Fava C, Grosso M, Malara D, Barile C
Radiol Med. 1987 Jul-Aug;74(1-2):18-22.
The possible ways of treating renal artery embolisms are reviewed with an examination of their advantages and defects. Surgical treatment has a fairly high mortality rate but quickly cures any type of vascular occlusion and will cure any concomitant problems such as arterial stenosis. Medical treatment with anticoagulant or thrombolytic drugs offers a lower short term mortality rate and is effective even on narrow blood vessels but the response varies according to the type of thromboembolic damage and the way the drugs are administered. Recently developed forms of radiological treatment are also examined. A personal technique successfully applied to an embolism in a patient with only one functioning kidney is described. It consists of a two-step mechanical and pharmacological attack. First the occluded artery was opened by means of a balloon catheter that was pushed beyond the embolism and withdrawn into the aorta after inflation of the balloon. Thrombolytic drugs (Urokinase) were then infused through the catheter into the bed of the renal artery in order to cure the secondary thrombosis found, as is generally the case, downstream of the embolism. The technique appears ideal for the treatment of patients with embolisms and total involvement of the renal parenchyma, especially when their general condition makes surgery inadvisable.
本文回顾了治疗肾动脉栓塞的可能方法，并对其优缺点进行了分析。手术治疗死亡率较高，但能迅速治愈任何类型的血管闭塞，并可解决诸如动脉狭窄等伴随问题。使用抗凝或溶栓药物进行药物治疗短期死亡率较低，即使对狭窄血管也有效，但治疗效果因血栓栓塞损伤类型和药物给药方式而异。文中还探讨了最近发展起来的放射治疗方法。介绍了一种成功应用于仅有一个功能肾的患者的栓塞治疗的个人技术。该技术包括机械和药物两步治疗。首先，通过将球囊导管推送至栓塞部位远端，球囊充气后再撤回主动脉，从而开通闭塞动脉。然后，通过导管将溶栓药物（尿激酶）注入肾动脉床，以治愈通常在栓塞下游发现的继发性血栓形成。该技术似乎是治疗伴有肾实质完全受累的栓塞患者的理想方法，尤其是当患者的一般状况不适合进行手术时。
