nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.24884/1561-6274-2003-7-3-35-43nefr-931Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИ. КЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯORIGINAL ARTICLES. CLINICAL INVESTIGATIONSНЕПОСРЕДСТВЕННЫЕ РЕЗУЛЬТАТЫ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ХРОНИЧЕСКОЙ ИШЕМИИ ПОЧЕКEARLY OUTCOMES OF SURGICAL MANAGEMENT OF CRONIC RENAL ISCHEMIAИгнашовА. М.IgnashovA. M.СеменовД. В.SemenovD. V.СмирновА. В.SmirnovA. V.ДобронравовВ. А.DobronravovV. A.ПротасовА. А.ProtasovA. A.АзовцевР. А.AzovtsevR. A.КисинаА. А.KisinaA. A.ШабунинМ. А.ShabuninM. A.ПоспеловД. А.PospelovD. A.Санкт-Петербургский государственный медицинский университет им. акад. И.П.ПавловаRussian Federation200310032003733543Copyright © Игнашов А.М., Семенов Д.В., Смирнов А.В., Добронравов В.А., Протасов А.А., Азовцев Р.А., Кисина А.А., Шабунин М.А., Поспелов Д.А., 20032003Игнашов А.М., Семенов Д.В., Смирнов А.В., Добронравов В.А., Протасов А.А., Азовцев Р.А., Кисина А.А., Шабунин М.А., Поспелов Д.А.Ignashov A.M., Semenov D.V., Smirnov A.V., Dobronravov V.A., Protasov A.A., Azovtsev R.A., Kisina A.A., Shabunin M.A., Pospelov D.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/931

ЦЕЛЬ ИССЛЕДОВАНИЯ. Оценить непосредственные результаты хирургического лечения больных с хронической ишемией почек. ПАЦИЕНТЫ И МЕТОДЫ. Хирургическое лечение хронической ишемии почек проведено 34 больным из 40 с окклюзионно-стенотическими поражениями почечных артерий (19 мужчинам и 15 женщинам в возрасте от 18 до 78 лет, в среднем — 53 ±14 года). Причинами нарушений проходимости ПА были: атеросклерозу 30, фибромускулярная дисплазия (1), перипротезный фиброз (1), тромбангиит(1) и диафрагмальная компрессия (1 (.Двусторонние поражения ПА имелись у 14 больных, из них у 13 с атеросклерозом. Артериальная гипертензия (АГ) была у 34 пациентов, а азотемия (креатинин от 0,13 до 0,4 ммоль/л, в среднем - 0,19 ±0,07) у 15 с атеросклерозом. Реваскуляризировано 34 почки у 29 больных (с двух сторону 5) с помощью: 24 шунтирований ПА(4 экстраанатомических), 1 эндартерэктомии, 1 протезирования, 1 декомпрессии и 7 эндоваскулярных ангиопластик. Только нефрэктомия выполненау 5. Сочетанные операции проведеныу 8 больных (24%). РЕЗУЛЬТАТЫ. АГ купирована у 11 (39%), течение ее улучшилось у 15 (54%) и осталась без изменений у 2 (7 %). Функция почек улучшилась у 6 (67%), стабилизировалась у 2(22%) больных и ухудшилась у 1 (11%). Летальные исходы (п = 6,17,6%) наблюдались только у больных с азотемией после сочетанных операций. ЗАКЛЮЧЕНИЕ. Реваскуляризация почек эффективна в коррекции почечной функции и АГ, но азотемия ухудшает результаты хирургического лечения в ближайшем послеоперационном периоде.

THE AIM of the investigation was to estimate the early outcomes of surgical treatment of patients with chronic renal ischemia. PATIENTSAND METHODS. Surgical treatment of chronic renal ischemia was carried on in 34 out of 40 patients with occlusive-stenotic Iesionsofthe renal arteries (19 men and 15 women aged from 18 to 78, average 53± 14 years). The causes of the lesions of the renal arteries (RA) were as follows: atherosclerosis (30), fibromuscular dysplasia (1), periprosthetic fibrosis (1), thromboangiitis (1) and diaphragmatic compression (1). Bilateral lesion of RA were foundin 14 patients, 13 out of them had atherosclerosis. Arterial hypertension (AH) was found in 34 patients, azotemia (creatinin from 0.013 to 0.4 mmol/l, average 0.19±0.07) in 15 patients with atherosclerosis. Revascularizationwas performed in 34 kidneys in 29 patients (bilaterally in 5) by means of 24 shuntingsof RA(4extraanatomical), 1 endarterectomy, 1 prosthesis, 1 decompression and 7 endovascular angioplasties. Nephrectomy only was performed in 5 cases. Combined operations were performed in 8 patients (24%). RESULTS. AH was arrested in 11 (39%) patients, its course was better in 15 (54%), remained unchanged in 2 (7%). Functions of the kidneys were improved in 6 (67%), stabilized in 2 (22%) patients and deteriorated in 1 (11%). Lethal outcomes (n=6; 17.6%) took place only in patients with azotemia after combined operations. CONCLUSION. Revascularization of the kidneys was effective in the correction of the renal function and AH, but azotemia worsened the results of surgical treatment in the earliest postoperative period.

