Guo Hongjie, Wang Chengen, Yang Min, Tong Xiaoqiang, Wang Jian, Guan Haitao, Song Li, Zou Yinghua
Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China.
Medicine (Baltimore). 2017 Oct;96(40):e8187. doi: 10.1097/MD.0000000000008187.
The purpose of this study was to evaluate the efficacy and safety of transarterial embolization (TAE) for iatrogenic renal arterial pseudoaneurysm and arteriovenous fistula at our center.Our retrospective analysis included 27 patients who received TAE for iatrogenic renal arterial pseudoaneurysm and arteriovenous fistula between January 2006 and January 2016. Data on demographics, type of minimally invasive renal procedures, clinical manifestation, imaging features, embolization procedure, and perioperative details were collected. The technical and clinical success rates were analyzed. Furthermore, the changes in serum creatinine and eGFR before and after embolization were recorded and compared by t test.The median time between iatrogenic renal injury and TAE was 3 days (range, 0-110 days), with most patients (24/27, 88.9%) receiving TAE within 14 days. Only 1 patient was diagnosed with renal artery pseudoaneurysm 110 days after laproscopic partial nephrectomy. The technical and clinical success rates were 100% and 96.3%, respectively, with 1 patient requiring a second embolotherapy at the third postoperative day. No other patient required additional endovascular or surgical intervention due to recurrent hemorrhage. The mean serum creatinine before TAE was 92.8 ± 25.3 μmol/L and after TAE, 96.1 ± 27.7 μmol/L (P = .095). The eGFR of pre- and postembolization was 75.2 ± 26.5 mL/min/1.73 m and 72.5 ± 26.2 mL/min/1.73 m (P = .16). No severe complications were observed during follow-up.This retrospective review demonstrated that TAE for the treatment of iatrogenic renal artery pseudoaneurysm and/or arteriovenous fistula was safe and associated with high technical and clinical success rate.
本研究的目的是评估在我们中心经动脉栓塞术（TAE）治疗医源性肾动脉假性动脉瘤和动静脉瘘的疗效及安全性。我们的回顾性分析纳入了2006年1月至2016年1月期间接受TAE治疗医源性肾动脉假性动脉瘤和动静脉瘘的27例患者。收集了人口统计学数据、微创肾脏手术类型、临床表现、影像学特征、栓塞过程及围手术期细节。分析了技术成功率和临床成功率。此外，记录栓塞前后血清肌酐和估算肾小球滤过率（eGFR）的变化，并通过t检验进行比较。医源性肾损伤与TAE之间的中位时间为3天（范围0 - 110天），大多数患者（24/27，88.9%）在14天内接受了TAE。仅1例患者在腹腔镜部分肾切除术后110天被诊断为肾动脉假性动脉瘤。技术成功率和临床成功率分别为100%和96.3%，1例患者在术后第3天需要进行第二次栓塞治疗。没有其他患者因复发出血而需要额外的血管内或手术干预。TAE前平均血清肌酐为92.8±25.3μmol/L，TAE后为96.1±27.7μmol/L（P = 0.095）。栓塞前后的eGFR分别为75.2±26.5mL/min/1.73m²和72.5±26.2mL/min/1.73m²（P = 0.16）。随访期间未观察到严重并发症。这项回顾性研究表明，TAE治疗医源性肾动脉假性动脉瘤和/或动静脉瘘是安全的，且技术成功率和临床成功率高。
