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孤立肾患者肾动脉动脉瘤的血运重建:病例报告

revascularization of renal artery aneurysms in a patient with solitary kidney: A case report.

作者信息

Chen Xi-Yang, Zhao Ji-Chun, Huang Bin, Yuan Ding, Yang Yi

机构信息

Department of Vascular Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.

出版信息

World J Clin Cases. 2019 Aug 26;7(16):2401-2405. doi: 10.12998/wjcc.v7.i16.2401.

Abstract

BACKGROUND

Multiple renal artery aneurysms (RAAs) involving multiple branches in a solitary kidney are rare and present a major challenge to surgeons. or repair combined with renal artery revascularization is the classical procedure for these complicated cases, which are not suitable for endovascular repair. The choice of bypass graft remains controversial because of the risk of aneurysmal degeneration for autologous graft.

CASE SUMMARY

A 39-year-old female patient presented with left lumbar pain for more than 3 mo. Computed tomography angiography showed congenital absence of the right kidney and three left RAAs involving multiple distal branches. This patient met the criteria for surgical repair due to symptoms of threatened rupture. According to the anatomy and location of multiple RAAs, revascularization with saphenous vein graft (SVG) was performed. At the 3-year follow-up, computed tomography angiography demonstrated the aneurysmal degeneration of the Y-shaped SVG. The patient remained asymptomatic and follow-up ultrasound showed no continuous growth of SVG aneurysm.

CONCLUSION

SVG aneurysm in RAA revascularization causes us to reflect on the choice of graft, especially for solitary kidney patients.

摘要

背景

孤立肾中累及多个分支的多发性肾动脉动脉瘤(RAA)较为罕见,给外科医生带来了重大挑战。开放修复联合肾动脉血运重建是治疗这些复杂病例的经典方法,这些病例不适合血管腔内修复。由于自体移植物存在动脉瘤样退变的风险,旁路移植物的选择仍存在争议。

病例摘要

一名39岁女性患者出现左腰疼痛3个多月。计算机断层扫描血管造影显示右肾先天性缺如,左肾有三个RAA累及多个远端分支。由于有破裂风险的症状,该患者符合手术修复标准。根据多个RAA的解剖结构和位置,采用大隐静脉移植物(SVG)进行血运重建。在3年随访时,计算机断层扫描血管造影显示Y形SVG发生了动脉瘤样退变。患者仍无症状,随访超声显示SVG动脉瘤无持续生长。

结论

RAA血运重建中的SVG动脉瘤促使我们反思移植物的选择,特别是对于孤立肾患者。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2ab9/6718801/e775be2e6673/WJCC-7-2401-g001.jpg

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