deSouza N M, Reidy J F, Koffman C G
Department of Radiology, Guy Hospital, London, England.
AJR Am J Roentgenol. 1991 Mar;156(3):507-10. doi: 10.2214/ajr.156.3.1899745.
The use of superselective embolization was assessed as a treatment for bleeding from postbiopsy arteriovenous fistulas (AVFs) in renal transplants. AVFs commonly occur after biopsy procedures in renal transplants, but severe bleeding is rare. Transcatheter embolization can be used to control bleeding, but unless it is sufficiently selective, the procedure results in loss of significant amounts of renal parenchyma. During a 4-year period, embolization procedures were attempted in seven patients 30-65 years old. All had AVFs shown on arteriography. Five patients underwent embolization; occlusion occurred only in the branch supplying the AVF. In one patient with three large AVFs, two were found to have occluded the day after embolization was attempted. In another, an AVF occluded when superselective catheter position was achieved but before embolization. Catheter manipulation in these cases may have precipitated occlusion. In five cases, coaxial embolization techniques were used. Embolization materials consisted of coils in three cases: 0.038 in. (0.97 mm) in one case, 0.025 in. (0.64 mm) in one case, 0.018 in. (0.46 mm) in one case; 0.038 in. (0.97 mm) coils and gelatin foam particles in one case; and localized contrast extravasation in one case. Serum creatinine level was measured before and after embolization in all patients, and radionuclide studies were undertaken in three cases. In all patients, bleeding was effectively controlled. None of the patients showed an increase in serum creatinine level after embolization, and in four, significant improvement was seen. Nuclear medicine studies showed no loss of renal function and a dramatic improvement in one patient. No complications due to the procedure were seen. Our experience suggests that superselective embolization with coaxial catheter techniques is an effective method of treating bleeding from postbiopsy AVFs in renal transplants with minimal loss of renal parenchyma.
评估了超选择性栓塞术作为肾移植活检后动静脉瘘（AVF）出血的一种治疗方法。AVF在肾移植活检术后很常见，但严重出血很少见。经导管栓塞术可用于控制出血，但除非具有足够的选择性，否则该操作会导致大量肾实质丧失。在4年期间，对7例30至65岁的患者尝试进行栓塞手术。所有患者在动脉造影中均显示有AVF。5例患者接受了栓塞治疗；仅在供应AVF的分支中发生了闭塞。在1例有3个大型AVF的患者中，在尝试栓塞后的第二天发现其中2个已经闭塞。在另1例患者中，在达到超选择性导管位置但尚未进行栓塞时，一个AVF闭塞了。在这些病例中，导管操作可能促使了闭塞的发生。在5例病例中，使用了同轴栓塞技术。栓塞材料在3例中为弹簧圈：1例为0.038英寸（0.97毫米），1例为0.025英寸（0.64毫米），1例为0.018英寸（0.46毫米）；1例为0.038英寸（0.97毫米）弹簧圈和明胶海绵颗粒；1例为局部造影剂外渗。在所有患者中，栓塞前后均测量了血清肌酐水平，并对3例患者进行了放射性核素研究。所有患者的出血均得到有效控制。栓塞后所有患者的血清肌酐水平均未升高，4例患者有显著改善。核医学研究显示肾功能无丧失，1例患者有显著改善。未发现该操作引起的并发症。我们的经验表明，采用同轴导管技术的超选择性栓塞术是治疗肾移植活检后AVF出血的有效方法，肾实质损失最小。
