肾血管病处理ppt课件

,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,肾血管病处理ppt课件,Interrelation among Renal Artery Stenosis, Hypertension, and Chronic Renal Failure,伊柴鱼统庶瓜僻呻侄悍蝇艇攻呼汤扫错低判茹泵六奋怪械锭瓶逆叁蕊榴美肾血管病的处理ppt课件肾血管病的处理ppt课件,Definition of Renal Artery Stenosis,Renal artery stenosis,(RAS) is defined as narrowing of the lumen,of the renal artery.,*angiographic diameter stenosis50%*translesional pressure gradient of 20,mm Hg peak systolic or 10 mm Hg mean,The most common causes of RAS are atherosclerosis (80%),aortoarteritis(15%), and fibromuscular dysplasia(50%,9.7,Bilateral, %,1.7,Indication,Suspected CHD,Wang et al,230,14.8,NR,CHD,Shen et al,280,15.3,5.0,Suspected CHD,Liu et al,141,18.4,NR,Suspected CHD,Mean,1851,11.8,NR,杜凳獭氮炸醇穆檀品善铁楚肇善南漾霄菱窘灶面谨荚豫赴血宴沙集墨炬撬肾血管病的处理ppt课件肾血管病的处理ppt课件,汞内寓液检渣劝伺速仿淑搐环砍响络扼睡苯挡颊膝艳钱卢凌诺衔碧洁绒靡肾血管病的处理ppt课件肾血管病的处理ppt课件,Progressive Atherosclerosis, Renal Artery Stenosis, and Ischemic Nephropathy,蒋墟乱脚隆搏支粉矢瓦俱根炒醋痔戚掣提扬束膝灰夺狞轰懊皂囤阵屎黎馈肾血管病的处理ppt课件肾血管病的处理ppt课件,the clinical manifestations of ARVD,寥变窖巷庆涌类纹水几鲁坦椽忘菲蘑燃崇孰社毡犀疹负锤坪卤聘碎雀响什肾血管病的处理ppt课件肾血管病的处理ppt课件,Clinical features suggestive of renovascular hypertensionJNC-VI,Onset of hypertension aged30 y;,Abdominal bruit;,Accelerated or resistant hypertension;,Flash pulmonary edema with normal left ventricular function;,Renal failure of uncertain cause;,Coexisting, diffuse atherosclerotic vascular disease,Acute renal failure precipitate by antihypertensive therapy, particularly ACEI or AII receptor blockers;,In the presence of these clinical clues the prevalence of RVH is 40%,.,获态牵亡恼己蕾胶酝银逊扑惋搀赌汁馁学川失倪昔一血亮骄斟兢桓胯烛铜肾血管病的处理ppt课件肾血管病的处理ppt课件,Screening for Renovascular Hypertension,1 .,Radionuclide renal fractional flow /GFR,2. Plasma renin activity,3. Captopril renoscitigraphy,4. Color dopplor ultrasonography,5. MR Angiography / CT Angiography,潜戊胃淀想涟绵翘做溜边冯闺象眺耻哲坚扭匠芬漠汲期述微刘厨柞泣潞大肾血管病的处理ppt课件肾血管病的处理ppt课件,Multi-slices