You are here

RENAL ARTER STENOZU NEDENİYLE ENDOVASKÜLER STENT VEYA BALON ANJİOPLASTİ UYGULANAN HASTALARIN RADYOLOJİK VE KLİNİK TAKİBİ

RADIOLOGICAL AND CLINICAL FALLOW UP RESULTS OF RENAL ARTERY STENTING OR BALLON ANGIOPLASTY IN PATIENTS WITH RENAL ARTERY STENOSIS.

Journal Name:

Publication Year:

Keywords (Original Language):

Abstract (2. Language): 
Aim: To determine the primary success rate and follow up results of renal artery stenting or balloon angioplasty in controlling renovascular hypertension and renal failure in patients with renal artery stenosis. Method: Before balloon angioplasty and stenting; renal angiography and Doppler ultrasonography findings were evaluated and also findings of MRA were estimated if present.The clinical estimation of the cases were made upon to renal functions, hypertension values and the changes of the number of medicines used. Results: Balloon expandable stents were placed in 32 renal arteries of 37 patients. Balloon angioplasty were used in 7 renal arteries of 37 patients (22 men, 15 women; mean age 50.24). There were hypertension in all of the patients. In 12 patients; there were disturbed renal functions. In order to determine the activity of the cure of the disease, the patients are followed by measuring blood pressures and serum creatinin levels before and after the stenting and balloon angioplasty. Stenosis rate was 30-100% (mean 74.15%).The lesions were ostial in 15 patients, truncal in 24 patients. Mean follow up time was 21.2 months (3-84 months). Hypertension was cured in 9 (24.33%) patients, improved in 19 (51.35%).patients In 9 (24.33%) patients there was no respond. In 12 patients with disturbed renal function, 8 (22.22%) patients showed improvement, 4 (11.10%) patients showed deterioration and 4 (11.10%) patients were stable. Conclusion: Revascularization of renal artery stenosis with stenting and balloon angioplasty is a simple, efficient and safe procedure. In patients with uncontrolled hypertension and progressive renal failure; revascularization of renal ar ter y stenosis with stenting and baloon angioplast y pointed out impor tant clinical benef it.
Abstract (Original Language): 
Amaç: Renal arter darlıklı hastalarda renal yetmezlik ve renovasküler hipertansiyonun kontrolünde balon anjioplasti veya renal artere stent uygulaması sonuçlarının takibi ve primer başarı oranını saptamak.Yöntem: Olguların renal anjioplasti ve stent uygulaması öncesi renal anjio bulguları, Doppler ultrasonografi bulguları ve varsa MR anjio bulguları değerlendirildi. Olguların klinik değerlendirilmesi renal fonksiyonları, tansiyon değerleri ve kullanılan ilaç sayısındaki değişikliklere göre yapıldı. Bulgular: Otuz yedi (22 erkek, 15 kadın; ortalama yaş 50.24) hastanın 32 renal arterine balon ile genişleyen stent yerleştirildi. 37 hastanın 7 renal arterine balon anjioplasti uygulandı. Tüm hastalarda hipertansiyon, 12 hastada böbrek disfonksiyonu bulunmaktaydı. Hastalar tedavinin etkinliğini belirlemek için, işlem öncesi ve sonrası kan basıncı ve serum kreatinin düzeyleri ile takip edildiler. Darlık oranı %30-%100 idi (ort %74.15). On beş hastada lezyonlar ostialdi. Yirmi dört hastada trunkaldi. Takip süresi ortalama 21.2 (3-84 ay) aydı. Hipertansiyon 9 (%24.33) hastada iyileşti. 19 hastada düzeldi. 9 hastada ise yanıt alınamadı. Böbrek fonksiyonu bozuk olan 12 hastanın da 8’inde (%22.22) düzelme görülürken, 4’ünde kötüleşme görüldü. 4 (%11.10)’ünde ise değişiklik izlenmedi. Sonuç: Renal arter darlıklarının stent ve perkütan transluminal anjioplasti ile revaskülarizasyonu, basit etkin ve güvenilir bir tedavi yöntemidir. İlerleyici böbrek yetmezliği ve kontrol edilemeyen hipertansiyonlu hastalarda perkutan transluminal anjioplasti ve stent ile renal arter darlıklarının revaskülarizasyonu önemli klinik yarar sağlamaktadır
132-143

REFERENCES

References: 

