HEART's Original [症例] 症例両側腎動脈ステント植え込み術が奏効した急性腎不全合併心不全の1例
症例は62歳,男性.脳梗塞で入院経過中に血圧上昇を伴い急性左心不全を発症した.薬剤抵抗性の高血圧症に対して腎動脈エコーを施行したところ,両側性粥状硬化性腎動脈狭窄を診断した.冠動脈造影上,3枝冠動脈病変を認め,心筋虚血も伴ったが,第55病日より,肺うっ血増悪,腎機能悪化から透析導入を余儀なくされた.両側腎動脈病変に対して経皮的ステント植え込み術を施行した直後から血圧の下降と安定化に伴い,心不全症状は消失し,腎機能改善から透析離脱にも成功した.急性腎不全合併心不全の増悪期において本治療が危機回避に有効であった症例であり報告する....
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| Published in | 心臓 Vol. 38; no. 3; pp. 276 - 281 |
|---|---|
| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
公益財団法人 日本心臓財団
2006
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0586-4488 2186-3016 |
| DOI | 10.11281/shinzo1969.38.3_276 |
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| Abstract | 症例は62歳,男性.脳梗塞で入院経過中に血圧上昇を伴い急性左心不全を発症した.薬剤抵抗性の高血圧症に対して腎動脈エコーを施行したところ,両側性粥状硬化性腎動脈狭窄を診断した.冠動脈造影上,3枝冠動脈病変を認め,心筋虚血も伴ったが,第55病日より,肺うっ血増悪,腎機能悪化から透析導入を余儀なくされた.両側腎動脈病変に対して経皮的ステント植え込み術を施行した直後から血圧の下降と安定化に伴い,心不全症状は消失し,腎機能改善から透析離脱にも成功した.急性腎不全合併心不全の増悪期において本治療が危機回避に有効であった症例であり報告する. |
|---|---|
| AbstractList | 症例は62歳,男性.脳梗塞で入院経過中に血圧上昇を伴い急性左心不全を発症した.薬剤抵抗性の高血圧症に対して腎動脈エコーを施行したところ,両側性粥状硬化性腎動脈狭窄を診断した.冠動脈造影上,3枝冠動脈病変を認め,心筋虚血も伴ったが,第55病日より,肺うっ血増悪,腎機能悪化から透析導入を余儀なくされた.両側腎動脈病変に対して経皮的ステント植え込み術を施行した直後から血圧の下降と安定化に伴い,心不全症状は消失し,腎機能改善から透析離脱にも成功した.急性腎不全合併心不全の増悪期において本治療が危機回避に有効であった症例であり報告する. |
| Author | 高橋, 康訓 常喜, 信彦 長谷, 弘記 板谷, 英毅 中村, 正人 杉, 薫 角田, 太郎 |
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| References | 18) Zeller T, Buttner HJ, Lorenz HM, et al: Late aortic dislocation of a stent following stent angioplasty for ostial renal artery stenosis. Catheter Cardiovasc Intery 2002; 56: 416-420 14) Olin JW, Piedmonte MR, Young JW, et al: The utility of duplex ultrasound scanning of renal arteries for diagnosing significant renal artery stenosis. Ann Intern Med 1995; 122: 833-838 5) Yamashita T, Ito F, Iwakiri N: Prevalence and Predictors of Renal Artery Stenosis in Patients Undergoing Cardiac Catheterization. Hypertens Res 2002; 25: 553-557 13) Hansen KJ, Tribble RW, Reavis SW, et al: Renal duplex sonography: evaluation of clinical utility. J Vasc Surg 1990; 12: 227-236 15) Khosla S, Kunjummen B, Manda R, et al: Prevalenca of renal artery stenosis requiring revascularization in patients initially refferd for coronary angiography. Cathet Cardiovasc Intery 2003; 58: 400-403 22) Zeller T, Muller C, Frank U, et al: Stent angioplastyof severe atherosclerotic ostial renal artery stenosis in patients with diabetes mellitus and nephrosclerosis. Catheter Cardiovasc Intery 2003; 58: 510-515 4) Feldman RL, Wargovich TJ, Bittle JA: No-touch technique for reducing aortic wall trauma during renal artery stenting. Catheter Cardivasc Intery 1999; 46: 245-248 8) Conlon PJ, ORiordan E, Kalra PA, et al: New insights into the epidemiologic and clinical manifestations of atherosclerotic renovascular disease. Am J Kidney Dis 2000; 35: 573-587 7) Conlon PJ, Athiracl K, Kovalik E, et al: Survival in renal vascular disease. J Am Sac Nephrol 1998; 9: 252-256 11) Simon N, Franklin SS, Bleifer KH, et al: Clinical characteristics of renovascular hypertension. JAMA 