Grego Franco, Frigatti Paolo, Antonello Michele, Lepidi Sandro, Ragazzi Roberto, Iurilli Vincenzo, Zucchetta Pietro, Deriu Giovanni P
Division of Vascular Surgery, Endovascular Surgery Section, Department of Medical and Surgical Sciences, University of Padova, Medical School, Padova, Italy.
Ann Surg. 2004 Jul;240(1):169-78. doi: 10.1097/01.sla.0000130721.78358.63.
The objective of this work was to evaluate any variation of renal function detected by renal scintigraphy after the suprarenal fixation of endografts for abdominal aortic aneurysm (AAA) repair.
In the few articles that have considered this problem, renal function was evaluated only by biochemical tests, which are inadequate in demonstrating small changes in renal function and in appreciating the worsening of a single kidney's function.
Between April 1999 and May 2002, 47 patients with an inappropriate infrarenal proximal neck had a suprarenal fixation for AAA. To assess renal function, a technetium-99m diethylene triamine penta-acetic acid (TC-DTPA) perfusion scintigraphy was performed preoperatively on the third postoperative day and at 6, 12 months, and then yearly thereafter. Worsening of renal function was defined as a decrease of glomerular filtration rate (GFR) > or =20% (detected with Gates method). Serum creatinine level was tested preoperatively and at the first and third postoperative day.
Endograft deployment was technically successful in 44 patients (93.6%); clinical perioperative success was obtained in 46 patients (97.8%). In 12 patients (25.5%), a permanent reduction of the GFR was observed using postoperative TC-DTPA perfusion scintigraphy. By 99m TC-DTPA perfusion scintigraphy, a permanent reduction of GFR was observed postoperatively in 12 patients. A slight GFR reduction (<20%) was present in 7 (14.9%) patients, due to the planned occlusion of accessory renal arteries. A more significant GFR reduction (>20%) was present unexpectedly in 5 (10.6%) patients, in 3 of these a single kidney was involved, in 5 both with an increase of the serum creatinine level >20%.
Suprarenal fixation of endografts in AAA treatment is a safe procedure with good early and midterm procedural results and a risk of GFR impairment (>20%) of 10.6%.
本研究旨在评估腹主动脉瘤（AAA）修复术中采用肾上固定方式植入血管内移植物后，通过肾闪烁显像检测到的肾功能变化。
在少数涉及该问题的文章中，仅通过生化检测评估肾功能，而生化检测在显示肾功能的微小变化以及判断单肾功能恶化方面存在不足。
1999年4月至2002年5月期间，47例肾下近端颈部不合适的患者接受了AAA肾上固定术。为评估肾功能，术前、术后第3天、6个月、12个月以及此后每年进行一次锝-99m二乙三胺五乙酸（Tc-DTPA）灌注闪烁显像。肾功能恶化定义为肾小球滤过率（GFR）下降≥20%（采用Gates法检测）。术前以及术后第1天和第3天检测血清肌酐水平。
44例患者（占93.6%）的血管内移植物植入技术成功；46例患者（占97.8%）获得临床围手术期成功。术后采用Tc-DTPA灌注闪烁显像发现，12例患者（占25.5%）的GFR出现永久性降低。通过99m Tc-DTPA灌注闪烁显像，术后发现12例患者的GFR出现永久性降低。7例患者（占14.9%）的GFR出现轻微降低（<20%），原因是计划封堵副肾动脉。5例患者（占10.6%）意外出现更显著的GFR降低（>20%），其中3例累及单肾，5例患者的血清肌酐水平均升高>20%。
AAA治疗中采用肾上固定方式植入血管内移植物是一种安全的手术，具有良好的早期和中期手术效果，GFR受损（>20%）的风险为10.6%。
