Dokument: Vergleich von Thrombendarteriektomie (TEA) und perkutaner transluminaler Angioplastie (PTA) ostialer- und ostiumnaher, arteriosklerotischer Nierenarterienstenosen – Ergebnisse einer prospektiv randomisierten Studie an 50 Patienten
| Titel: | Vergleich von Thrombendarteriektomie (TEA) und perkutaner transluminaler Angioplastie (PTA) ostialer- und ostiumnaher, arteriosklerotischer Nierenarterienstenosen – Ergebnisse einer prospektiv randomisierten Studie an 50 Patienten | |||||||
| Weiterer Titel: | Operative vs. interventional treatment for ostial renal artery occlusive disease (RAOOD): Results of a prospective randomized trial | |||||||
| URL für Lesezeichen: | https://docserv.uni-duesseldorf.de/servlets/DocumentServlet?id=11490 | |||||||
| URN (NBN): | urn:nbn:de:hbz:061-20090618-110709-1 | |||||||
| Kollektion: | Dissertationen | |||||||
| Sprache: | Deutsch | |||||||
| Dokumententyp: | Wissenschaftliche Abschlussarbeiten » Dissertation | |||||||
| Medientyp: | Text | |||||||
| Autor: | Rossbach, Sebastian [Autor] | |||||||
| Dateien: |
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| Beitragende: | Prof. Dr. Sandmann, Wilhelm [Betreuer/Doktorvater] Prof.Dr. Rump, L. Christian [Gutachter] | |||||||
| Stichwörter: | Nierenarterienstenose, OP,TEA, PTA, | |||||||
| Dewey Dezimal-Klassifikation: | 600 Technik, Medizin, angewandte Wissenschaften » 610 Medizin und Gesundheit | |||||||
| Beschreibungen: | Einleitung und Ziele
Patienten mit renovaskulärer Hypertonie und/ oder Niereninsuffizienz aufgrund einer ein-oder beidseitigen Nierenarterienstenose(NAST) können sich sowohl einem offen chirurgischen Therapieversuch (Thrombendarteriektomie) oder einer katheterunterstützten Ballondilatation (perkutane transluminale Angioplastie) mit oder ohne Stent unterziehen. Da bisher wenig vergleichende Daten vorliegen, vergleicht die Arbeit beide Verfahren in einer prospektiven, randomisierten Studie im Hinblick auf technischen Erfolg, Offenheitsrate, Nierenfunktion und Komplikationen. Patienten und Methoden Zwischen 1998 und 2004 mussteten aus 330 aufeinander folgenden Patienten mit ein- oder beidseitiger arteriosklerotischer NAST, 149 aufgrund eines zweiten erforderlichen Eingriffes ausgeschlossen werden (Kombi-OP), 114 lehnten die Randomisation ab und 17 mussten ausgeschlossen werden, weil entweder die Stenose nicht angemessen für die PTA oder aber der Patient nicht operable war. 50 Patienten (18w/32m, Altersurchschnitt 64,4Jahre) stimmten der Randomisation zu und wurden entweder der offenen Chirurgie (TEA)(n=27) oder aber der PTA Stent (n=22) Therapie zugelost. 2 Patienten wechselten trotz Randomisation zur chirurgischen Therapie, ein Patient brach die Studie ab. Bei allen Patienten wurden die Einschlusskriterien für die Studie in einer interdisziplinären Konferenz von Radiologen, Nephrologen und Gefässchirurgen genehmigt. Nachuntersucht wurden die Patienten mittels farbcodierter Duplexsonographie und zusätzlich mittels Angiographie in Fällen mit Verdacht auf Restenose. Ergebnisse Insgesamt wurden 77 Arterien behandelt (49 TEA, 28 PTA). Die 4 Jahres-Mortalität lagen bei der OP bei 25%, bei der PTA bei 18%, kein Patient verstarb innerhalb von 30-Tagen. In der offenen chirurgischen Gruppe (TEA) waren 96% technisch erfolgreich, in der PTA Stent Gruppe waren 90% technisch erfolgreich. Die 4-Jahres-Offenheitsrate (≥70%) der behandelten Nierenarterien betrug 90,1% nach offener Chirurgie und 79,9% nach PTA Stent Intervention. Beide Gruppen zeigten signifikante Verbesserungen (p<0,0001) des arteriellen Hypertonus und die Nierenfunktion konnte in beiden Gruppen verbessert oder stabilisiert werden. Schlussfolgerung Beide Techniken, TEA und PTA mit Stent versprechen zufriedenstellende kurze und mittellange Resultate bei der Therapie von ostialen und ostiumnahen NAST. Die Nierenfunktion und der arterielle Hypertonus können mit beiden Verfahren therapiert werden. Die TEA verspricht signifikant bessere Offenheitsraten als PTA Stent und bleibt Goldstandard.OBJECTIVES: Patients with either renovascular hypertension (RVH) and/or renal insufficiency (RI) due to renal artery ostial occlusive disease (RAOOD) can successfully undergo an open surgical reconstruction procedure (OSRP) or percutaneous balloon stent angioplasty (PTRA + stent). However, despite stenting PTRA does not remove the often calcified atheromatosed plaque and a comparison of both treatment modalities concerning complications and durability has never been performed. METHODS: From 1998 to 2004 we performed OSRP in 330 patients with RVH and/or RI for various locations of RAOD. During this time period 50 patients (female 18, male 32, mean age 64, 4 years) with RAOOD of at least 70% stenosis (DSA and duplex criteria) in one or both renal arteries, who did not require other aorto/iliac reconstructive procedures agreed and were randomized to either OSRP or PTRA + stent. Patients were followed on a regular basis for 3 years and longer. End points were re-occurrence of RAOD, impairment of either kidney function or RVH. RESULTS: We treated 77 arteries (PTRA + stent n=28, OSRP n=49). There was no early mortality in either group, but perioperative morbidity was 13% in the interventional and 4% in the surgical group. Three year follow-up mortality was 18% in the interventional and 25% in the surgical group. Both groups showed significant improvement of RVH (p>0,001 in both groups) as well as improvement or stabilization in patients with impaired renal function. Freedom from recurrent RAOD (>70%) over 3 years was achieved in 90,1% of the surgical and 79,9% of the interventional group(p=0,140). CONCLUSION: Both treatment modalities showed good early results concerning RVH, kidney function and renal perfusion. Despite a higher number of bilateral renal artery reconstructions in patients undergoing OSRP, which was probably due to the preferred technique of transaortic endarterectomy eliminating the plaque originating in the aorta and usually extending in both renal arteries, mortality was not higher and procedure related morbidity was even lower compared to PTRA + stent. These findings and also better durability of OSRP imply, that surgical reconstruction remains the gold standard for patients with RAOOD before PTRA + stent may be considered. | |||||||
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| Lizenz: |  Urheberrechtsschutz | |||||||
| Bezug: | 1998-2009 | |||||||
| Fachbereich / Einrichtung: | Medizinische Fakultät | |||||||
| Dokument erstellt am: | 18.06.2009 | |||||||
| Dateien geändert am: | 12.06.2009 | |||||||
| Promotionsantrag am: | 17.06.2008 | |||||||
| Datum der Promotion: | 10.06.2009 |
