Imaging Anatomical And Clinical Analysis Of Renal Arteries By Angiography

Background：Since2009， the efficacy of the renal sympathetic denervation(RDN) for thetreatment of resistant hypertension has been initially verified and used in clinical practices.Nowadays, to treat heart failure by RDN is a research hotspot too.Renal artery stenosis（RAS） can cause multiple kinds of serious clinical events suchas resistant hypertension, ischemic renal disease, and it is also significantly correlated withcoronary heart disease（CHD） and acute coronary syndrome（ACS）. Currently, to treatresistant hypertension by releasing the RAS has become a common mesure in China andabroad.Whether RDN or the releasing of RAS is accomplished by means of intervention，and renal arteriography is the basis of this procedure.Unlike traditional pathologic anatomy, renal arteriography can not only directlyobserve the length, diameter, implantation angle of the renal arteries, but also get theinside diameter, in order to determine whether there is vascular stenosis or other lesions,furthermore, the physicians can perform the RDN through special catheters, release thestenosis or obstruction of renal arteries by angioplasty or stent during the arteriography.This study is a comprehensive and detailed analysis of the anatomical features of the renalarteries by arteriography in Chinese people, aims to assist interventional physicians toquickly and accurately determine the location of the renal arteries, and to identify thepresence or absence of disease, variation, etc. In addition, we study the relationshipbetween renal artery imaging anatomical features with age and some chronic diseases suchas coronary heart disease, hypertension, diabetes, hyperlipidemia, to understand theimpact of these factors on the renal artery anatomy, this is important to the prevention andtreatment of these diseases.Purposes：1. Analyze the anatomical features of the renal arteries by arteriography.2. Analyze the relationship between renal artery imaging anatomical features withsome clinical factors Contents：Part1: Select1052patients hospitalized for coronary angiography, bilateral renalarteriography was routinely performed after. Analyze the implantation location, length,inside diameter, origination angle, bending angle, branch and variation, then summarizethe imaging anatomical features of Chinese people.Part2: Consult the clinical history of1052patients, and then study the relationshipbetween renal artery imaging anatomical features with age, smoking, hypertension,coronary heart disease, diabetes, hyperlipidemia and other clinical disorders.Methods：By the use of QAngio XA7.2, a quantitative analysis software for peripheral andcoronary vessels in X-ray angiograms of Medis medical imaging systems, we analyzed theimage data of1052patients who were hospitalized during January to September in2009and received bilateral renal arteriography through femoral artery pathway in the DSAroom of the Cardiology Department of Ruijin Hospital, measured the original location(byusing the12thlumbar vertebrae as a bony landmark), compare the original levels in bothsides, measure the length(distance to the branching), the inside diameter in3levels(proximal opening side, midpoint, distal side where the main renal artery dividedinto branches), the origination angle between the renal artery with the abdominal aorta, thebend angel(the angle between the proximal third and the distal third of the renal arterytrunk), the variation, etc. These collected data were statistically analyzed. We summarizedthe imaging anatomical features of renal arteries in Chinese people. Meanwhile,combining the anatomy with their clinical histories, we studied the relationship betweenthe anatomical features with age, smoking, and some chronic diseases such ashypertension, coronary heart disease, diabetes, hyperlipidemia.Results：Part1: After the analysis of renal arteriography image data for1052patients, wefound: the majority of left (86.91%) and right (88.04%) renal arteries are single withlength longer than1.5cm; the majority renal arteries originate at the level between theupper third of the1stlumbar vertebra to the medium third of the2ndone,94.54%for theleft and94.98%for the right; in56.86%of these cases, the origin of the right renal arteryis higher than the left one, and in21.97%of the cases, the origination levels on both sidesare equal; the length of the left renal arteries(31.14±9.50mm) is shorter than the rightsides(36.93±11.84mm); At the level of the origin and the midpoint, the inside diameter of the left renal arteries is larger, at the distal level, there is no significant difference; theinside diameter of males is larger than females; the origination angle(Angle α, the inferiorangle between the renal artery and the abdominal aorta) on the left is69.47±12.62o,compares with63.08±15.35oon the right; the Angle α is significantly positive correlatedwith the inside diameter of renal artery; the β Angel(the angle between the proximal thirdand the distal third of the main renal artery) of the left side is134.33±27.14o，smaller than145.40±23.85oof the right side, that means the left renal arteries are more tortuous.Part2: Age is significantly negative correlated with the inside diameter of renalartery; the inside diameter at the level of the origination of renal arteries in patients whohave hypertension, diabetes or coronary heart disease is smaller, perhaps related to theirpromotion effect on the development of atherosclerosis.Conclusions：Interventional physicians should master the imaging anatomical and variationalfeatures of renal arteries of Chinese people. During interventional procedures, physiciansshould firstly look for the origin of renal arteries between the upper third of the1stlumbarvertebra to the medium third of the2ndone, and look for the origin of right renal arteriesabove the left side or at the same level, then expand the scope if they cannot be found. Inthis way they can shorten the operation time, reduce the incidence of complications.Clinicians need to pay more attention to the prevention and treatment of hypertension,diabetes and other chronic diseases, thus slowing the process of vascular aging andatherosclerosis, and controlling the increasing incidence of cardiovascular diseases year byyear.