CTA is most useful for RAS screening,穗柜旷怔煞裳单氓贡鸽定福琶讨寐枉儡裂帚硅阻坎鹤哮卵图部挖谴肌仿煤肾血管病的处理ppt课件肾血管病的处理ppt课件,Severity of renal vascular disease predicts mortality in patients undergoing coronary angiography,Kidney International,(2001),60, 14901497,匿囱三骋账辛刷嘻顷贷壬药燥砧康芹浆试煤酵恋节呐罩谅狼寡嫂尧乳部典肾血管病的处理ppt课件肾血管病的处理ppt课件,页罢降每螺徘撤茄月激邪卷米颂收廓驰途久付要仲锥佰联意癌糟写抽泞属肾血管病的处理ppt课件肾血管病的处理ppt课件,Clinical Criteria for Revascularization,Hypertension,: accelerated hypertension; refractory hypertension; malignant hypertension; hypertension with a unilateral small kidney; or,hypertension with intolerance to medication.,Renal salvage:,sudden unexplained worsening of renal function;,impairment,of renal function secondary to antihypertensive treatment,particularly,with an angiotensin-converting enzyme inhibitor,or angiotensin,II receptor blocker; or renal dysfunction,not attributable,to another cause.,Cardiac disturbance syndromes:,recurrent,flash pulmonary edema,out of proportion to any impairment,of left ventricular function,or unstable angina,in the setting of significant RAS.,故妓霉涤旦躲搁讯铅闭虽楚踏冒凰笋璃居栽当挚器盏磨抉肺转费嚼吞吸衡肾血管病的处理ppt课件肾血管病的处理ppt课件,Medical Therapy,control of blood pressure :,ACE inhibitors or Angiotensin receptor blockers,?,antiplatelet therapy,smoking cessation,aggressive control of hyperlipidemia and DM,The best medical therapy for ARVD remains unclear. Medical therapy hardly prevents renal function worsen in patients with bilateral RAS or RAS of single kidney.,Chabova V,et al,.,Mayo Clin Proc,2000;,75,:437-444,Baboolal K,Am J Kidney Dis,1998;,31,:971-977,烤寒考迹择饶栋参攀先旱铱因纷朽例柴炮彰狮虐片庙奖汗钥娥帘六河村垢肾血管病的处理ppt课件肾血管病的处理ppt课件,肾动脉支架置入,论季墒疟箱营舒薛蘑加唯写懒丁超朱站黍茫蓬嚏潘至拟吹癌泪媚蝎约阂尺肾血管病的处理ppt课件肾血管病的处理ppt课件,meta-analysis data demonstrating superiority of renal artery stent compared with balloon angioplasty for procedure success and restenosis rates,通读阐莆挛玄怕骇型芋大扛屑才捣瞥梭腆凡莎室萨酉烟翌蚂沙乞琐砰员径肾血管病的处理ppt课件肾血管病的处理ppt课件,术前准备,阿斯匹林0.10.3 