1. Alin JW. Renal artery disease: diagnosis
and management. Mt Sinai J Med 2004;
71(2): 73-85.
2. İlkay E, Yavuzkır M, Dağlı N, Akbulut M,
Karaca I, Arslan N. Renal arter darlığı
saptanan hipertansif hastalarda renal
artere stent uygulaması: dokuz aylık takip
sonuçları-Orijinal araştırma. Anadolu
Kardiyol Derg, 2003; 3: 2-7.
3. Sos TA, Trost DW. Renal vascular disease
as a cause of hypertension. Curr Opinion
Nephrol Hypertension 1995; 4: 76-81.
4. Dustan HP. Renal artery disease and
hypertension. Med Clin North Am 1997;81:
1199-12.
5. Textor SC, Renovascular hypertension.
Endocrinol Metab Clin North Am 1994; 23:
235-53.
6. Schreiber MJ, Pohl MA, Novick AC. The
natural history of atherosclerotic and
fibrous renal artery disease. Urol Clin
North Am 19894; 11: 383-92.
7. Noss J. Radiological management of
atherosclerotic renal artery stenosis.
Intervent Radiol Monitor 1998; 1: 97-
104.
8. Cantaşdemir M, Numan F, Mihmanlı
İ, Aksoy H, Adaletli İ. Fibromuskuler
displaziye bağlı renovasküler hipertansiyon
tedavisinde perkütan transluminal renal
anjioplasti. Tanısal ve girişimsel radyoloji
2001; 7: 607-14.
9. Dotter CJ, Judkins MP. Transluminal
treatment of arteriosclerotic obstruction:
description of a new technique and a
preliminary report of its application.
Circulation 1964; 30: 654-70.
10. Grüntzig A, Vetter W, Meier B, Kuhlmann
U, Lutoff U, Siegenthaler W. Treatment
of renovascular hypertension with
percutaneous transluminal dilatation of
a renal artery stenosis. Lancet 1978; 1:
801-2.
11. Cantaşdemir M, Kuruğoğlu S, Mihmanlı,
Kantarcı F, Aksoy H, Numan F. Çocuklarda
perkütan translüminal renal anjioplasti.
Tanısal ve girişimsel radyoloji 2001; 7:
615-20.
12. Daniels SR, Loggie JM, McEnry PT,
Towbin RB, Clinical spectrum of intrinsic
renovascular hypertension. Pediatrics
1987; 80: 698-704.
13. Roninson L, Gedroyc W, Reidy J, Saxton
HM. Renal artery stenosis in children. Clin
Radiol 1991; 44: 376-82.
14. Karaköse S, Karabacakoğlu A. Üriner
sistemde girişimsel radyolojik işlemler.
Klinik Aktüel Tıp Dergisi. 2005; Ocak: 14-
29.
15. Karaköse S, Sert Ü, Cumhur T, Ödev K.
Renal arter stenozlarının tedavisinde
intravasküler stent. S Ü Tıp Fakültesi
Dergisi 1993; 9(3): 345-50.
16. Abir-Khalil S, Bendahmane R, Zaim S,
et al. Percutaneous transluminal renal
anjioplasty in hypertension. Ann Cardiol
Angiol 2004; 53(1): 23-8.
17. Schillinger M, Minar E, Ahmadi R, Treating
renal artery stenosis. A statement pro
endovascular therapy. Herz 2004; 29(1):
68-75.
18. Baltacıoğlu F, Ekinci G, Akpınar İ, Çimşit
N, Tuğlular S, Akoğlu E. Renal arter
darlıklarının stent ile endovasküler
tedavisi: teknik ve klinik sonuçlar. Tanısal
ve girişimsel radyoloji 2002; 8: 527-32.
19. Weibull H, Bergqvist D, Jonsson K, et
al. Long term results after percutaneous
transluminal anjioplasty of atherosclerotic
renal artery stenosis: the importance of
intensive follow up. Eur J Vasc Surg 1991;
5: 291.
20. Baumgartner I, Triller J, Mahler F. Patency
of percutaneous renal anjioplasty.
Hypertension 1993; 21: 89.
21. Zeller T, Frank U, Muller C et al.
Stent-supported angioplasty of severe
atherosclerotic renal arter stenosis
preservers renal function and improves
blood pressure control: long term results
from a propective registry of 456 lesions.
J Endovasc Ther 2004; 11(2): 95-106.
22. Bucck RA, Puchner S, Reiter M, et al.
Long-term follow-up after renal artery
stenting. Wein Klin Worshenschr 2003;
115(21-22): 788-92.
