Fanai Vanlalmalsawmdawngliana, Mishra Animesh, Ete Tony, Malviya Amit, Kumar Arun
Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND.
Cureus. 2022 Mar 21;14(3):e23350. doi: 10.7759/cureus.23350. eCollection 2022 Mar.
Fibromuscular dysplasia (FMD) is a potentially treatable cause of renovascular hypertension and it typically affects young females. FMD usually involves distal two-thirds of the renal artery and percutaneous transluminal renal angioplasty (PTRA) is the treatment of choice for FMD with resistant hypertension. PTRA is a safe procedure with minimal complications. However, renal subcapsular hematoma due to reperfusion injury is a rare complication following PTRA. A 32-year-old male presented with resistant hypertension. Arteriography of renal arteries showed >90% stenosis of ostial-proximal left renal artery with a string of beads appearance. PTRA was performed with the deployment of a 4 x 10 mm balloon-expandable stent in the stenotic segment of the left renal artery. However, computed tomography of the abdomen revealed massive left perinephric subcapsular hematoma without peritoneal collection. As the patient was hemodynamically stable, no invasive intervention was done, and discharged without requiring any anti-hypertensive medication. Putative reperfusion injury may provoke bleeding complications after renal angioplasty in a case of long-standing renal artery stenosis and can be managed conservatively with close surveillance in certain cases.
纤维肌性发育不良（FMD）是肾血管性高血压的一个潜在可治疗病因，通常影响年轻女性。FMD通常累及肾动脉的远端三分之二，经皮腔内肾血管成形术（PTRA）是治疗伴有顽固性高血压的FMD的首选方法。PTRA是一种安全的手术，并发症极少。然而，再灌注损伤导致的肾包膜下血肿是PTRA术后一种罕见的并发症。一名32岁男性因顽固性高血压就诊。肾动脉造影显示左肾动脉开口近端狭窄>90%，呈串珠样表现。在左肾动脉狭窄段置入一枚4×10mm球囊扩张支架进行PTRA。然而，腹部计算机断层扫描显示左肾周大量包膜下血肿，无腹腔积液。由于患者血流动力学稳定，未进行有创干预，出院时无需任何抗高血压药物。在长期肾动脉狭窄的情况下，假定的再灌注损伤可能会在肾血管成形术后引发出血并发症，在某些情况下可通过密切监测进行保守处理。