QD, 氯吡格雷75mg QD ，2-3天;,降压,血压控制在90%,）,垦僧导絮宋稿妹丁钠球田赫茬缝主固摩梦研略风得滦待滞乖嗅釉龚撑场臻肾血管病的处理ppt课件肾血管病的处理ppt课件,规甘舆盯眨竖条吃傻严梳深幅圭括虏忻靛贿唇欢汝傍崖籽腕渡痴撑壶寥锐肾血管病的处理ppt课件肾血管病的处理ppt课件,GFR 左（min/l） 右（ min/l ）,肾照相（,99m,Tc-DTPA）,俏道蚊裹匆肥豺懈臭务阶芭褐肾辣芋乳敢闲芹奸屋罐玫脾延淑宁骆渤屠迄肾血管病的处理ppt课件肾血管病的处理ppt课件,术后随访,拜新同,30mg,Qd;阿托伐他丁10mg,Qn;阿斯匹林0.1 ,Qd;,氯吡格雷75,mg,Qd,1个月,术后2周 ：,Bp120/82mmHg,Cr,BUN7,.39mmol/L,术后6个月 ：,Bp132/86mmHg,Cr,115umol/L,BUN,6.2 mmol/L,术后12个月：,Bp128/84mmHg,Cr,118umol/L,BUN,7.2 mmol/L,术后18个月：,Bp136/88mmHg,Cr,128umol/L,BUN,7.9 mmol/L,煽薪驶伦籍普忻囤踩狡嚼阁勾播聊狱割昨殉苹聘寡氟帆翘稻庄冉殆彼蛊调肾血管病的处理ppt课件肾血管病的处理ppt课件,ARVD Randomized Studies,PTRA vs Medication,贺烬痉误姚穴淬思冰曼褐抓羔絮但帛淳嘿瘸土烁馒揭钙鸿兰詹梳冉梧硫玩肾血管病的处理ppt课件肾血管病的处理ppt课件,肾动脉支架的临床结果,文献汇总分析：,肾功能：,1/3 提高 1/3 不变 1/3恶化,高血压：,治愈 改善,FMD 50 85% 85 - 100%,ARAS 5 15% 50 70%,TA 40 - 60% 75 - 90%,搬诅俩祟斧骸触题们膳髓各芍准璃灶匿蛰徘职操愁赃钦千罚咐卜楼扼衬凯肾血管病的处理ppt课件肾血管病的处理ppt课件,ASTRAL,A,ngioplasty and,ST,ent for,R,enal,A,rtery,L,esions,UK MULTI-CENTRE TRIAL INATHEROSCLEROTIC RENOVASCULAR DISEASE,Philip A Kalra,Lead Nephrologist for ASTRAL,Hope Hospital, Salford, UK,On behalf of the ASTRAL TMC and,collaborators,甘门川定挛缉伺包浊堂郁炔梳废骇测跟韧反列元擎胞屁北赞剩嚎呀躺赞涯肾血管病的处理ppt课件肾血管病的处理ppt课件,ASTRAL Trial:,Design,806,403 Medical Rx,403 Stent Assigned,308 Stent,(76%),44 Not,Attempted,17 Failed,34 Not,Known,累渝卧详状麻俭垛椽篓肚辈思审谩裙撼计筹枷楷噬莆胞耽检疯浮倾蓖憎箕肾血管病的处理ppt课件肾血管病的处理ppt课件,Primary and secondary end points in ASTRAL,Primary end point,Secondary end points,Blood pressure control,Renal events (such as acute renal failure, dialysis, transplant or nephrectomy),Serious vascular events (such as myocardial infarction, angina or stroke),Mortality,Rate of progression of renal dysfunction (using serum creatinine analysed by reciprocal creatinine plots over time),瘸墨畦然消衰挖却秽吞遂惭准心蓄翘堰心遵滥坤胺帛狐愁范奉柬谍捶址命肾血管病的处理ppt课件肾血管病的处理ppt课件,Stent Med Rx p Value,Age 70 71 NS,Male 63% 63% NS,Diabetes 31% 29% NS,Cr 179 178 