23. Jensen G: Renovascular hypertension. New
diagnostic and therapeutic procedures.
Scand J Urol Nephrol Supll 1985: 170:
1–78.
24. Keller MS, Korsvik HE, Weiss RM:
Diuretic Doppler sonography with
correative scintigraphy in children with
hydronephrosis. Soc Pediatr Radiol 192:
35: 4922.
25. Amis ES, Cronan JJ, Pfister RC, Yoder IC:
Ultrasonic inaccuracies in diagnosing renal
obstruction. Urology 1982; 19: 105.
26. Baxter GM, Aitchison F, Sheppard D,
Moss JG, McLeod MJ, Harden PN, et al.
Colour Doppler ultrasound in renal artery
stenosis: intrarenal waveform analysis. Br
J Radiol 1996; 69: 810–5.
27. Blaufox MD, Middleton ML, Bongiovanni
J, Davis Br. Cost efficacy of the diagnosis
and therapy of renovascular hypertension- J Nucl Med 1996; 37: 171–7.
28. BrklJacic BB, Mrzljak V, Drinkovic I,
Soldo D, Sabljar-matovinovic M, Hebran
A. Renal vascular resistance in diabetic
nephropathy: Duplex Doppler US
evalution. Radiology 1994; 1992: 549
–54.
29. Gottlieb RH, Lieberman JL, Pabico RC,
Waldman DL. Diagnosis of renal artery
stenosis in transplanted kidneys value
of Doppler waveform analysis of the
intrarenal arteries. AJR Am J Roentgenol
1995; 165: 1441–6.
30. Handa N, Fukunaga R, Uehara A, Etani
H, Yaneda S, Kimura K, et al. EchoDoppler velocimeer in the diagnosis of
hypertensive patients: The renal artery
Doppler technique. Ultrasound Med Biol
1986; 12: 945–52.
31. Krummw B, Blum U, Schwertfeger E,
Flugel P, Hollstin F, Scholmeyer P, et al.
Diagnosis of renovascular disease by
intra-and extrarenal Doppler scanning.
Kidney Int 1996 Oct: 50(4): 1288-92.
32. Platt JF, Rubin JM, Ellis JH, DiPietro MA.
Duplex Doppler ultrasound of the kidney:
Differentiation of obstructive from non–
obstructive dilatation. Radiology 1989;
171: 515–7.
33. Postma CT, Bijlstra PJ, Rosenbuch G,
Thien T. Pattern recognition of loss of
early systolic peak by Doppler ultrasound
has alow sensivity for the detecion of
renal artery stenosis. J Hum Hypertens
1996: 10: 181–4.
34. Rone PC, Oliva VL, Bui Bt, Froment D,
Harel C, Nicolet V, et al. Renal artery
stenosis: evalution of Doppler US after
inhibition of angiotensin – converting
enzyme with captropril. Radiology 1995;
196: 675-9.
35. Schulte KL, Spies KP, Van Gemmeren
D, Lenz T, Gotzen R, Distler A, et al.
Screening and diagnosis for eliminating
renovascular hypertension. Value of
24 hour blood pressure monitoring and
color–coded duplex ultrasound diagnosis].
Med Klin 1997: 92: 313-8.
36. Schwerk WB, Restrepo IK,Stellwaag M,
Klose KJ, Schade – Brittinger C: Renal
artery stenosis: Grading with image
– directed Doppler US evaluation of renal
resistive index. Radiology 1994: 190:
785–90.
37. Scout LM, Taylor KJW: The kidney.
In: Taylor KJW, Burns PN, Wells PNT,
eds. Clinical Applications of Doppler
Ultrasound. 2nd ed. New York: Raven
Pres, 1995: 155–78.
38. Sevestre MA, Reix T, Makdassi Ri Jarry
G, Hermida JS, Remond A, et al. Echo –
Doppler and stenosis of the renal arteries.
Report of 86 cases. J Mal Vasc 1996: 21:
72–7.
39. Spies KP, Fobbe F, El – Bedewi M, Wolf KJ,
Distler A, Schulte KL. Color – coded duplex
sonograhpy for non invasive diagnosis
and granding of renal artery stenosis. Am
J Hypertens 1995; 8: 1222–31.
40. Stavros AT, Parker SH, Yakes WF,
Chantelois AE, Burke BJ, Meyers PR, et
al. Segmental stenosis of renal artery
Pattern recognition of tardus and parvus
abnormalities with duplex songraphy -
Radiology 1992: 184: 487-92.
41. Dorros G, Jaff M, Mathiak L, He T.
