Efficacy And Safty Analysis Of Surgery Therapy Of Takayasu Arteritis Involving Renal Arteries

Part I Objective To analyze the risk factors related to restenosis after percutaneous transluminal angioplasty(PTA)in patients with Takayasu arteritis(TA).Materials and methods Retrospectively analyze the clinical and medical history data of 43 patients with TA treated with PTA from June 2003 to November 2018,who were included in our database(registration number: Chi CTR1800018752).SPSS 24.0 software was used for single factor analysis and multi-factor regression analysis.Results 43 patients with PTA were followed up for an average of(64 ± 42.21)months.A total of 22 patients had28(47.5%)postoperative restenosis.The average restenosis time was(23.4 ± 27.4)months.The restenosis rate was 9.09% in aorto-iliac artery,52.27% in renal,and the head and neck artery restenosis rate was 100%.The difference in restenosis rate between different lesions was statistically significant(P = 0.003).Patients with symptoms of headache(P = 0.002),syncope(P = 0.003),low back pain(P = 0.049)had a higher rate of restenosis after operation.Multivariate logistic analysis showed that the preoperative ESR(OR = 1.260,95% CI: 1.050-1.512,P = 0.013)and CRP(OR =1.464,95% CI: 1.015-2.112,P = 0.042)were postoperative Risk factors for restenosis.Conclusion PTA is safe and effective in patients with TA involving the aorto-iliac and renal arteries.It can be used as the first choice of treatment.But the efficacy in carotid arteries was poor.Patients with elevated ESR before surgery had a higher restenosis rate after PTA.Part IIObjective Analyze the safety,effectiveness and risk factors of different treatments for multiple arteritis involving renal artery.Materials and Methods: Retrospectively analyze the clinical and medical history data of 84 patients with TA involving renal arteries that was included in our Takara Database(Registration No:Chi CTR1800018752)from June 2003 to November 2018 for surgical intervention.SPSS 24.0 was used for single factor analysis and multi-factor regression analysis.Results The median follow-up time was 64.5(1-187)months.The restenosis rate was47.4%.There was no death(0%),and the recurrence rate was 37.9%.In the intervention group,the success rate of PTA was 63.7%,and the stent implantation rate was 36.3%.Perioperative complication rate was 3.3%.The restenosis rate of interventional therapy was 60%,of which the restenosis rate of PTA was 60.8%,and the restenosis rate of renal artery stent implantation was 58.6%.The symptom recurrence rate was 50.63%.The perioperative complication rate of renal vascular reconstruction was 18.5%.The restenosis rate was 19.4%.The symptom recurrence rate was 11.1%.When the ESR was elevated,the restenosis rate of interventional therapy was significantly increased(P = 0.004),and vascular bypass was not affected(P = 0.878).Conclusion Interventional therapy and renal vascular reconstruction are both effective means of treating TA-induced renal artery stenosis.Interventional therapy can be the first choice.The rate of restenosis is high when ESR is elevated.Renal vascular reconstruction is feasible after interventional treatment failure,and the safety and effectiveness of renal vascular reconstruction under drug protection are increased.