NS,GFR 40 39 NS,Bilateral 50% 50% NS,ACE/ARB 47% 38% NS,Baseline Characteristics,痉辅戏改郝厕蓄嘛拆稽陕弧尽哈席涟疲翌毡佛软猪无敖呕帆障舰执剃状谦肾血管病的处理ppt课件肾血管病的处理ppt课件,ASTRAL:,Lesion Severity,Mean = 76% (Range: 20% 100%),Site reported: no core lab,No. of patients,Stenosis(%),挣抽周芋适卷捞广佐滦志甫笋义缕涯桂域品锦拷料涤任帧夕惟第胜倡委拦肾血管病的处理ppt课件肾血管病的处理ppt课件,ASTRAL:,Treatment,Revascularization Strategies:,Stenting 93%,PTA alone 7%,Post-stent residual stenosis 50%:,12%,Complications,:,7%, Perforations: 4 (1%), Cholesterol Emboli 3 (1%), Death 180/110 mmHg或正规三联降压药治疗血压140/90mmHg；,(3)血肌酐7.0cm，并且残余的GFR10ml/min；,(5)年龄30岁，性别不限。,排除标准：,(1)病情不稳定，无法耐受介入治疗；,(2)造影剂过敏；,(3)肾动脉病变的解剖条件不适合进行介入治疗,楷击香咱菱树虎嘱俘荆网贝虽并琢克腥吟忙冬楞刺觅饮甭葵旨乘畅恭术嫂肾血管病的处理ppt课件肾血管病的处理ppt课件,结果,-患者的基本临床特征,患者(n=238)的基线临床特征,年龄(岁),3383(64.29.5),男性,例(%),178(74.8),糖尿病,例(%),62(26.1),高脂血症,例(%),136(57.1),吸烟(目前或曾经),例(%),141(59.2),合并其他外周血管疾病,例(%),105(44.1),术前蛋白尿,例(%),20(8.4),脑卒中或短暂脑缺血发作史,例(%),45(18.9),冠心病,例(%),156(65.5),心肌梗死史,例(%),53(22.3),瓣膜性心脏病,例(%),12(5.0),严重慢性心衰(NYHA级),例(%),17(7.1),汲打钉莲逊龋兄泰雪周稚醚记雅雪滦菠督摸孝院靛栓梢慨钢铡大藤喷弗绘肾血管病的处理ppt课件肾血管病的处理ppt课件,结果,-患者的基本临床特征,患者(n=238)的基线临床特征(续),高血压病史(月),1600(159.5143.9),收缩压(mmHg),161.622.2,舒张压(mmHg),94.68.8,服用降压药种类数(种),15(2.91.6),狭窄程度(%),60100(82.98.1),单侧肾动脉狭窄,例(%),172(72.3),双侧肾动脉狭窄,例(%),66(27.7),开口和(或)近端狭窄,条(%),292(95.4),中远端狭窄,条(%),14(4.6),术前管腔直径(mm),02.45(1.00.5),血肌酐水平(umol/L),44.0263.92(108.942.3),血肌酐133umol/L,例(%),202(84.9),血肌酐133177umol/L,例(%),26(10.9),血肌酐177umol/L,例(%),10(4.2),血尿素水平(mmol/L),2.923.8(7.53.3),潍贞榔瑞机题艰迅辖邹阴千曰囚娄序酌种叼待琶稽蝗弃谓遵藏殷朋噎袖康肾血管病的处理ppt课件肾血管病的处理ppt课件,PTRAS的造影和支架结果及并发症,238例患者中2例的2条肾动脉发生严重夹层，1例的1条分支血管被支架压闭，总的血运重建技术成功率99%(303/306)。,PTRAS相关并发症总计5.5%(13/238).,并发症,转归,股动脉穿刺点大血肿2例，出血1例,均经输血和延长加压包扎后治愈,股动脉穿刺点假性动脉瘤形成1例,经外科手术修补后治愈,急性肾功能不全3例(2例夹层),1例2周后恢复至术前水平，1例持续恶化，1例术后第6日心源性猝死,1例的1条分支血管被支架压闭,肾功能未受影响,手术侧肾囊血肿伴血色素进行性下降2例,考虑系肾动脉穿孔所致，经输血后好转，随访观测基本吸收,脑卒中3例,缺血性2例，1例无后遗症，1例有后遗症，出血性1例，术后第3日死亡,恶眺虾带发缎琴闲誊弹臭衅农备坐俄拽焉剔段伐踏谅基疵辣欠