1972; 220: 1209-1218 20) Ellis K, Murtagh B, Loghin C, et al: The use of brachytherapy to treat renal artery in-stent restenosis. J Intery Cardiol 2005; 18: 49-54 9) Textor SC: ACE inhibitors in renovascular hypertension. Cardiovasc Drugs Ther 1990; 4: 2292-2235 1) Safian RD, Textor SC: Renal-artery sterosis. N Engl J Med 2001; 344: 431-442 6) Khosla 5, White CJ, Collins TJ, et al: Effect of renal artery stent implantation in patients with renovascular hypertension presenting with unstable angina or congestive heart failure. Am J Cardiol 1997; 80: 363-366 16) Morris CS, Bonnevie GJ, Najarian KE, et al: Nonsurgical treatment of acute iatrogenic renal artery injuries occurring after renal artery angioplasty and stenting. Am J Radial 2001; 177: 1353-1357 3) Strandness DE Jr: Duplex imaging for the detection of renal artery stenosis. Am J Kidney Dis 1994; 24: 674-678 12) Kohler TR, Zieler RE, Martin RL, et al: Noninvasive diagnosis of renal artery stenosis by ultrasonic duplex scanning. J Vasc Surg 1986; 4: 450-456 17) Bloch MJ, Trost DW, Sos TA, et al: Type B aortic dissection complicating renal artery ngioplasty and stent placement. J Vasc Intery Radial 2001; 12: 517-520 19) Nolan BW, Schermerhorn ML, Powell RJ, et al: Restenosis in gold-coated renal artery stents. J Vasc Surg 2005; 42: 40-46 10) Nally JV Jr, Black FIR: State-of-the-art review: captopril renography-pathophysiological considerations and clinical observations. Semin Nuel Med 1992; 22: 85-97 21) Radermachter J, Chavan A, Bleck J, et al: Use of doppler ultrasonography to predict the outcome of therapy for renal-artery stenosis.. N Engl J Med 2001; 344: 410-417 2) Martin LG, Rundbacck JH, Sacks D, et al: Quality improvement guidelines for angiography, angioplasty, and stent placement in the diagnosis and treatment of renal artery stenosis in the diagnosis and treatment of renal artery stenosis in adults. J Vasc Intery Radial 2002; 13: 1069-1083 |
| References_xml | – reference: 1) Safian RD, Textor SC: Renal-artery sterosis. N Engl J Med 2001; 344: 431-442 – reference: 8) Conlon PJ, ORiordan E, Kalra PA, et al: New insights into the epidemiologic and clinical manifestations of atherosclerotic renovascular disease. Am J Kidney Dis 2000; 35: 573-587 – reference: 22) Zeller T, Muller C, Frank U, et al: Stent angioplastyof severe atherosclerotic ostial renal artery stenosis in patients with diabetes mellitus and nephrosclerosis. Catheter Cardiovasc Intery 2003; 58: 510-515 – reference: 15) Khosla S, Kunjummen B, Manda R, et al: Prevalenca of renal artery stenosis requiring revascularization in patients initially refferd for coronary angiography. Cathet Cardiovasc Intery 2003; 58: 400-403 – reference: 3) Strandness DE Jr: Duplex imaging for the detection of renal artery stenosis. Am J Kidney Dis 1994; 24: 674-678 – reference: 9) Textor SC: ACE inhibitors in renovascular hypertension. Cardiovasc Drugs Ther 1990; 4: 2292-2235 – reference: 14) Olin JW, Piedmonte MR, Young JW, et al: The utility of duplex ultrasound scanning