окклюзионно-стенотические поражения почечных артерийхроническая ишемия почекреваскуляризация почекocclusive-stenotic lesions of the renal arterieschronic renal ischemiarevascularization of the kidneysReferencesGreco BA, Breyer JA. Atherosclerotic ischemic renal disease. Am J Kidney Dis 1997; 29 (2): 167 -187Greco BA, Breyer JA. Atherosclerotic ischemic renal disease. Am J Kidney Dis 1997; 29 (2): 167 -187Alkazar J.M, Rodicio JL Ischemic nephropathy: clinical characteristics and treatment. Am J Kidney Dis 2000; 36 (5): 883 -893Alkazar J.M, Rodicio JL Ischemic nephropathy: clinical characteristics and treatment. Am J Kidney Dis 2000; 36 (5): 883 -893Rimmer JM, Gennari FJ. Atherosclerotic renovascular disease and progressive renal failure. Ann Intern Med 1993; 118(3): 712-719Rimmer JM, Gennari FJ. Atherosclerotic renovascular disease and progressive renal failure. Ann Intern Med 1993; 118(3): 712-719Campdera FJG, Luno J, Vinuesa SG, Valderrabano F. Renal vascular disease in the elderly. Kidney internat 1998; 54 [Suppl 68]: S-73-S-77.Campdera FJG, Luno J, Vinuesa SG, Valderrabano F. Renal vascular disease in the elderly. Kidney internat 1998; 54 [Suppl 68]: S-73-S-77.Benjamin ME, Hansen KJ, Craven TE, et al. Combined aortic and renal surgery. Ann Surgery 1996; 223 (5): 555 -565Benjamin ME, Hansen KJ, Craven TE, et al. Combined aortic and renal surgery. Ann Surgery 1996; 223 (5): 555 -565Cambria RP, Brewster DS, Lyitalien Gl, et al. Renal reconstruction for the preservation of renal function. J Vasc Surgery 1996; 24 (3): 371 -380Cambria RP, Brewster DS, Lyitalien Gl, et al. Renal reconstruction for the preservation of renal function. J Vasc Surgery 1996; 24 (3): 371 -380Hallet JW, Textor SC, Kos PB, et al. Advanced renovascular hypertension and renal insufficiency: trends in medical comorbidity and surgical approach from 1970 to 1993. J Vac Surgery 1994; 21 (5): 750 -759Hallet JW, Textor SC, Kos PB, et al. Advanced renovascular hypertension and renal insufficiency: trends in medical comorbidity and surgical approach from 1970 to 1993. J Vac Surgery 1994; 21 (5): 750 -759Hansen KJ, Cheer GS, Craven TE. et al. Management of ischemic nephropathy: dialisys -free survival after surgical repair. J Vasc Surgery 2000; 32 (3): 472 -481Hansen KJ, Cheer GS, Craven TE. et al. Management of ischemic nephropathy: dialisys -free survival after surgical repair. J Vasc Surgery 2000; 32 (3): 472 -481Mailloux LU, Napolitano B, Bellucci AG, et al. Renal vascular disease causing End-Stage Renal Disease incidence, clinical correlates and outcomes: a 20-year clinical experience. Am J Kidney Dis 1994; 24 (4): 622 -629Mailloux LU, Napolitano B, Bellucci AG, et al. Renal vascular disease causing End-Stage Renal Disease incidence, clinical correlates and outcomes: a 20-year clinical experience. Am J Kidney Dis 1994; 24 (4): 622 -629Coen G, Manni M1 Giannoni MF, et al. Ischemic nephropathy in elderly nephrologic and hypertensive population. Am J Nephrology 1998; 18 (3): 221 -227Coen G, Manni M1 Giannoni MF, et al. Ischemic nephropathy in elderly nephrologic and hypertensive population. Am J Nephrology 1998; 18 (3): 221 -227Van Ampting JM, Penne EL, Beek FJ,et al. Prevalence of atherosclerotic renal artery stenosis in patients starting dialysis. Nephrol Dial Transplant 2003; 18 (6): 1147 -1151Van Ampting JM, Penne EL, Beek FJ,et al. Prevalence of atherosclerotic renal artery stenosis in patients starting dialysis. Nephrol Dial Transplant 2003; 18 (6): 1147 -1151Acher CW1 Belzer FO, Grist TM, et al. Late renal function in patients undergoing renal revascularisation for control of hypertension and/or renal preservation. Cardiovasc Surgery 1996; 4 (5): 602-606Acher CW1 Belzer FO, Grist TM, et al. Late renal function in patients undergoing renal revascularisation for control of hypertension and/or renal