Unità Clinico Operativa di Radiologia, Università degli Studi di Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149 Trieste, Italy.
Radiol Med. 2011 Sep;116(6):945-59. doi: 10.1007/s11547-011-0684-7. Epub 2011 Apr 19.
This study reviews our experience over the last 10 years with procedures of embolisation and/or exclusion of the renal arteries, their parenchymal branches and the polar arteries [renal artery embolisation (RAE)].
Twenty-seven patients (19 men and eight women; age range 37-93 years; mean 74 years) underwent RAE. The indications were: symptomatic gross haematuria in nine patients (33.3%) (tumour-related in seven and iatrogenic in two), symptomatic inoperable renal tumour in five (18.5%), large subcapsular or perirenal haematoma in three (11.1%) and aneurysm of the main renal artery in two (7.4%). Eight patients (29.6%) scheduled for endovascular aneurysm repair (EVAR) of the abdominal aorta underwent prophylactic embolisation of the renal polar branch arising from the aneurysmal sac or the subrenal aortic neck to prevent the possible revascularisation of the sac. Different embolisation agents were used: coils (17 cases), embolisation particles (14 cases), glue (one case), coated stent (two cases) and mechanical occlusion devices (two cases). In 11 cases, two to three different embolisation agents were used together.
Technical success was achieved in 26/27 patients (96.3%); in one case, embolisation of a polar artery arising from the aneurysmal sac was not possible. One case of gross haematuria recurred 13 months after the procedure and was re-treated with success. There were no cases of major or minor complications.
RAE is an effective and minimally invasive procedure in the treatment of neoplastic/iatrogenic symptomatic gross haematuria and in the palliative treatment of inoperable renal tumours. One possible new indication is the prophylactic exclusion of the polar artery arising from the neck or the sac of an abdominal aortic aneurysm in patients who are candidates for EVAR. In our experience, we observed very low morbidity and a short hospital stay. This procedure requires the availability of various materials for performing embolisation and experience in their use.
本研究回顾了过去 10 年来我们在肾动脉、其实质分支和极动脉栓塞和/或闭塞（肾动脉栓塞（RAE））方面的经验。
27 例患者（19 例男性和 8 例女性；年龄 37-93 岁；平均 74 岁）接受了 RAE。适应证为：9 例（33.3%）有症状性肉眼血尿（7 例与肿瘤相关，2 例为医源性）、5 例（18.5%）有症状性不可切除肾肿瘤、3 例（11.1%）有大的肾包膜下或肾周血肿和 2 例（7.4%）主肾动脉瘤。8 例（29.6%）计划行腹主动脉腔内修复术（EVAR）的患者预防性栓塞来自动脉瘤囊或肾下主动脉颈部的肾极支动脉，以防止可能对囊进行再血管化。使用了不同的栓塞剂：线圈（17 例）、栓塞颗粒（14 例）、胶（1 例）、涂层支架（2 例）和机械闭塞装置（2 例）。在 11 例中，两种或三种不同的栓塞剂一起使用。
26/27 例（96.3%）患者达到技术成功；1 例来自动脉瘤囊的极支动脉栓塞不成功。1 例肉眼血尿在术后 13 个月复发，再次成功治疗。无重大或轻微并发症发生。
RAE 是治疗肿瘤/医源性症状性肉眼血尿和不可切除肾肿瘤姑息治疗的有效、微创方法。一个新的可能适应证是在适合 EVAR 的患者中预防性排除来自腹主动脉瘤颈部或囊的极支动脉。根据我们的经验，我们观察到发病率非常低，住院时间短。该手术需要有各种用于栓塞的材料，并具备使用这些材料的经验。
