Kimura Yasushi, Osuga Keigo, Ono Yusuke, Nakazawa Tetsuro, Higashihara Hiroki, Tomiyama Noriyuki
Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
J Vasc Interv Radiol. 2018 Jul;29(7):952-957. doi: 10.1016/j.jvir.2018.01.763. Epub 2018 Apr 6.
To retrospectively evaluate the role of selective renal artery embolization for renal arteriovenous fistulae (AVFs) with dilated venous sac.
Between 2002 and 2015, 14 patients (7 men and 7 women; mean age, 60 years) with a single renal AVF with dilated venous sac underwent selective renal artery embolization. Three patients presented with gross hematuria, 4 presented with occult blood in urine, and 1 presented with chronic heart failure. Five patients had a history of renal biopsy or partial nephrectomy. Embolic agents used included pushable fibered coils, detachable microcoils, hydrogel coils, N-butyl 2-cyanoactylate, and/or absolute ethanol. Technical success was defined as complete angiographic occlusion of the renal AVF without visualization of the venous sac. Clinical success was defined as the disappearance of the AVF on ultrasound and contrast-enhanced computed tomography, without any symptoms.
Fifteen sessions of selective renal artery embolization were performed. Technical success was achieved in 13 sessions (86.7%). Clinical success was achieved in 13 patients (92.9%) after a mean follow-up of 48 months (range, 6-155 months). Two major complications occurred-renal vein thrombosis (n = 1) and renovascular hypertension (n = 1)-and were successfully managed with warfarin and an angiotensin-II receptor blocker, respectively. The former patient required re-embolization because of recanalization. No significant changes were observed in the mean serum creatinine level (.86 mg/dL vs .85 mg/dL; P = .67) and the mean estimated glomerular filtration rate (66.0 mL/min/1.73m vs 67.4 mL/min/1.73m; P = .4) after 6 months.
Selective renal artery embolization is a safe and effective treatment for renal AVFs with dilated venous sac.
回顾性评估选择性肾动脉栓塞术对伴有扩张性静脉囊的肾动静脉瘘（AVF）的作用。
2002年至2015年间，14例（7例男性和7例女性；平均年龄60岁）患有单个伴有扩张性静脉囊的肾AVF患者接受了选择性肾动脉栓塞术。3例出现肉眼血尿，4例出现尿潜血，1例出现慢性心力衰竭。5例有肾活检或部分肾切除术病史。使用的栓塞剂包括可推送纤维圈、可脱性微圈、水凝胶圈、N-丁基-2-氰基丙烯酸酯和/或无水乙醇。技术成功定义为肾AVF在血管造影上完全闭塞，静脉囊不可见。临床成功定义为超声和增强计算机断层扫描上AVF消失，且无任何症状。
进行了15次选择性肾动脉栓塞术。13次（86.7%）实现了技术成功。平均随访48个月（范围6 - 155个月）后，13例患者（92.9%）获得临床成功。发生了2例主要并发症——肾静脉血栓形成（n = 1）和肾血管性高血压（n = 1），分别通过华法林和血管紧张素II受体阻滞剂成功处理。前1例患者因再通需要再次栓塞。6个月后，平均血清肌酐水平（0.86 mg/dL对0.85 mg/dL；P = 0.67）和平均估计肾小球滤过率（66.0 mL/min/1.73m对67.4 mL/min/1.73m；P = 0.4）未观察到显著变化。
选择性肾动脉栓塞术是治疗伴有扩张性静脉囊的肾AVF的一种安全有效的方法。
