ;Contralateral femoral approach ;Final result of PES;Methods(2) Follow-up Protocol and Data Collection ;Statistical analysis;Results;;A total of 20 stents were deployed in 20 stenotic lesions and the technical success rate was 100%. The mean percentage of stenosis on angiography was reduced from 81.0 ± 11.2% before to 3.3 ± 4.5% after PES (p 0.001). At hospital discharge, 18 patients (100%) were clinically improved, of whom 14 were eligible for over 1 year of follow-up, and 7 were eligible for over 6 years. The mean follow-up was 48.6 ± 39.1 months. ;Follow-up and comparison of systolic and diastolic BP before and after PES;Follow-up and comparison of the number of anti-hypertensive medications before an