Skip to main content

Advertisement

SpringerLink
Log in

Nierenarterienstenose mit renovaskulärer hypertonie

Diagnostik, Therapie und Ergebnisse

Renal artery stenosis with renovascular hypertension-diagnosis, therapeutic procedure and results

  • Published:
Acta Chirurgica Austriaca Aims and scope Submit manuscript

Zusammenfassung

Neue diagnostische und therapeutische methoden kennzeichnen die heutige situation, der renovaskulären hypertonie.

Diagnostisch: Digitale subtraktionsangiographie, seitengetrennte reninbestimmung, selektive pharmakoarteriographie. Therapeutisch: Perkutane transluminale angioplastik (PTA).

63% Mäanner, 37% frauen, 70% arteriosklerose sowie ein durchschnittsalter, von 44 jahren kennzeichnen das krankengut. Die chirurgischen ergebnisse bei 83 patienten ergaben in 47% eine normalisierung, in 22% eine besserung sowie negative resultate und mortalität in 13% bzw. 12%. Die Letalität ist in der gruppe der simultanen zusatzeingriffe hoch, so daß wir sie wenn mõglich vermeiden. Morbidität und vor allem Mortalität sind bei anwendung der PTA gering. Aus diesem grund wird sie als erster therapieschritt bei der, RVH mit nierenarterienstenose durchgeführt. Die früh- bis mittelfristigen ergebnisse bei 51 Patienten sind: 39% normalisierung und 51% besserung über 16 monate.

Summary

New diagnostic and therapeutic procedures changed the attitude, toward the approach to renovascular hypertension: intravenous digital subtraction, angiography (DSA), highly selective pharmaco-arteriography as diagnostic tools; percutaneous transluminal angioplasty (PTA) as new refined therapeutic procedure. Lateralizing venous renins and classical vascular surgery are generally accepted methods. 83 vascular reconstructions with 70% atherosclerosis and a mean age of 44 years are reported. Postoperative normotensive: 47% improved: 22% over a period of 5 years. Over all postoperative mortality: 12%, by surgical reasons: 6%; no therapeutic effect: 13%. Simultaneous vascular procedures in our experience are yielding significant higher mortality rates than unilateral elective reconstructions and should therefore be avoided. Complications during or after 51 PTAs are uncommon, favouring this procedure as first step in the therapy of RVH today. Early results are encouraging: 39% became normotensive, 51% improved during a mean observation period of 16 months.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Literatur

  1. Bookstein, J. J.: Appraisal of arteriography in estimating the hemodynamic significance of renal artery stenoses. Invest. Radiol. 1, 281 (1966).

    Article  PubMed  CAS  Google Scholar 

  2. Brewster, D. C., Buth, J., Darling, R. C., Austen, W. C.: Combined aortic and renal artery reconstruction. Am. J. Surg. 131, 457 (1976).

    Article  PubMed  CAS  Google Scholar 

  3. Colapinto, R. F., Stronell, R. D., Harries-Jones, E. P., Gildiner, M., Hobbs, B. B., Farrow, G. A., Wilson, D. R., Morrow, J. D., Logan, A. G., Birch, S. J.: Percutaneous, transluminal dilatation of the renal artery: Follow-up studies on renovascular hypertension. AJR 139, 727 (1982).

    PubMed  CAS  Google Scholar 

  4. Dean, R. H., Foster, J. H.: Criteria for the diagnosis of renovascular hypertension. Surgery 74, 926 (1973).

    PubMed  CAS  Google Scholar 

  5. Dean, R. H.: Aortorenal bypass. In: Vascular surgery. Ed. Rutherford, p. 1001. Saunders, Philadelphia 1977.

    Google Scholar 

  6. Dean, R. H.: What is new in renal revascularization? In: Vascular Surgery—Issues in current practice. Eds. R. M. Greenhalgh, C. W. Jamieson, A. N. Nicolaides, p. 245. Grune & Stratton 1986.

  7. Ernst, C. B., Daugherty, M. E., Kotchen, T. A.: Relationship between collateral development and renin in experimental renin arterial stenosis. Surgery, 80, 252 (1976).

    PubMed  CAS  Google Scholar 

  8. Foster, J. H., Dean, R. H., Pinkerton, J. A., Rhamy, R. K.: Ten years experience with the surgical management of renovascular hypertension. Ann. Surg. 177, 755 (1973).

    Article  PubMed  CAS  Google Scholar 

  9. Fry, W. J., Brink, B. E., Thompson, N. W.: New techniques in the treatment of extensive fibromuscular disease involving the renal arteries. Surgery 68, 959 (1970).

    PubMed  CAS  Google Scholar 

  10. Fry, W. J., Wylie, E. J., Dean, R. H., Stanley, J. C.: Symposium: Renovascular hypertension. Cont Surg. 13, 49, (1978).

    Google Scholar 

  11. Fry, W. J.: Treatment of renovascular hypertension. In: Advances in Surgery 19. Ed. J. A. Mannick, p. 51. Year Book Medical Publishers, 1986.

  12. Grüntzig, A., Vetter, W., Meier, B., Kuhlmann, U., Lutolf, U., Seigenthaler, W.: Treatment of renovascular hypertension with percutaneous transluminal dilatation of a renalartery stenosis. Lancet 1, 801 (1978).

    Article  PubMed  Google Scholar 

  13. Katzen, B. T., Chang, J., Knox, W. G.: Percutaneous transluminal angioplasty with the Grüntzig balloon catheter. A review of 70 cases. Arch. Surg. 114, 1389 (1979).

    PubMed  CAS  Google Scholar 

  14. Lawson, J. D., Shack, R. B., Polterauer, P., Hollifield J. W., Rhamy, R. K., Dean, R. H.: Revascularization of the poorly functioning kidney. Surg. 85, 44 (1970).

