Moncure A C, Brewster D C, Darling R C, Abbott W M, Cambria R P
General Surgical Services, Massachusetts General Hospital, Boston 02114.
J Vasc Surg. 1988 Aug;8(2):154-9.
Of 15 patients having revascularization of the right renal artery with the use of the hepatic circulation from May 1984 through March 1987 at the Massachusetts General Hospital, eight patients had this accomplished with end-to-end anastomosis of the gastroduodenal artery and right renal artery. Operative indications were acute azotemic renal failure (three patients), poorly controlled renovascular hypertension (four patients), and staged repair of bilateral renal artery disease (one patient). All revascularizations were successful in restoring renal function or rendering hypertension manageable and were assessed by means of renal flow scans, celiac angiography, or return of function in those patients with a solitary, functioning kidney. All patients survived the operation with one late death caused by myocardial infarction after abdominal aortic aneurysm repair. The gastroduodenal artery may be used as the source for arterial inflow in revascularization of the right renal artery by end-to-end anastomosis in approximately 50% of instances, conferring the advantage of the use of only one anastomosis and obviating the long-term possibility of vein graft failure.
1984年5月至1987年3月期间，在马萨诸塞州总医院，15例患者利用肝循环对右肾动脉进行了血管重建，其中8例患者通过胃十二指肠动脉与右肾动脉的端到端吻合完成了血管重建。手术指征包括急性氮质血症性肾衰竭（3例）、难以控制的肾血管性高血压（4例）以及双侧肾动脉疾病的分期修复（1例）。所有血管重建均成功恢复了肾功能或使高血压得到控制，并通过肾血流扫描、腹腔动脉造影或对单肾有功能患者的功能恢复情况进行评估。所有患者术后均存活，1例患者在腹主动脉瘤修复术后因心肌梗死晚期死亡。在大约50%的情况下，胃十二指肠动脉可通过端到端吻合用作右肾动脉血管重建的动脉流入源，具有仅使用一个吻合口的优点，并消除了静脉移植物失败的长期可能性。
