Rigdon E E, Durham J R, Massop D W, Wright J G, Smead W L
Department of Surgery, Ohio State University, Columbus.
Ann Vasc Surg. 1991 Mar;5(2):133-7. doi: 10.1007/BF02016745.
Hepatic and splenic arteries have been used increasingly as inflow sources to avoid aortorenal bypass in patients whose cardiac dysfunction may be exacerbated by aortic clamping and in patients with previous aortic grafting in whom periaortic dissection is more hazardous than incising undisturbed tissue planes. During an 18-month period, eight patients with atherosclerotic renal artery stenosis and azotemia were treated with six hepatorenal and five splenorenal artery bypasses. Serum creatinine improved initially in all patients. Severe hypertension, present in five patients, improved significantly in four (80%). In one-half the gastroduodenal branch of the hepatic artery was suitable for end-to-end anastomosis to the renal artery, obviating the need for an interposition graft. Hepatorenal bypass is a safe, simple procedure that has been associated with few complications, although occasional transient subclinical evidence of hepatic dysfunction has been reported. Splenorenal bypass requires a relatively more hazardous exposure and is associated with a low risk of splenic and pancreatic injury, especially when the spleen and splenic flexure of the colon are mobilized to expose the splenic artery. The risk of splenic injury is substantially reduced when the splenic artery is approached through the retroperitoneum at the base of the transverse mesocolon as described.
肝动脉和脾动脉越来越多地被用作流入源，以避免在心脏功能不全可能因主动脉钳夹而加重的患者以及先前接受过主动脉移植且主动脉周围剥离比切开未受干扰的组织平面更危险的患者中进行主动脉-肾动脉搭桥术。在18个月的时间里，对8例患有动脉粥样硬化性肾动脉狭窄和氮质血症的患者进行了6次肝-肾动脉搭桥术和5次脾-肾动脉搭桥术。所有患者的血清肌酐最初均有所改善。5例存在严重高血压的患者中，4例（80%）有显著改善。在一半的病例中，肝动脉的胃十二指肠分支适合与肾动脉进行端端吻合，无需使用中间移植物。肝-肾动脉搭桥术是一种安全、简单的手术，并发症较少，尽管曾有报道偶尔出现肝功能障碍的短暂亚临床证据。脾-肾动脉搭桥术需要相对更危险的暴露，且与脾和胰腺损伤的低风险相关，尤其是当游离脾脏和结肠脾曲以暴露脾动脉时。按照所述，当通过横结肠系膜根部的腹膜后途径接近脾动脉时，脾损伤的风险会大幅降低。