Multicenter palmaz stent renal artery
stenosis revascularization registery
report: four-year follow up of 1058
succesful patients. Cathet Cardiovasc
ıntervent 2002, 55: 182-9.
42. Dorros G, Prince CR, Mathiak LM. Stenting
of a renal artery stenosis achieves beter
relief of the obstructive lesion than balon
angioplasty. Cathet Cardiovasc Diagn
1993; 29. 191-8.
43. Canzanello VJ, Millan VG, Spiegel
JE, et al. Percutaneous transluminal
renal angioplasty in management of
atherosclerotic renovascular hypertension:
results in 100 patients. Hypertension
1989; 13: 163.
44. Van de Ven PJG, Kaatee R, Beutler JJ, et al.
Arterial stenting and balloon angioplasty
in osteal atherosclerotic renovascular
disease: a randomized trial. Lancet 1999;
353: 282–6.
45. Baumgartner I, Aesch K, Do D, et al.
Stent placement in ostial and non-ostial
atherosclerotic renal arterial stenosis: a
prospective follow-up study. Radiology
2000; 216: 498.
46. Leertouwer C, Gussenhoven J, Bosch J
et al. Stent placement for renal arterial
stenosis: where do we stand? A meta-
analysis. Radiol 2000; 216: 78-85.
47. Savage M, Fischman L, Rake R, et al.
Efficacy of coronary stenting versus
balon angioplasty in small coronary
arteries. Stent restenosis study (STRESS)
investigators. J Am Coll Cardiol 1998; 31:
307-11.
48. Bolduc P, Oliva L, Therasse E, Giroux
M, Bouchard L, Perreault P, et al.
Diagnosis and treatment of renovascular
hypertension: a cost-benefit analysis. AJR
2005; 184: 931-7.
49. Boudewijn G, Vasbinder C, Nelemans PJ,
et al. Diagnostic test for renal artery
stenosis in patients suspected of having
renovasculer hypertension: a metaanalysis. Ann Intern Med 2001; 135: 401-11.
50. Detection, evaluation, and treatment
of renovascular hypertension. Final
report. Working group on renovascular
hypertension. Arch intern med. 1987;
147: 820-9.
51. Harding MB, Smith LR, Himmelsteine SI.
Renal artery stenosis: prevalance and
associated risks factors in patients undergoing routine cardiac catheterization. J
Am Nephrol Soc 1992; 2: 1608.
52. Blaufoks MD, Middleton ML, Davis Br, et
al. Cost efficiency of the diagnosis and
therapy of renovascular hypertension. J
Nucl Med 1996; 37: 71.
53. Cambria RP, Brewster DL, L’Italien G.
Simultaneous aortic and renal artery
reconstruction: evolution of an eighteen
year experience. J Vasc Surg 1995; 21:
916-25.
54. Xue F, Bettmann AM, Lengdon DR,
et al. Outcome and cost comparison
of percutaneous transluminal renal
angioplasty, renal arterial stent placement
and renal arterial by-pass grefting.
Radiology 199; 212: 378.
55. Dorros G, Jaff M, Mathiak L, et al.
Four-year follow up of palmaz schatz
stent revascularization as treatment for
atherosclerotic renal artery stenosis.
Circulation 1998; 98: 642.
56. Scoble JE, Sweny P, Stansby G, Hamilton G.
Patients with atherosclerotic renovascular
disease presenting to a renal unit: an
audit of outcome. Postgrad Med J 1993;
69: 461-5.
57. Martin G, Casarellaj, Gaylord G. Azotemia
caused by renal artery stenosis: treatment
by percutaneous angioplasty 1988; 150:
839-44.
58. Harden N, Macleod J, Rodger R et al.
Effects of renal artery stenting on
progression of renovascular renal failure.
Lancet 1997; Vol 349: 1133-6.
59. Rees CR, Palmaz JC, Becker GJ et al.
Palmaz stent in atherosclerotic stenoses
involving the ostia of the renal arteries:
preliminary report of a multicenter study.
Radiology 1991; 181: 507-14.

Thank you for copying data from http://www.arastirmax.com