preservation. Cardiovasc Surgery 1996; 4 (5): 602-606Steinbach F, Noviek AC, Campbell S, Dykstra. D Long -term survival after surgical revascularisation atherosclerotic renal artery disease. J Urology 1997; 158 (1): 38 -41Steinbach F, Noviek AC, Campbell S, Dykstra. D Long -term survival after surgical revascularisation atherosclerotic renal artery disease. J Urology 1997; 158 (1): 38 -41Brothers TE, Elliott BM, Robison JG, et al. Stratification of mortality for risk for renal artery surgery. Am Surgeon 1995; 61 (1): 45 -51Brothers TE, Elliott BM, Robison JG, et al. Stratification of mortality for risk for renal artery surgery. Am Surgeon 1995; 61 (1): 45 -51Morris GC. Surgical treatment of renal hypertension. Ann Surgery 1960; 151: 854 -866Morris GC. Surgical treatment of renal hypertension. Ann Surgery 1960; 151: 854 -866Князев МД, Кротовский ГС. Хирургическое лечение окклюзионных поражений почечных артерий. Воронеж, 1974Князев МД, Кротовский ГС. Хирургическое лечение окклюзионных поражений почечных артерий. Воронеж, 1974Лопаткин НА, Мазо ЕБ Диагностика вазоренальной гипертонии и выбор метода ее лечения. М.: Медицина, 1975Лопаткин НА, Мазо ЕБ Диагностика вазоренальной гипертонии и выбор метода ее лечения. М.: Медицина, 1975Покровский AB, Спиридонов AA. Современное состояние проблемы вазоренальной гипертонии. Кардиология 1972; 3: 52-59Покровский AB, Спиридонов AA. Современное состояние проблемы вазоренальной гипертонии. Кардиология 1972; 3: 52-59Schwartz CJ1 White TA. Stenosis of renal artery: An unselected necropsy study. Br Med J 1964; 2: 1415 -1421Schwartz CJ1 White TA. Stenosis of renal artery: An unselected necropsy study. Br Med J 1964; 2: 1415 -1421Morris GC, De Bakey ME, Cooley DA. Surgical treatment of renal failure of renovascular origin. JAMA 1962; 182 (6): 609Morris GC, De Bakey ME, Cooley DA. Surgical treatment of renal failure of renovascular origin. JAMA 1962; 182 (6): 609Kaufman J. Renal artery stenosis and azotemia. Surg Gynec Obstet 1973; 137 (5): 949 -952Kaufman J. Renal artery stenosis and azotemia. Surg Gynec Obstet 1973; 137 (5): 949 -952Besarab A, Brown RS, Rubin NT, et al. Reversible renal failure following bilateral renal artery occlusive disease. JAMA 1976; 235 (26): 2838-2841Besarab A, Brown RS, Rubin NT, et al. Reversible renal failure following bilateral renal artery occlusive disease. JAMA 1976; 235 (26): 2838-2841Lawrie GM, Morris GC, Glaeser DH, De Bakey ME. Renovascular reconstruction: factors affecting long-term prognosis in 919 patients -followed up to 31 years. Am J Cardiology 1989; 63 (15): 1085 -1092Lawrie GM, Morris GC, Glaeser DH, De Bakey ME. Renovascular reconstruction: factors affecting long-term prognosis in 919 patients -followed up to 31 years. Am J Cardiology 1989; 63 (15): 1085 -1092Mersier C, Piquet P, Alimi Y, et al. Occlusive disease of the renal arteries and chronic renal failure: the limits to reconstructive surgery. Ann Vasc Surgery 1990; 4 (2): 166 -170Mersier C, Piquet P, Alimi Y, et al. Occlusive disease of the renal arteries and chronic renal failure: the limits to reconstructive surgery. Ann Vasc Surgery 1990; 4 (2): 166 -170Reilly JM, Rubin BG, Thompson RW, et al. Revascularisation of the solitary kidney: a challenging problem in a high risk population. Surgery 1996; 120 (4): 732 -736Reilly JM, Rubin BG, Thompson RW, et al. Revascularisation of the solitary kidney: a challenging problem in a high risk population. Surgery 1996; 120 (4): 732 -736Rees CR, Palmaz JC, Becker GJ, et al. Palmaz-stent in atherosclerotic stenosis involving the ostia of the renal arteries: preliminary report of a multicenter study. Radiology 1991; 181 (2): 507-514Rees CR, Palmaz JC, Becker GJ, et al. Palmaz-stent in atherosclerotic stenosis involving the ostia of the renal arteries: preliminary report of a multicenter study. Radiology 1991; 181 (2): 