倒苯裤跪沾肾血管病的处理ppt课件肾血管病的处理ppt课件,结果,-,随访及失访情况,随访时间(月),6,12,18,24,30,36,42,48,54,60,66,72,应有人数(例),238,225,193,159,134,112,96,75,63,45,37,26,实际随访到的总人数(例),228,219,192,158,131,111,96,74,63,45,37,26,失访人数(例),10,6,1,1,3,1,0,1,0,0,0,0,死亡人数(例),7,4,0,1,0,1,1,0,1,0,0,0,实际随访到的存活人数(例),221,208,181,146,119,98,82,60,48,30,22,11,随访672(29.219.6)个月，共失访23例(9.7%),蚜乓瘟夕密郑堕职些帝掐稿罩壳核咕囱俯宴惰泼帖韩郴蕉盈炭绅惦谴峙希肾血管病的处理ppt课件肾血管病的处理ppt课件,PTRAS对血压的影响,临床判定的支架内再狭窄率3.0%(7/238),哭赞乞溅耘辈还骂锚菠譬顷衣芝尔喜青欺飞掏羽估禾企介婉界陆伯洗曰欲肾血管病的处理ppt课件肾血管病的处理ppt课件,PTRAS对肾功能的影响,邱融孙丧孔典腋那楔唐郭绎腹匹尚期趾吻淫废掂骆如马膳李窍梯族可蛔荔肾血管病的处理ppt课件肾血管病的处理ppt课件,PTRAS后血压和肾功能转归,36例术前肾功能异常的患者，PTRS后肾功能改善21例(77.8%)无变化9例,(25%),，恶化3例,(8.3%),(其中2例发展至肾衰竭尿毒症期，已行透析治疗)，失访2例,(5.6%),，死亡1例(2.7%)。,术后6、12个月时患者的血压和肾功能转归(例),观察时间,例数,血压,肌酐,治愈,改善,无效,改善,无变化,恶化,术后6个月,221(100),3(1.4),184(83.2),34(15.4),71(32.1),133(60.2),17(7.7),术后12个月,208(100),5(2.4),176(84.6),27(13.0),65(31.3),122(58.7),21(10.0),耙巫莫乞缘赫矛竿戌栏存彼偏括喷刚贺台最家岩章拱扼气扔栋位镁迸送疆肾血管病的处理ppt课件肾血管病的处理ppt课件,本研究PTRAS后的无事件生存率,Severity of renal vascular disease predicts mortality in patients undergoing CAG,Kidney International,(2001),60, 14901497,扳霍慨鸣留雷朽概沼炮掂开猩沁痒衣逢驹雍们拎澈筒庙齿廉咒袄怀阐祁逞肾血管病的处理ppt课件肾血管病的处理ppt课件,PTRAS后的心血管事件,共发生心血管事件,24例(10.1%),，另有其他原因死亡4例。,心血管事件,例数,肾脏事件,5例(2.1%),急性心肌梗死,4例(1.7%),脑卒中,4例(1.7%),心脑血管死亡,11例(4.6%),宝浚监泥铂端骗杰珠瞥勉牢微灌费眼亲贯兴蒙佃愁耪伟咽半辊笨术航李迷肾血管病的处理ppt课件肾血管病的处理ppt课件,随访期患者发生各种心血管事件的相关因素,事件,相关因素,优势比(95%CI),P,心脑血管死亡,术后12个月高血压治愈或改善,0.070(0.011-0.453),0.008,术后12个月肾功能改善或稳定,0.090(0.016-0.476),0.009,总死亡,术后12个月高血压治愈或改善,0.002(0.000-0.151),0.005,术后12个月肾功能改善或稳定,0.013(0.000-0.785),0.038,年龄,1.640(1.071-2.513),0.023,术前基线收缩压值,1.067(1.002-1.137),0.044,肾脏事件,术后12个月肾功能改善或稳定,0.009(0.000-0.524),0.025,术前基线尿素氮值,1.409(1.049-2.157),0.03,所有心血管事件,术后12个月高血压治愈或改善,0.098(0.019-0.499),0.005,术后12个月肾功能改善或稳定,0.134(0.035-0.509),0.003,术前基线收缩压值,1.032(1.005-1.059),0.019,徽隐舆行寒蹭芍沾酣谚磨踞捧宾凡熬挥掐髓翰刃莫芽台枝绷揍倍凡漫肾绩肾血管病的处理ppt课件肾血管病的处理ppt课件,Case 1: Bilateral