Percutaneous Endovascular Intervention in Transplant Renal Artery Stenosis: Long-term Outcome in the Chinese Population
PPY Lui, PSF Lee, HKY Tam, RKL Lee, LWY Chan, JHY Leung, CM Chu
Hong Kong J Radiol 2014;17:247-54
DOI: 10.12809/hkjr1414233
Objective: To assess the technical success and long-term outcome in Chinese patients with transplant renal artery stenosis (TRAS) after percutaneous transluminal angioplasty (PTA), with or without stenting.
Methods: A retrospective review of 44 consecutive PTA (with or without stenting) in 35 patients with TRAS from September 2003 to January 2012 in two regional hospitals of the New Territories East Cluster, Hong Kong was conducted. Technical success, complications, serum creatinine level, arterial blood pressure, and number of antihypertensive medications taken before and after intervention were assessed and compared. Graft survival was estimated using Kaplan-Meier method.
Result: Of 44 interventions (17 PTA and 27 PTA with stenting) performed, 35 were primary interventions and the remaining 9 were secondary for re-stenosis. Overall technical success rate was 95.5% (PTA: 88.2%; PTA with stenting: 100%). No major complication or graft loss during intervention was observed. There were four minor complications including a self-limiting dissection in external iliac artery and three puncture site haematomas. There was no significant difference in restenosis rate between the PTA (25.0%) and PTA with stenting (26.1%) groups (p > 0.05). There was a persistent improvement in graft dysfunction and hypertensive control in the short and intermediate term, with satisfactory clinical success in patients presenting with graft dysfunction (100%) and hypertension (94%). Long-term clinical success in hypertensive control was relatively sustained (84.6%) while that in creatinine level it was only partially sustained (68.5%) with a mean follow-up of 70.3 (standard deviation, 32.9) months. Estimated allograft survival after all interventions was 100% at 1 year and 97% at 5 years.
Conclusion: Treatment of haemodynamically significant TRAS with percutaneous endovascular intervention is a safe procedure with high technical success, showing beneficial effects in improving allograft function and blood pressure in the short and intermediate term, as well as good long-term graft survival.
中文摘要
移植後腎動脈狹窄的經皮血管內介入治療：華籍人口中的遠期療效
呂沛欣、李醒芬、譚家盈、李嘉樂、陳慧儀、梁凱瑩、朱卓文
目的：評估經皮腔內血管成形術（PTA）治療移植後腎動脈狹窄（TRAS）華籍患者（有或無支架）的技術成功率和長期預後。
方法：回顧分析於2003年9月至2012年1月期間，香港新界東聯網兩間分區醫院中35名TRAS患者中的連續44例PTA（有或無支架）。評估及比較以下幾方面：技術成功率、併發症、血清肌酸酐水平、動脈血壓，以及術前術後服用的系列抗高血壓藥物量。並採用Kaplan-Meier方法估計移植物的存活率。
結果：44例手術（17例PTA和27例有支架PTA）中，35例為首次手術，其餘9例為再狹窄引起的二次手術。整體技術成功率為95.5%（PTA：88.2%；有支架PTA：100%）。手術中未觀察到嚴重併發症或移植物損失。但有四例輕微併發症，包括髂外動脈自限性離斷一例和穿刺部位血腫三例。PTA組和有支架PTA組在再狹窄率方面無顯著差異，前者25.0%，後者26.1%（p > 0.05）。短期和中期觀察發現移植物功能障礙和高血壓兩方面持續改善，有移植物功能障礙（100%）和高血壓（94%）的病人的臨床成功率令人滿意。平均隨訪期70.3（標準差32.9）個月的數據顯示高血壓控制較為持續（84.6%），但肌酐水平控制只有部分持續（68.5%）。手術後同種異體移植物存活率為一年期100%和五年期97%。
結論：血流動力學對TRAS而言意義重大，經皮血管內介入治療對於此病來說既安全，又有高成功率；不但有利於移植腎功能和血壓的中短期改善，還有提高移植物存活率的長期效果。