Asunto(s)
Procedimientos Endovasculares/métodos , Recuperación de la Función , Obstrucción de la Arteria Renal/cirugía , Arteria Renal/fisiopatología , Circulación Renal/fisiología , Stents , Angiografía , Enfermedad Crónica , Humanos , Masculino , Persona de Mediana Edad , Arteria Renal/diagnóstico por imagen , Obstrucción de la Arteria Renal/diagnóstico , Obstrucción de la Arteria Renal/fisiopatología , Ultrasonografía DopplerRESUMEN
The prospective investigation of 185 patients (118 men and 67 women in the age of 35-79 years (on the average 60+/-9 years) with atherosclerotic renovascular disease was carried out. The disease was detected by one- (62%) and two- (38%) hemodynamic value (>50%) of renal artery stenosis. Renal function, arterial pressure, cardiovascular death cases were estimated in 4 groups of patients during the period of 2,5-126 months (on the average 33 months). The patients of the first group (n=103) were undergone the renal revascularization (51 open and 80 endovascular). The patients of the second group (n=20) were after combined open renal revascularization (25) and after performed reconstruction of abdominal aorta and its branches and lower extremities arteries concerning aneurysmatic and occlusive lesions. The patients of the third group (n=19) had only reconstruction of lower extremities arteries concerning their ischemia without renal revascularization. The patients of the fourth group (n=43) haven't been operated because of the refusal of intervention. The lowest rate of survival was in the fourth group, who used the conservative therapy. Long-term survival didn't differ after open and endovascular therapy. The Koks regression analysis showed, that the improvement of long-term survival of the patients was associated with renal revascularization [Exp(B)=0,25, p<0,001] and didn't depend on the method of renal arteries reconstruction. A strategy of careful selection of patients with the application of interdisciplinary approach should be the base of clinical practice in renovascular disease.