Nishie Ryosuke, Toya Naoki, Fukushima Soichiro, Ito Eisaku, Murakami Yuri, Akiba Tadashi, Ohki Takao
Division of Vascular Surgery, The Jikei University Kashiwa Hospital, Kashiwa, Japan.
Department of Surgery, Division of Vascular Surgery, Jikei University Kashiwa Hospital, 163-1, Kashiwa-shita, Kashiwa, Chiba, 277-8567, Japan.
Surg Case Rep. 2017 Dec;3(1):58. doi: 10.1186/s40792-017-0334-y. Epub 2017 Apr 27.
Prior reports indicate that intentional coverage of the accessory renal arteries (ARAs) with a diameter larger than 3 mm during endovascular aneurysm repair (EVAR) increases risk of additional treatment for type II endoleak. Here, we report a case of prophylactic coil embolization for a 4 mm ARA originating from an abdominal aortic aneurysm.
A 76-year-old woman was admitted to our hospital after noticing an abdominal pulsatile mass. Computed tomography (CT) imaging revealed an abdominal aortic aneurysm (AAA) with a maximum diameter of 53 mm. Preoperative CT scan showed a right ARA, 4 mm in diameter, which was considered likely to lead to type II endoleak following EVAR. ARA coil embolization was performed at the time of EVAR. We observed no endoleaks and no infarct of the inferior pole of the right kidney on completion angiography. The postoperative course was uneventful, and the patient was discharged 7 days later. Postoperative eGFR (58.4 ml/min) was not significantly different from preoperative level (56.7 ml/min). After EVAR, blood pressure was under control, and no additional anti-hypertensive medicines were required. Postoperative enhanced CT image showed that the distal portion of the ARA was well perfused without type II endoleak from ARA.
Prophylactic coil embolization for a large ARA originating from an abdominal aortic aneurysm appears to be safe and effective in preventing type II endoleak following EVAR.
先前的报告表明，在血管内动脉瘤修复术（EVAR）期间有意覆盖直径大于3毫米的副肾动脉（ARA）会增加II型内漏额外治疗的风险。在此，我们报告一例对起源于腹主动脉瘤的4毫米ARA进行预防性弹簧圈栓塞的病例。
一名76岁女性在发现腹部搏动性肿块后入住我院。计算机断层扫描（CT）成像显示一个最大直径为53毫米的腹主动脉瘤（AAA）。术前CT扫描显示一条直径4毫米的右侧ARA，被认为在EVAR术后可能导致II型内漏。在EVAR手术时进行了ARA弹簧圈栓塞。在完成血管造影时，我们未观察到内漏，也未发现右肾下极梗死。术后过程顺利，患者在7天后出院。术后估算肾小球滤过率（eGFR）（58.4毫升/分钟）与术前水平（56.7毫升/分钟）无显著差异。EVAR术后，血压得到控制，无需额外的抗高血压药物。术后增强CT图像显示ARA远端灌注良好，无ARA导致的II型内漏。
对起源于腹主动脉瘤的大型ARA进行预防性弹簧圈栓塞在预防EVAR术后II型内漏方面似乎是安全有效的。
