Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.
J Vasc Surg. 2018 Aug;68(2):451-458.e2. doi: 10.1016/j.jvs.2017.12.032. Epub 2018 Mar 12.
Coil embolization is one of the most common endovascular approaches to treatment of renal artery aneurysms (RAAs). The purpose of this retrospective study was to compare complications, mortality, and morbidity associated with sac packing, coil trapping, and inflow occlusion.
The records of all patients with RAAs treated with coil embolization at our center from June 2003 to May 2017 were retrospectively reviewed. Demographics of the patients, aneurysm characteristics, management strategies, perioperative and long-term outcomes, and complications were analyzed.
A total of 52 patient records were reviewed; 28 patients received sac packing and 24 patients underwent coil trapping/inflow occlusion. There was no significant difference in patients' demographics or RAA characteristics between the groups. The mean aneurysm diameter was 25.6 ± 8.4 mm in the sac packing group and 31.1 ± 16.8 mm in the coil trapping/inflow occlusion group (P = .130). Most aneurysms in the sac packing group originated from the main renal artery bifurcation (67.9%), whereas in the coil trapping/inflow occlusion group, most aneurysms originated from the renal segmental branch arteries (54.2%). The immediate technical success rate was 100%, and the in-hospital mortality rate was 0% in both groups. Sac packing was more likely to be associated with endoleak immediately after the procedure (28.6% vs 8.3%; P = .065). The overall perioperative complication rate was not statistically different between the groups (7.1% vs 16.7%; P = .284). The mean duration of follow-up was 37.67 ± 29.84 months and 49.35 ± 28.11 months in the sac packing and coil trapping/inflow occlusion groups, respectively (P = .192). No deaths related to RAAs or aneurysm rupture occurred in either group. The overall morbidity rate was similar between groups (12.5% vs 25%; P = .284). Partial renal infarction occurred in two and five patients in the sac packing and coil trapping/inflow occlusion groups, respectively (8.3% vs 25%; P = .132). Impaired renal function was more frequent after coil trapping/inflow occlusion (0% vs 15%; P = .049). A single patient in the sac packing group required further intervention for reperfusion of the aneurysmal sac at 4 months (4.2% vs 0%; P = .356).
Sac packing might be a safe and effective way to treat RAAs located at the main bifurcation or in branch arteries and may be preferable to coil trapping/inflow occlusion, considering the potential loss of functional renal mass.
血管内线圈栓塞术是治疗肾动脉动脉瘤（RAAs）最常用的方法之一。本回顾性研究的目的是比较单纯囊袋填塞、线圈栓塞和血流阻断相关的并发症、死亡率和发病率。
对 2003 年 6 月至 2017 年 5 月在我院接受线圈栓塞治疗的所有 RAA 患者的病历进行回顾性分析。分析患者的人口统计学特征、动脉瘤特征、治疗策略、围手术期和长期结局以及并发症。
共回顾了 52 例患者的记录；28 例患者接受了囊袋填塞，24 例患者接受了线圈栓塞/血流阻断。两组患者的人口统计学特征或 RAA 特征无显著差异。囊袋填塞组的平均动脉瘤直径为 25.6±8.4mm，线圈栓塞/血流阻断组为 31.1±16.8mm（P=0.130）。囊袋填塞组的大多数动脉瘤起源于主肾动脉分叉处（67.9%），而线圈栓塞/血流阻断组的大多数动脉瘤起源于肾段动脉分支（54.2%）。即刻技术成功率均为 100%，两组患者的院内死亡率均为 0%。囊袋填塞后即刻更易发生内漏（28.6% vs 8.3%；P=0.065）。两组围手术期并发症总发生率无统计学差异（7.1% vs 16.7%；P=0.284）。囊袋填塞组的平均随访时间为 37.67±29.84 个月，线圈栓塞/血流阻断组为 49.35±28.11 个月（P=0.192）。两组均无与 RAA 或动脉瘤破裂相关的死亡病例。两组总发病率相似（12.5% vs 25%；P=0.284）。囊袋填塞组有 2 例和 5 例患者发生部分肾梗死（8.3% vs 25%；P=0.132）。线圈栓塞/血流阻断后肾功能不全更常见（0% vs 15%；P=0.049）。囊袋填塞组 1 例患者在 4 个月时因动脉瘤囊再通需要进一步介入治疗（4.2% vs 0%；P=0.356）。
对于位于主分叉或分支动脉的 RAA，单纯囊袋填塞可能是一种安全有效的治疗方法，考虑到功能性肾单位的潜在损失，可能优于线圈栓塞/血流阻断。