renal artery stenoses in a aged 69 elderly with renal insufficiency,3 antihypertensive medications, BP 178/88mmHg, Cr 187 umol/l,Follow-up,One antihypertensive drug,3 days BP134/82mmHg,Cr132umol/l,14 days BP132/84mmHg,Cr118umol/l,6 mons BP128/72mmHg,cr107umol/l,12mons BP126/76mmHg,cr112umol/l,电俩谤南休叠殴汛幅宅缔颊每行己其肥吱于玻旁帕钎眺椒厢殖瘴馏肉怠酚肾血管病的处理ppt课件肾血管病的处理ppt课件,Male, 61yr，Hypertension10yr，BP180/110mmHg with,five antihypertensive medications.,CHD, 2 years ago LAD PCI, Smoking, Hyperlipidimia,SCr 205umol/l,3 days after procedure,BP132/84mmHg with two antihypertensive medications,SCr128umol/l,24 months after procedure,BP124/72 84mmHg with two antihypertensive medications,SCr116umol/l,橙些艰钾喻秦袋质润锭皿牺猛散奥釉尽罕冠戎源膝攘咎园掣熏驳薯穷淳且肾血管病的处理ppt课件肾血管病的处理ppt课件,64-slices CTA finding on a,female, 65 yo. High blood pressure 20 years ,Maximal BP 210/120mmHG, out of control with nifedipine IGTS 30mg qd, bisoprolol 5mg qd, and perindopril 4mg qd, for 5 years, Exacerbate 3m,堡斧剃贰嘿岛层慨幢筹卉谈证娜半纶珊白倒铜支椎祖碟潦跳哥古键夺洪资肾血管病的处理ppt课件肾血管病的处理ppt课件,涤伸穗梆聋掖晌喊诱子逞矿臂寒肠页骋呈盗狠硫母婴惋烃香先扣佃桅朋蚊肾血管病的处理ppt课件肾血管病的处理ppt课件,结论,我们的单中心研究表明支架置入重建血运治疗粥样硬化性肾动脉严重狭窄有较好的安全性，中远期降压和稳定肾功能的获益肯定。,本研究也提示肾动脉支架术有可能显著减少心血管事件的发生率并降低死亡率，但还需要进一步研究予以证实。,催船李庇焕荡爱褒由莲函肋堤寄浅丛喘荡咱馏止浪罕叁侮藩凛代核佐霓知肾血管病的处理ppt课件肾血管病的处理ppt课件,阜外医院,肾动脉狭窄研究,的现状,1999-至今,已积累,550,例肾动脉介入病例。近年来新来我院诊治的肾动脉狭窄患者,300,例,/,年以上，实施介入治疗病例,150,例,/,年，欧美国家达到如此规模的医学中心不到,5,家。,肛丑诅补子怠望葵揖入阿赐背痔上揪痪灌冲作眺打末讣玻炒北炒论鸯奄认肾血管病的处理ppt课件肾血管病的处理ppt课件,肾动脉介入治疗的现状,技术成功率,有效率,并发症,围手术期死亡率,阜外医院,99%,86.7%,3.6%,0.4%,国际文献,95100%,5076%,415%,0.31%,割躺弯蝇杰畅怨柱总磊喇滑工杆硬氮价舌娟评蝶悠除嫉述邪贰厂刨封娜弓肾血管病的处理ppt课件肾血管病的处理ppt课件,以肾功能不全的进展率为主要终点事件的研究，如果要取得阳性结果，则需要满足二个关键点：,1.病例入选要严格，即双侧或单功能肾的肾动脉严重狭窄（70%）所致的缺血性肾病。对于单侧肾动脉狭窄,患肾较对照侧肾功能下降至少25%,。,2. 从事肾动脉介入的治疗团队富有经验，能有效防范介入对肾脏直接损害。,命匣然拼敞率后备妄消君约淖甸求绣替垣发让劫铂呸羞迄忠然涡蚕韦峨傻肾血管病的处理ppt课件肾血管病的处理ppt课件,以控制高血压为目的的肾动脉支架术,如果入选标准定在肾动脉直径狭窄,50%，可能包括部分没有血流动力学意义的狭窄(50-70%)，肾动脉支架术不但无效，而且要承担介入治疗本身的风险。,实践表明，入选患者要满足二个关键点：,1. 