A Prospective Observational Study On The Correlation Between Short-term And Long-term Blood Pressure Control And Renal Parameters In Patients With Renal Artery Stenosis, And The Comparison Of Surgical Procedures And Prognosis In Patients With Renal Artery

Objectives:It is still controversial whether patients with renal artery stenosis will benefit from drug therapy or vascular reconstruction.This study intends to identify factors associated with the short-term and long-term blood pressure control of patients with renal artery stenosis after endovascular treatment.Methods:This study prospectively enrolled patients who was diagnosed with renal artery and received unilateral renal artery endovascular treatment at the Vascular Surgery Center of Peking Union Medical College Hospital.Important clinical information of the patients was collected,including demographic information,comorbidities,laboratory examinations,physical examinations,and imaging data.All patients performed FD-PBV perfusion examination before and after endovascular treatment.We kept follow up with the patients and record the follow-up data.The binary logistic regression was used to analyze variables that affect the patient’s blood pressure control in the short and long term.Results:40 patients were included in this study.Male patients accounted for 67.5%,with an average age of 53.1±16.79 years old.The main cause was atherosclerosis(85%).45%of patients with a smoking history and 27.5%with a drinking history.Comorbidities were hypertension(100%),hyperlipidemia(22.5%),hyperhomocysteinemia(20%),stroke(17.5%),renal function insufficiency(17.5%),coronary heart disease(15%),diabetes or impaired glucose tolerance(12.5%).The short-term cure rate of hypertension was 17.5%,the improvement rate was 22.5%,and the ineffective rate was 60%.Renal parameters were determined by PBV and other imaging technology.Binary logistic regression was used to explore factors that may affect the recent blood pressure control,suggesting that renal RI and postoperative volume increase are main factors affecting short-term blood pressure control.Patients with higher renal RI are lesser conducive to the short-term blood pressure control(OR<0.001,95%CI(0.000,0.224),p=0.018).The increased volume of the affected kidney after endovascular treatment is a protective factor for the short-term blood pressure control(OR=1.101,95%CI(1.004,1.208),p=0.040).A total of 28 people were included in the analysis of long-term blood pressure control.Binary logistic regression analysis of factors that may affect long-term blood pressure control showedthat renal RI is a risk factor that affects long-term blood pressure control.Patients with higher renal RI are lesser conducive to the long-term blood pressure control(OR<0.001,95%CI(0.000,0.457),p=0.033).Conclusion:This study evaluated the correlation between renal parameters and short-term and long-term blood pressure control in patients with renal artery stenosis.Renal RI is a risk factor for short-term blood pressure control,and the increased kidney volume after endovascular treatment is a protective factor for short-term blood pressure control.Renal RI is a risk factor for long-term blood pressure control.Objectives:Renal artery involvement in Takayasu arteritis can cause refractory hypertension and chronic renal insufficiency.With the advancement of technology,more and more applications of endovascular treatment are used.Endovascular treatment has the advantages of less trauma and repeatability,while the long-term patency rate of open surgery is better.At present,there are few controlled studies on endovascular treatment and open surgery in the field of Takayasu arteritis with renal artery involvement.This study intends to compare the patency rates of these two procedures and analyze risk factors that affect vascular restenosis.Methods:Clinical information was retrospectively collected from patients who were diagnosed with Takayasu arteritis and received renal vascular reconstruction for the first time in Peking Union Medical College Hospital from 2013 to 2017.Clinical information includes demographic information,comorbidities,laboratory examinations,physical examination,medical medication,surgical treatment,and follow up data.The Kaplan-Meier Curve and log-rank tests were used to compare the primary patency rates of the two procedures and analyze risk factors related to vascular restenosisResults:A total of 28 patients were enrolled in this study and 40 lesions were treated.One patient underwent endovascular treatment and open surgery on both sides of the kidney respectively.85.7%were female patients,and 89.3%were younger than 40 years old.Comorbidities were hypertension(100%)and heart failure(10.3%).After vascular reconstruction,the mean arterial pressure dropped from 102.32±15.33mmHg to 95.47±14.92mmHg(p=0.004).20 patients with 25 lesions received endovascular procedures.Percutaneous balloon angioplasty(PTA)was performed in 16 lesions and stenting in 9 lesions.The median hospital stay was 11 days,and complications occurred in 4 patients(2 with ecchymosis at the wound site,1 with hematoma at the punction site,1 with left upper abdominal pain).9 patients underwent open surgery procedures and 15 lesions were treated.Autologous saphenous vein was used in 12 lesions,artificial blood vessels in 2 lesions,and Roland arch-renal artery anastomosis was done in 1 lesion.The median hospital stay was 25 days,and complications occurred in 6 patients(1 with retroperitoneal hematoma,1 with ecchymosis at the incision site,1 with incision pain and discomfort,1 with coronary artery spasm and thrombocytopenia,1 with common peroneal nerve palsy,1 with fever and pancreatitis and anemia).The median hospitalization and complications in endovascular treatment were significantly lower than those in the open surgery group(p<0.001 and p=0.043).The median follow-up time for endovascular treatment was 11 months,the 1/3-year primary patency rate was 75.3%and 60.2%,and the restenosis rate was 52%.The median follow-up time of the open surgery group was 28 months,and the 1/3-year primary patency rate was 80%and 66%respectively,and the restenosis rate was 33%.No significant difference was found between the two groups.The median follow-up time of the PTA group was 16 months,the 1/3-year patency rate was 76.2%and 61%,and the restenosis rate was 62.5%.The stent placement group had a median follow-up time of 18 months,1/3-year primary patency rate was 75%and 60%,and the restenosis rate was 33.3%.No significant difference was found between the two groups.This study did not find any risk factors associated with restenosis.Conclusion:Both endovascular treatment and open surgery have a good control effect on blood pressure.The endovascular treatment group has lesser hospitalization time,lesser operation trauma,and lower complication rate,while the open surgery group has a longer hospital stay and higher complication rate.There was no significant difference in the 1/3-year primary patency rate between endovascular treatment group and open surgery group.No significant difference in the 1/3-year primary patency rate between PTA group and stenting group was found.