Estudo comparativo retrospectivo entre aquisição de imagem bidimensional versus tridimensional na avaliação hemodinâmica invasiva de pacientes submetidos à intervenção percutânea da estenose da artéria do rim transplantado
Data
2023-07-20
Autores
Santos, Gustavo Rocha Feitosa 
Orientadores
Barbosa, Adriano Henrique Pereira
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: A doença renal crônica (DRC) é uma condição que resulta na progressiva perda da função renal ao longo do tempo, afetando milhões de pessoas no Brasil e globalmente. O transplante renal é uma opção terapêutica eficaz para pacientes com doença renal terminal, oferecendo resultados superiores em comparação com a hemodiálise. No entanto, complicações vasculares, como a estenose da artéria renal, podem ocorrer após o transplante. A angiografia bidimensional é o método tradicional para diagnosticar essa complicação, mas a angiografia tridimensional rotacional (3D-RA) tem se mostrado uma abordagem avançada e precisa, permitindo uma visualização detalhada dos vasos sanguíneos em três dimensões. Embora a 3D-RA apresente vantagens, sua adoção em larga escala ainda pode ser limitada pelo custo e disponibilidade de especialistas treinados.
Objetivos: Portanto, o objetivo do presente trabalho foi avaliar a utilidade da angiografia rotacional tridimensional (3D-RA) no diagnóstico da estenose da artéria do rim transplantado em comparação com a aquisição de imagem bidimensional. Métodos: Foi realizada uma análise retrospectiva dos dados armazenados na plataforma REDcap/EPM, com um total de 6.829 pacientes submetidos a transplante renal no Hospital do Rim durante o período de dezembro de 2006 a janeiro de 2015. Dentre esses pacientes, foram selecionados 313 com suspeita clínica e ultrassonográfica de EART, os quais passaram por arteriografia renal no Hospital São Paulo. Resultados: Dos 313 participantes, 79% eram homens e 21% eram mulheres. A média de idade da amostra foi de 40,88 anos. Cerca de 85,62% dos pacientes foram diagnosticados com hipertensão arterial sistêmica (HAS). A maioria dos pacientes em tratamento para HAS utilizava inibidores da enzima conversora de angiotensina (35,88%) e betabloqueadores (52,67%). A angiografia rotacional tridimensional (3D-RA) apresentou resultados semelhantes à arteriografia renal bidimensional (2D) no diagnóstico de estenose da artéria do rim transplantado (EART). Portanto, a 3D-RA pode ser uma alternativa eficaz para o diagnóstico da EART. Conclusões: Esses achados sugerem que a angiografia rotacional tridimensional 3D-RA pode ser uma alternativa eficaz e confiável para o diagnóstico da estenose da artéria do rim transplantado, oferecendo uma abordagem complementar à arteriografia renal 2D.
Introduction: Chronic kidney disease (CKD) is a condition that results in the progressive loss of renal function over time, affecting millions of people in Brazil and globally. Kidney transplantation is an effective therapeutic option for patients with end-stage renal disease, offering superior outcomes compared to hemodialysis. However, vascular complications such as renal artery stenosis may occur after transplantation. Two-dimensional angiography is the traditional method for diagnosing this complication, but three-dimensional rotational angiography (3D-RA) has emerged as an advanced and accurate approach, allowing detailed visualization of blood vessels in three dimensions. Despite the advantages of 3D-RA, its widespread adoption may still be limited by cost and the availability of trained specialists. Objectives: Therefore, the aim of this study was to evaluate the utility of three-dimensional rotational angiography (3D-RA) in the diagnosis of renal artery stenosis in transplanted kidneys compared to two-dimensional imaging. Methods: A retrospective analysis of data stored in the REDcap/EPM platform was conducted, including a total of 6,829 patients who underwent kidney transplantation at the Kidney Hospital during the study period from December 2006 to January 2015. Among these patients, 313 with clinical and ultrasound suspicion of renal artery stenosis were selected for renal arteriography at the São Paulo Hospital. Results: Of the 313 participants, 79% were male and 21% were female. The mean age of the sample was 40.88 years. Approximately 85.62% of the patients were diagnosed with systemic arterial hypertension (SAH). The majority of patients undergoing SAH treatment were using angiotensin-converting enzyme inhibitors (35.88%) and beta-blockers (52.67%). Three-dimensional rotational angiography (3D-RA) yielded similar results to two-dimensional renal arteriography (2D) in diagnosing transplant renal artery stenosis (TRAS). Therefore, 3D-RA can be an effective alternative for TRAS diagnosis. Conclusions: These findings suggest that three-dimensional rotational angiography (3D-RA) may serve as an effective and reliable alternative for diagnosing renal artery stenosis in transplanted kidneys, providing a complementary approach to two-dimensional renal arteriography (2D).
Introduction: Chronic kidney disease (CKD) is a condition that results in the progressive loss of renal function over time, affecting millions of people in Brazil and globally. Kidney transplantation is an effective therapeutic option for patients with end-stage renal disease, offering superior outcomes compared to hemodialysis. However, vascular complications such as renal artery stenosis may occur after transplantation. Two-dimensional angiography is the traditional method for diagnosing this complication, but three-dimensional rotational angiography (3D-RA) has emerged as an advanced and accurate approach, allowing detailed visualization of blood vessels in three dimensions. Despite the advantages of 3D-RA, its widespread adoption may still be limited by cost and the availability of trained specialists. Objectives: Therefore, the aim of this study was to evaluate the utility of three-dimensional rotational angiography (3D-RA) in the diagnosis of renal artery stenosis in transplanted kidneys compared to two-dimensional imaging. Methods: A retrospective analysis of data stored in the REDcap/EPM platform was conducted, including a total of 6,829 patients who underwent kidney transplantation at the Kidney Hospital during the study period from December 2006 to January 2015. Among these patients, 313 with clinical and ultrasound suspicion of renal artery stenosis were selected for renal arteriography at the São Paulo Hospital. Results: Of the 313 participants, 79% were male and 21% were female. The mean age of the sample was 40.88 years. Approximately 85.62% of the patients were diagnosed with systemic arterial hypertension (SAH). The majority of patients undergoing SAH treatment were using angiotensin-converting enzyme inhibitors (35.88%) and beta-blockers (52.67%). Three-dimensional rotational angiography (3D-RA) yielded similar results to two-dimensional renal arteriography (2D) in diagnosing transplant renal artery stenosis (TRAS). Therefore, 3D-RA can be an effective alternative for TRAS diagnosis. Conclusions: These findings suggest that three-dimensional rotational angiography (3D-RA) may serve as an effective and reliable alternative for diagnosing renal artery stenosis in transplanted kidneys, providing a complementary approach to two-dimensional renal arteriography (2D).