Zhang Hongwei, Jia Bangsheng, Zeng Ling, Xiao Zhenghua, Shen Jiayu, Qian Hong, Zhang Eryong, Hu Jia
Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
BMC Surg. 2018 Nov 16;18(1):100. doi: 10.1186/s12893-018-0440-1.
Thoracic endovascular aortic repair (TEVAR) is the therapeutic choice for type B aortic dissection. One of the most unfavored complications of this procedure is hemorrhage, which has a low incidence but high mortality. Renal hemorrhage (RH) after endovascular aortic repair has been rarely reported. We presented two cases of unexpected RH after TEVAR for complicated type B aortic dissection, and the potential causes, diagnosis and therapeutic management were discussed.
A 67-year-old female developed hypotension and progressively decrease of hemoglobin within 5 h after TEVAR for acute complicated type B dissection. Bedside ultrasonography and abdominal computed tomography angiography revealed a massive right perinephric hematoma. The right renal angiography detected multiple tortuous vascular branches with diffuse perinephric bleeding. The main trunk of right renal artery was embolized. The patient recovered uneventfully and presented with normal renal function 6 months later. Another patient was a 69-year-old male who was admitted for endovascular repair of a chronic complicated type B aortic dissection. The patient presented with hemodynamic instability early after TEVAR. Bedside ultrasonography showed a giant left retroperitoneal hematoma. The abdominal angiography revealed two active bleeding sits located in the distal branches of left renal artery. A super-selective embolization of the two arteries was performed, however the patient developed abdominal compartment syndrome and died of multiple organ failure.
Unexpected RH after endovascular repair of aortic dissection might be associated with iatrogenic and idiopathic factors. Close surveillance and clinician's awareness of this rare complication is crucial for accurate and prompt diagnosis. Renal angiography and subsequent selective embolization of bleeding vessels are effective interventions for treating this fatal condition.
胸主动脉腔内修复术（TEVAR）是B型主动脉夹层的治疗选择。该手术最不利的并发症之一是出血，其发生率低但死亡率高。血管腔内主动脉修复术后的肾出血（RH）鲜有报道。我们报告了2例TEVAR治疗复杂B型主动脉夹层后意外发生RH的病例，并讨论了其潜在原因、诊断及治疗处理方法。
一名67岁女性在接受TEVAR治疗急性复杂B型夹层后5小时内出现低血压，血红蛋白逐渐下降。床旁超声和腹部计算机断层血管造影显示右侧肾周巨大血肿。右侧肾动脉造影发现多个迂曲的血管分支伴弥漫性肾周出血。对右侧肾动脉主干进行了栓塞。患者恢复顺利，6个月后肾功能正常。另一例患者是一名69岁男性，因慢性复杂B型主动脉夹层接受血管腔内修复术入院。该患者在TEVAR术后早期出现血流动力学不稳定。床旁超声显示左侧巨大腹膜后血肿。腹部血管造影显示左侧肾动脉远端分支有两处活动性出血部位。对这两条动脉进行了超选择性栓塞，但患者出现腹腔间隔室综合征，死于多器官功能衰竭。
主动脉夹层血管腔内修复术后意外发生的RH可能与医源性和特发性因素有关。密切监测以及临床医生对这种罕见并发症的认识对于准确及时的诊断至关重要。肾动脉造影及随后对出血血管的选择性栓塞是治疗这种致命疾病的有效干预措施。