of renal arteries for diagnosing significant renal artery stenosis. Ann Intern Med 1995; 122: 833-838 – reference: 18) Zeller T, Buttner HJ, Lorenz HM, et al: Late aortic dislocation of a stent following stent angioplasty for ostial renal artery stenosis. Catheter Cardiovasc Intery 2002; 56: 416-420 – reference: 6) Khosla 5, White CJ, Collins TJ, et al: Effect of renal artery stent implantation in patients with renovascular hypertension presenting with unstable angina or congestive heart failure. Am J Cardiol 1997; 80: 363-366 – reference: 20) Ellis K, Murtagh B, Loghin C, et al: The use of brachytherapy to treat renal artery in-stent restenosis. J Intery Cardiol 2005; 18: 49-54 – reference: 11) Simon N, Franklin SS, Bleifer KH, et al: Clinical characteristics of renovascular hypertension. JAMA 1972; 220: 1209-1218 – reference: 16) Morris CS, Bonnevie GJ, Najarian KE, et al: Nonsurgical treatment of acute iatrogenic renal artery injuries occurring after renal artery angioplasty and stenting. Am J Radial 2001; 177: 1353-1357 – reference: 13) Hansen KJ, Tribble RW, Reavis SW, et al: Renal duplex sonography: evaluation of clinical utility. J Vasc Surg 1990; 12: 227-236 – reference: 4) Feldman RL, Wargovich TJ, Bittle JA: No-touch technique for reducing aortic wall trauma during renal artery stenting. Catheter Cardivasc Intery 1999; 46: 245-248 – reference: 7) Conlon PJ, Athiracl K, Kovalik E, et al: Survival in renal vascular disease. J Am Sac Nephrol 1998; 9: 252-256 – reference: 12) Kohler TR, Zieler RE, Martin RL, et al: Noninvasive diagnosis of renal artery stenosis by ultrasonic duplex scanning. J Vasc Surg 1986; 4: 450-456 – reference: 2) Martin LG, Rundbacck JH, Sacks D, et al: Quality improvement guidelines for angiography, angioplasty, and stent placement in the diagnosis and treatment of renal artery stenosis in the diagnosis and treatment of renal artery stenosis in adults. J Vasc Intery Radial 2002; 13: 1069-1083 – reference: 17) Bloch MJ, Trost DW, Sos TA, et al: Type B aortic dissection complicating renal artery ngioplasty and stent placement. J Vasc Intery Radial 2001; 12: 517-520 – reference: 5) Yamashita T, Ito F, Iwakiri N: Prevalence and Predictors of Renal Artery Stenosis in Patients Undergoing Cardiac Catheterization. Hypertens Res 2002; 25: 553-557 – reference: 19) Nolan BW, Schermerhorn ML, Powell RJ, et al: Restenosis in gold-coated renal artery stents. J Vasc Surg 2005; 42: 40-46 – reference: 10) Nally JV Jr, Black FIR: State-of-the-art review: captopril renography-pathophysiological considerations and clinical observations. Semin Nuel Med 1992; 22: 85-97 – reference: 21) Radermachter J, Chavan A, Bleck J, et al: Use of doppler ultrasonography to predict the outcome of therapy for renal-artery stenosis.. N Engl J Med 2001; 344: 410-417 |
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| SubjectTerms | ステント 粥状硬化性腎動脈狭窄症 腎動脈エコー 高血圧 |
| Title | HEART's Original [症例] 症例両側腎動脈ステント植え込み術が奏効した急性腎不全合併心不全の1例 |
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