Rodriguez-Rapale Victor A, Martinez-Trabal Jorge L
1 Vascular Surgery Division, Department of Surgery, St. Luke's Memorial Hospital, Ponce Health Sciences University, Ponce, PR, USA.
Vasc Endovascular Surg. 2019 Jan;53(1):82-85. doi: 10.1177/1538574418798113. Epub 2018 Sep 4.
: Little has been reported regarding endovascular therapy with stent of renal artery hilar aneurysms. To that end, we herein report the outcomes of 3 hilar renal artery aneurysms (RAA) treated with an endovascular technique that makes use of a covered stent and coil embolization in the repair of hilar RAA and deem using this technique is better than traditional open approach with back-table repair and autotransplatation.
: Since November 2014, 3 consecutive patients have been referred to the vascular surgery service for evaluation of a right RAA; these patients' aneurysms were diagnosed with a CT arteriogram prior to evaluation. These patients, typically treated with open surgery, were deemed to be candidates for endovascular repair and were treated as follows: (1) cannulation of the right Common Femoral Artery with a selective arteriogram of the right renal artery, (2) covered stent to dominant hilar artery branch, and (3) coil embolization of the remaining branches/tributaries. Perioperative outcomes and quality measures were analyzed and compared.
: The aneurysms were successfully covered and excluded as confirmed by a completion arteriogram. There were no perioperative morbidities (ie, acute kidney injury, endoleak, etc), and all 3 patients were discharged home the same days of their interventions. At their follow-up visits, the patients were free of symptoms and had normal renal functions as well as Computed tomography angiography (CTA) confirming successfully excluded aneurysms and no endoleaks.
: The technique we used demonstrated excellent outcomes with minimal comorbidities and preservation of renal function. As with many endovascular interventions, our technique compared favorably to traditional open technique in terms of technical feasibility, decreased length of stay, faster recovery, maintaining renal function, and reduced complication rates.
关于肾动脉肾门部动脉瘤的血管内支架治疗的报道较少。为此，我们在此报告3例肾动脉肾门部动脉瘤（RAA）采用血管内技术治疗的结果，该技术在修复肾门部RAA时使用覆膜支架和弹簧圈栓塞，并认为使用该技术优于传统的开放手术方法，即体外修复和自体肾移植。
自2014年11月以来，连续3例患者因右侧RAA评估转诊至血管外科；这些患者的动脉瘤在评估前通过CT血管造影诊断。这些通常接受开放手术治疗的患者被认为是血管内修复的候选者，并按以下方式治疗：（1）经右股总动脉插管并进行右肾动脉选择性血管造影，（2）对主要的肾门动脉分支置入覆膜支架，（3）对其余分支/属支进行弹簧圈栓塞。分析并比较围手术期结果和质量指标。
通过完成血管造影证实动脉瘤成功被覆盖并排除。无围手术期并发症（即急性肾损伤、内漏等），所有3例患者均在干预当天出院。在随访时，患者无症状，肾功能正常，计算机断层扫描血管造影（CTA）证实动脉瘤成功排除且无内漏。
我们使用的技术显示出极佳的效果，合并症最少且肾功能得以保留。与许多血管内干预一样，我们的技术在技术可行性、缩短住院时间、更快恢复、维持肾功能和降低并发症发生率方面优于传统开放技术。
