肾血管病的处理课件.ppt

ManagementofRenovascularHypertension

阜外心血管病医院心内科蒋雄京

InterrelationamongRenalArteryStenosis,Hypertension,andChronicRenalFailure

DefinitionofRenalArteryStenosis

Renalarterystenosis(RAS)isdefinedasnarrowingofthelumenoftherenalartery.

*angiographicdiameterstenosis50%

*translesionalpressuregradientof20mmHgpeaksystolic

or10mmHgmean

ThemostcommoncausesofRASareatherosclerosis(80%),aortoarteritis(15%),andfibromusculardysplasia(5%)inChina

AngiographicAppearanceoftheThreeCommonFormsofRenalArteryStenosis

Prevalence1.1~3%inhypertensivepopulation2.20~30%inpatientswithsecondaryhypertension

IncidenceofRenalArteryStenosis

atCardiacCatheterization

AuthorsYearCountryPatientsAgeCAD(%)HT(%)RAS(%)Crowley1998USA141526189726.3Conlon2000Ireland398752100586.3Weber2002Austria17763626711Yamashita2002Japan2896676487Rihal2002USA29765NA10019.2Buller2004Canada83767683214.3Addad2005Tunisia30058100359CAD=Coronaryarterydisease;HTN=Hypertension;RAS=significantrenalarterystenosis;NA=nonavailable.

IncidenceofRenalArteryStenosisatCardiacCatheterization

inChinesepopulationStudyAuthorsZhangetalPts,n1200RAS50%9.7Bilateral,%1.7IndicationSuspectedCHDWangetal23014.8NRCHDShenetal28015.35.0SuspectedCHDLiuetal14118.4NRSuspectedCHDMean185111.8NR

ProgressiveAtherosclerosis,RenalArteryStenosis,andIschemicNephropathy

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