Department of Vascular and Endovascular Surgery, 37896Hospital Israelita Albert Einstein, São Paulo, Brazil.
67796Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
Vasc Endovascular Surg. 2022 Nov;56(8):812-816. doi: 10.1177/15385744221120975. Epub 2022 Aug 11.
Although rare, as the population ages, abdominal aortic aneurysm synchronous to abdominal malignancies, as renal cell carcinoma, is expected to become more prevalent. There are only two case reports of minimally invasive surgeries to treat these synchronous diseases, with endovascular aortic repair and laparoscopic nephrectomy, but they were performed in two stages, with iodinated contrast and without robotic assistance.
We herein present a case of a 71-year-old patient with chronic kidney disease, a 6.4 cm infra-renal abdominal aortic aneurysm associated and a suspicious 6 cm solid-cystic expansile lesion in the right kidney, successfully treated at one stage with endovascular aortic repair using carbon dioxide as a contrast medium and with robotic right partial nephrectomy, aiming to preserve the renal function as much as possible. The patient's postoperative course was free of complications with hospital discharge on the fifth postoperative day, with a serum creatinine of 0.84 mg/dL.
single-stage minimally invasive surgical treatment of AAA and RCC can be a safe and feasible approach. Combining a robot-assisted laparoscopic partial nephrectomy with an EVAR using carbon dioxide as a contrast medium was safe and successfully preserved renal function.
随着人口老龄化，虽然罕见，但腹主动脉瘤与腹部恶性肿瘤（如肾细胞癌）同时发生的情况预计会更为常见。仅有两例关于微创治疗这些同时性疾病的病例报告，即血管内主动脉修复术和腹腔镜肾切除术，但它们是分两阶段进行的，使用了碘造影剂且没有机器人辅助。
我们在此介绍一例 71 岁慢性肾脏病患者，其存在 6.4 厘米的肾下型腹主动脉瘤，并在右肾上极发现一个 6 厘米的实性囊性膨胀性病变，成功地进行了一期治疗，采用二氧化碳作为对比剂的血管内主动脉修复术，并进行机器人辅助右部分肾切除术，以尽可能保留肾功能。患者术后无并发症，术后第 5 天出院，血清肌酐为 0.84 毫克/分升。
腹主动脉瘤和肾细胞癌的一期微创外科治疗可能是一种安全可行的方法。将机器人辅助腹腔镜肾部分切除术与二氧化碳作为对比剂的 EVAR 相结合是安全的，并且成功地保留了肾功能。
