Jahangiri Younes, Ashwell Zachary, Farsad Khashayar
Department of Interventional Radiology, Charles T. Dotter Institute, Oregon Health and Science University, Portland, Oregon, USA.
Diagn Interv Radiol. 2017 Sep-Oct;23(5):371-378. doi: 10.5152/dir.2017.16415.
We aimed to identify factors related to technical and clinical success of percutaneous revascularization for blunt renal arterial trauma.
All cases of percutaneous revascularization for blunt renal arterial trauma were searched in the available literature. We included a case of iatrogenic renal artery occlusion at our institution treated by percutaneous stenting 20 hours after injury. A pooled cohort analysis of percutaneous revascularization for blunt renal artery injury was then performed to analyze factors related to technical and clinical success. Clinical failure was defined as development of new hypertension, serum creatinine rise, or significant asymmetry in split renal function.
A total of 53 cases have been reported, and 54 cases were analyzed including our case. Median follow-up was 6 months. Technical success was 88.9% and clinical success was 75%. Of 12 treatment failures (25%), 66.7% occurred during the first postprocedure month. Time from injury to revascularization was not a predictor of clinical success (OR=1.00, P = 0.681). Renal artery occlusion was significantly associated with clinical failure (OR=7.50, P = 0.017) and postintervention antiplatelet therapy was significantly associated with treatment success (OR=0.16, P = 0.043). At 37-month follow-up, the stented renal artery in our case remained patent and the patient was normotensive with preserved glomerular filtration rate.
Percutaneous revascularization for blunt renal arterial injury resulted in relatively high technical and clinical success. Time-to-revascularization was independent of successful outcomes. Clinical success was significantly associated with a patent renal artery at the time of intervention and with postprocedure antiplatelet therapy.
我们旨在确定与钝性肾动脉创伤经皮血管重建术的技术和临床成功相关的因素。
在现有文献中检索所有钝性肾动脉创伤经皮血管重建术的病例。我们纳入了本院1例医源性肾动脉闭塞患者，其在受伤20小时后接受了经皮支架置入治疗。然后对钝性肾动脉损伤经皮血管重建术进行汇总队列分析，以分析与技术和临床成功相关的因素。临床失败定义为新发高血压、血清肌酐升高或分肾功能显著不对称。
共报告了53例病例，包括我们的病例在内共分析了54例。中位随访时间为6个月。技术成功率为88.9%，临床成功率为75%。在12例治疗失败病例（25%）中，66.7%发生在术后第一个月内。受伤至血管重建的时间不是临床成功的预测因素（OR=1.00，P = 0.681）。肾动脉闭塞与临床失败显著相关（OR=7.50，P = 0.017），干预后抗血小板治疗与治疗成功显著相关（OR=0.16，P = 0.043）。在37个月的随访中，我们病例中的支架置入肾动脉保持通畅，患者血压正常，肾小球滤过率保留。
钝性肾动脉损伤经皮血管重建术取得了相对较高的技术和临床成功率。血管重建时间与成功结果无关。临床成功与干预时肾动脉通畅以及术后抗血小板治疗显著相关。