507-514Hennequin LM, Joffre FG, Rousseau HP, et al. Renal artery stent placement: long-term results with the Wallstent endoprosthesis. Radiology 1994; 191 (3): 713 -719Hennequin LM, Joffre FG, Rousseau HP, et al. Renal artery stent placement: long-term results with the Wallstent endoprosthesis. Radiology 1994; 191 (3): 713 -719Van de Ven PJG, Beutler JJ, Kaatee R, et al. Transluminal vascular stent for ostial atherosclerotic renal artery stenosis. Lancet 1995; 346 (8975): 672 -674Van de Ven PJG, Beutler JJ, Kaatee R, et al. Transluminal vascular stent for ostial atherosclerotic renal artery stenosis. Lancet 1995; 346 (8975): 672 -674Dorros G, Jaff M, Mathiak L, et al. Four-year following-up of Palmaz-Schatz stent revascularisation as treatment atherosclerotic renal artery stenosis. Circulattion 1998; 98 (7): 642 -647Dorros G, Jaff M, Mathiak L, et al. Four-year following-up of Palmaz-Schatz stent revascularisation as treatment atherosclerotic renal artery stenosis. Circulattion 1998; 98 (7): 642 -647Zuccala A, Losino F, Zucchelli PS. Renovascular disease in diabetes mellitus: treatment by percutaneous transluminal renal angioplasty. Nephrol Dial Transpl 1998; 13 [Suppl 8]: 26 -29Zuccala A, Losino F, Zucchelli PS. Renovascular disease in diabetes mellitus: treatment by percutaneous transluminal renal angioplasty. Nephrol Dial Transpl 1998; 13 [Suppl 8]: 26 -29Erdoes LS, Berman SS, Hunter GC, Mills JL. Comparative analysis of percutaneous transluminal angioplasty and operation for renal revascularisation. Am J Kid Dis 1996; 27 (4): 496 -503Erdoes LS, Berman SS, Hunter GC, Mills JL. Comparative analysis of percutaneous transluminal angioplasty and operation for renal revascularisation. Am J Kid Dis 1996; 27 (4): 496 -503Darling RC, Kreienberg PB, Chang BB, et al. Outcome of renal artery reconstruction. Ann Surgery 1999; 230 (4): 524 -530Darling RC, Kreienberg PB, Chang BB, et al. Outcome of renal artery reconstruction. Ann Surgery 1999; 230 (4): 524 -530Hansen KJ, Deitch JS, Oskin TC, et al. Renal artery repair. Consequence of operative failure. Ann Surgery 1998; 227 (5): 678 -689Hansen KJ, Deitch JS, Oskin TC, et al. Renal artery repair. Consequence of operative failure. Ann Surgery 1998; 227 (5): 678 -689O’Donovan RM, Gutierrez OH, Izzo JLJ. Preservation of renal function by percutaneous renal angioplasty in high-risk elderly patients: short -term outcome. Nephron 1992; 60: 187 -192O’Donovan RM, Gutierrez OH, Izzo JLJ. Preservation of renal function by percutaneous renal angioplasty in high-risk elderly patients: short -term outcome. Nephron 1992; 60: 187 -192Bush RL, Najibi S, MacDonalds MJ, et al. Endovascular revascularisation of renal artery stenosis: technical and clinical results. J Vase Surgery 2001; 33 (5): 1041 -1049Bush RL, Najibi S, MacDonalds MJ, et al. Endovascular revascularisation of renal artery stenosis: technical and clinical results. J Vase Surgery 2001; 33 (5): 1041 -1049Crinnion JN, Gough MJ. Bilateral renal artery atherosclerosis -the results of surgical treatment. Eur J Vasc Endovase Surgery 1996; 11 (3): 353 -358Crinnion JN, Gough MJ. Bilateral renal artery atherosclerosis -the results of surgical treatment. Eur J Vasc Endovase Surgery 1996; 11 (3): 353 -358Wright RS, Reeder GS, Herzog CA, et al. Acute myocardial infarction and renal dysfunction: a high-risk combination. Ann Intern Med 2002; 137 (7); 563 -570Wright RS, Reeder GS, Herzog CA, et al. Acute myocardial infarction and renal dysfunction: a high-risk combination. Ann Intern Med 2002; 137 (7); 563 -570Novick AC. Percutaneous transluminal angioplasty and surgery of renal artery. Eur J Vase Surgery 1994; 8 (1): 1 -10Novick AC. Percutaneous transluminal angioplasty and surgery of renal artery. Eur J Vase Surgery 1994; 8 (1): 1 -10

The authors declare that there are no conflicts of interest present.