    Google Scholar 

  15. Miller, G. A., Ford, K. K., Braun, S. D., Newman, G. E., Moore, A. V., Malone, R., Dunnick, N. R.: Percutaneous transluminal angioplasty vs. surgery for renovascular hypertension. AJR 144, 447 (1985).

    PubMed  CAS  Google Scholar 

  16. Nordhus, O., Ekström, Liljeqvist, L., Tidgren, B.: Renal artery reconstruction in renovascular hypertension. Scand. J. Thoac. Cardiovasc. Surg. 12, 111 (1978).

    CAS  Google Scholar 

  17. Olbert, F., Ogris, E., Muzika, N., Schlegl, A., Vacariu, O., Diez W.: Perkutane transluminale Angioplastie (PTA) im Bereich der Arteria realis—Indikation, Technik und Ergebnisse. Wien. klin. Wschr. 97 (1985).

  18. Polterauer, P., Dean, R. H., Hollifield J. H., Rhamy, R. K.: Totalverschluß der Nierenarterie und eingeschränkte Nierenfunktion als besonderes Problem der renovaskulären Hypertonie. Indikation und Ergebnisse. Kongreßbericht der österreichischen Gesellschaft für Chirurgie. S. 592. Demeter, 1979.

  19. Polterauer, P., Piza, F., Wagner, O., Kretschmer, G., Schemper, M.: Nierenarterienstonose—renovaskuläre Hypertonie: Rekonstruktionsergebnisse. Angio archiv 1, 119 (1981).

    Google Scholar 

  20. Polterauer, P., Dean, R. H., Hollifield, J. W.: Hinweise zur chirurgischen Behandlung der renovaskulären Hypertonie: Erfahrung an 400 operierten Nierenarterienstenosepatienten. Wien. klin. Wschr. 92, 433 (1980).

    PubMed  CAS  Google Scholar 

  21. Polterauer, P., Piza, F., Wagner, O., Kretschmer, G., Schemper, M.: Renovascular hypertension—renal artery stenosis: Results of sixty-five consecutive reconstructions. Angiology 33, 781 (1982).

    PubMed  CAS  Google Scholar 

  22. Puijlaert, C. B. A. J., Boomsma J. H. B., Ruijs, J. H. J., et al.: Transluminal renal artery dilatation in hypertension: Technique, results and complications in 60 cases. Urol. Radiol. 2, 201 (1981).

    Article  PubMed  CAS  Google Scholar 

  23. Schwilden, E. D., Van Dongen, R. J. A. M.: Behandlung von abdominellen Aorten-Aneurysmen in Kombination mit ein- oder beidseitigen Nierenarterienstenosen. VASA 5, 47 (1976).

    PubMed  CAS  Google Scholar 

  24. Shapiro, A. P., Perez, C., Stable, E., Scheib, E. T., Bron, K., Moutsos, S. E., Berg, G., Misage, J. R.: Renal artery stenosis and hypertension: Observations on current status of therapy from a study of 115 patients. Am. J. Med. 47, 175 (1969).

    Article  PubMed  CAS  Google Scholar 

  25. Stanley, J. C., Fry, W. J.: Surgical treatment of renovascular hypertension. Arch. Surg. 112, 1291 (1977).

    PubMed  CAS  Google Scholar 

  26. Stanley, J. C., Ernst, C. B., Fry, W. J.: Fate of 100 aortorenal vein grafts: Characteristics of late graft expansion. Aneurysmal dilation, and stenosis. Surgery 74, 931 (1973).

    PubMed  CAS  Google Scholar 

  27. Tegtmeyer, C. J., Kofler, T. J., Ayers, C. A.: Renal angioplasty: Current status. AJR 142, 17 (1984).

    PubMed  CAS  Google Scholar 

  28. Van Way, C. W.: Clinical conditions in the management of hypertension and renovascular hypertension. In: Vascular surgery. Ed. Rutherford, S. 971. Saunders, Philadelphia 1977.

    Google Scholar 

  29. Vollmar, J., Nadjafi, S., Rosenthal, J.: Surgical considerations in the treatment of renovascular hypertension. Surg. Gynec. Obstet. 144, 553 (1977).

    PubMed  CAS  Google Scholar 

  30. Wilms, G. E., Baert, A. L., Staessen, J. A., Amery, A. K.: Renal artery stenosis: Evaluation with intravenous digital subtraction angiography. Radiology 160, 713 (1986).

    PubMed  CAS  Google Scholar 

  31. Wylie, E. J., Perloff, D. L., Stoney, R. J.: Autogenous tissue revascularisation techniques in surgery for renovascular hypertension. Ann. Surg. 170, 416 (1969).

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Zentralen institut für radiodiagnostik der universität wien, Wien, Österreich

    G. Wittich, F. Karnel & F. Olbert

  2. Ludwig-Boltzmann Institut für radiologisch physikalische umordiagnostik, Wien, Österreich

    P. Polterauer & F. Piza

  3. õntgeninstitut der I. Chirurgischen universitätsklinik Wien, Wien, Õterreich

    G. Lechner

  4. I. Chirurgische Universitätsklinik Wien, Alser Straße 4, A-1090, Wien

    P. Polterauer & F. Piza

Authors
  1. P. Polterauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. Wittich
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G. Kretschmer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. F. Karnel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. F. Piza
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. F. Olbert
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. G. Lechner
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Polterauer, P., Wittich, G., Kretschmer, G. et al. Nierenarterienstenose mit renovaskulärer hypertonie . Acta Chir Austriaca 18, 455–460 (1986). https://doi.org/10.1007/BF02656376

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02656376

Schlüsselwõrter

Key-words

Search

Navigation