Ramamoorthy Sonia L, Vasquez Julio C, Taft Peter M, McGinn Robert F, Hye Robert J
Department of Surgery, University of California, San Diego Medical Center, San Diego, CA, USA.
Ann Vasc Surg. 2002 Mar;16(2):157-62. doi: 10.1007/s10016-001-0154-0. Epub 2002 Feb 13.
Isolated spontaneous renal artery dissection is a rare condition that can result in renal parenchymal loss and severe hypertension. Although several risk factors have been identified in association with renal artery dissection, the natural history is not well defined. The rarity and nonspecific presentation of the disease often lead to diagnostic delay. That, coupled with the anatomic limitations imposed by dissection into small branch arteries, frequently precludes successful revascularization. Over a 12-month period, four cases of spontaneous renal artery dissection (SRAD) were treated at a single institution. The patients (ages 44-58 years) presented with acute onset of abdominal/flank pain, fever, and hematuria. Diagnostic work-up included an abdominal CT scan revealing segmental renal infarction. Angiographic evaluation was diagnostic for renal artery dissection in all cases. In one case there was evidence of fibromuscular dysplasia (FMD), and in a second there was acute dissection superimposed upon atherosclerotic disease. Diagnosis was made within 12-72 hr of the onset of symptoms. All patients were managed expectantly with anticoagulation. Two patients were known to have a history of hypertension prior to admission. All four patients have required antihypertensive treatment following dissection, but the condition has been easily controlled. Renal function has remained stable in all cases. None of the four cases required exploration. Two of the four patients underwent repeat angiographic evaluation for recurrent symptoms of pain. In the case of the patient with FMD, a new dissection was seen in the contralateral renal artery, and in the second, repeat angiogram revealed proximal remodeling of the dissected artery. Management strategies for SRAD include surgical revascularization, endovascular intervention, and observation with or without anticoagulation. The available literature does not demonstrate a clear benefit of treatment with any of these modalities. In the short term, the combination of anticoagulation and expectant management appears to produce satisfactory outcomes for this difficult problem.
孤立性自发性肾动脉夹层是一种罕见疾病，可导致肾实质丧失和严重高血压。尽管已确定了一些与肾动脉夹层相关的危险因素，但其自然病程仍不明确。该疾病的罕见性和非特异性表现常导致诊断延迟。这再加上夹层累及小分支动脉所带来的解剖学限制，常常使成功的血管重建无法实现。在12个月的时间里，一家机构治疗了4例自发性肾动脉夹层（SRAD）患者。这些患者年龄在44至58岁之间，表现为突发腹痛/侧腹痛、发热和血尿。诊断性检查包括腹部CT扫描，显示节段性肾梗死。血管造影评估在所有病例中均确诊为肾动脉夹层。1例有纤维肌发育不良（FMD）证据，另1例在动脉粥样硬化疾病基础上发生急性夹层。在症状出现后12至72小时内做出诊断。所有患者均接受抗凝的保守治疗。2例患者入院前有高血压病史。所有4例患者夹层后均需要抗高血压治疗，但病情很容易得到控制。所有病例肾功能均保持稳定。4例患者均未需要进行探查。4例患者中有2例因疼痛复发症状接受了重复血管造影评估。在患有FMD的患者中，对侧肾动脉出现了新的夹层，在另1例患者中，重复血管造影显示夹层动脉近端重塑。SRAD的治疗策略包括手术血管重建、血管内介入以及抗凝或不抗凝的观察。现有文献未表明这些治疗方式中的任何一种具有明显益处。短期内，抗凝与保守治疗相结合似乎能为这个难题带来令人满意的结果。