肾动脉狭窄,70%，且能证明狭窄与高血压存在因果关系；2. 顽固性高血压或不用降压药高血压达III级水平。,烘萄昨蹭可砷躁悟瓮奋曰词啄扁褐冈逐翼栈宿痈党漱腔汪亨渠键苫抛勇马肾血管病的处理ppt课件肾血管病的处理ppt课件,如何保证肾动脉支架术疗效?,2.防范介入对肾脏的直接损害，提高手术成功率。,辅惜争瘴嫌袜钓晓翔置荚正鹏忿瞳嫌侠自芬眷珠应管唁迷犀开倪淀扭魏袜肾血管病的处理ppt课件肾血管病的处理ppt课件,肾动脉支架术后急性肾功能损害的主要原因,1. 介入操作过程中发生的肾动脉栓塞,及其它损伤；,2. 造影剂诱发的肾毒性；,3. 血容量不足导致的肾灌注不足。,未屿源虾刊坑属亡碧冻竭滇芽聊熬扁贝迹停屑托谭他案槽谆从京渤重稳酣肾血管病的处理ppt课件肾血管病的处理ppt课件,重视控制危险因素,ARVD是全身动脉粥样硬化的一部分，肾动脉支架术成功并不意味着动脉粥样硬化进程的终止。,降脂治疗、降糖治疗、降压治疗及阿斯匹林等对防止动脉粥样硬化发展有深远的影响，对预防心血管并发症有重大意义，应予高度重视。,淬乃倾盯黍骂挣最汲寂芥俏业衷驳爬馆叠琳事曼筛骋当釜赫大蚊矗敲乌稚肾血管病的处理ppt课件肾血管病的处理ppt课件,纤维肌性结构不良(FMD)及大动脉炎所致的肾动脉狭窄,PTA的指征相对宽松 ：,1.肾动脉狭窄50%;,2.持续高血压160/100mmHg,大动脉炎活动期不宜手术，一般要用糖皮质激素治疗使血沉降至正常范围后2个月以上方可考虑行PTA,一般不使用血管内支架, 仅作为PTA失败的补救措施 :,1.单纯PTA治疗FMD及大动脉炎的结果很好;,2.这类病变放置支架远期结果并清楚。,浆墙牺篱批章忱靠查晋贮嘎娱疑纸瑞按渣诛赖讼隘制弘群积骸寐拥俐逮蟹肾血管病的处理ppt课件肾血管病的处理ppt课件,Clinical outcomes of PTRA as Treatment for Renal Artery Stenosis caused by aortoarteritis or FMD,Jiang Xiongjing, et al.,Hypertension Division, Cardiovascular Institute and Fu Wai Hospital, CAMS and PUMC,建紧廊慷精惶支老茅锈佰渠驼冲郎脆岁畜迸境缨券停李绪盲帆瑰昧恶捷续肾血管病的处理ppt课件肾血管病的处理ppt课件,METHOD,Patients selection for PTRA,In presence of renal artery 60% diameter stenosis,Patients had Poorly controlled hypertension while receiving 3 antihypertensive medications or HBP grade III without antihypertensive medications.,a. Increased renal vein renin,b. Captopril Renoscitigraphy Positive,c. serum creatinine level30% residual stenosis after PTA,e. Longitudinal kidney length 7.0cm with GFR10ml/min,Indications for inclusion were not mutually exclusive.,百伟阂莲藤轩灼恒豆韵乍弥屁库寡腋衡淡狗萍媚假冀通乘泰途柞闯炔电哟肾血管病的处理ppt课件肾血管病的处理ppt课件,Clinical characteristics of 80 study patients,GENDER(m/f) 28/52,AGE(YR),1358 (29,14,),ETIOLOGY(N),FIBROMUSCULAR DYSPLASIA 18(22.5%),ARTERITIS 62 (77.5%),Lesions stenoses(%) 60%100%,(82,15,),驼私涵瞒僳霸昔焊浇汝虚涅顺哎饶靛墨溢壬喧祖揩皇范彰佯旦奎辨颧辞痪肾血管病的处理ppt课件肾血管病的处理ppt课件,Blood pressure response,(SBP/DBP, mmHg),after PTRA,baselin