Division of Emergency Medicine, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
Surg Today. 2011 Jul;41(7):1020-3. doi: 10.1007/s00595-010-4368-z. Epub 2011 Jul 12.
When renal artery occlusion occurs secondary to blunt trauma, the recovery rate of renal function after open revascularization is varied and far from satisfactory. Although the optimal treatment for this type of injury has not been established, percutaneous revascularization by endovascular stenting has recently been advocated for patients with unilateral renal artery occlusion. We herein report a case of blunt renal artery occlusion treated with an endovascular stent. After the placement of the stent, renal arteriography showed multiple nonflow-limiting contrast defects in the distal renal arteries, suggesting peripheral thrombosis. Although the duration of warm renal ischemia appears to be the crucial determinant of renal function, multiple thrombi in the distal renal arteries, which would be undetectable during open surgery, could also affect the functional outcome. The presence of these thrombi may explain the limited success of surgical revascularization in such cases.
当肾动脉阻塞是由钝性创伤引起时，开放血管重建后肾功能的恢复率是多变的，远不能令人满意。虽然这种损伤的最佳治疗方法尚未确定，但最近提倡对单侧肾动脉阻塞的患者进行经皮血管内支架置入术。我们在此报告一例用血管内支架治疗的钝性肾动脉阻塞。支架置入后，肾动脉造影显示远端肾动脉多处非血流限制的造影剂缺损，提示周围血栓形成。虽然温热性肾缺血的持续时间似乎是肾功能的关键决定因素，但在开放手术中无法检测到的远端肾动脉内的多个血栓也可能影响功能结果。这些血栓的存在可能解释了在这种情况下手术血管重建的有限成功。
