Tayal Mohit, Nandolia Khanak K, Sharma Pankaj, Mittal Ankur, Chauhan Udit
Radiodiagnosis, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND.
Urology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND.
Cureus. 2022 Dec 31;14(12):e33166. doi: 10.7759/cureus.33166. eCollection 2022 Dec.
Purpose To evaluate the safety and efficacy of N-butyl-2-cyano-acrylate (NBCA) for endovascular management of iatrogenic renal-vascular injuries and effects on renal function. Material & Methods Fifteen patients with diagnosed or suspected iatrogenic renal vascular injuries, following percutaneous procedures formed the study group. All the patients were having retroperitoneal hemorrhage or hematuria, with hemodynamic instability at the time of presentation. Pseudoaneurysms, active extravasation of contrast, and the arteriovenous fistula were identified as the cause of bleeding on digital subtraction angiography. Patients underwent trans arterial super-selective embolization. Renal function was monitored using serum creatinine, estimated glomerular filtration rate (eGFR), and mean blood pressure of all the patients at immediate post-procedure and two months intervals. Results Technical and clinical success was achieved in all the cases using NBCA alone. Patients improved hemodynamically. None of the patients required repeat embolization. No derangement in renal function was observed immediately after the procedure and at interval follow-up. Conclusion NBCA can be used as a safe embolizing agent to provide a quick and effective cure for iatrogenic renovascular injuries. Renal parenchymal loss can be minimized by super selective technique.
目的 评估正丁基-2-氰基丙烯酸酯（NBCA）用于医源性肾血管损伤血管内治疗的安全性和有效性以及对肾功能的影响。材料与方法 15例经皮操作后诊断或疑似医源性肾血管损伤的患者组成研究组。所有患者均有腹膜后出血或血尿，就诊时存在血流动力学不稳定。数字减影血管造影显示假性动脉瘤、造影剂活动性外渗和动静脉瘘为出血原因。患者接受经动脉超选择性栓塞治疗。使用血清肌酐、估计肾小球滤过率（eGFR）以及所有患者术后即刻和每隔两个月的平均血压监测肾功能。结果 所有病例单独使用NBCA均取得技术和临床成功。患者血流动力学得到改善。无一例患者需要重复栓塞。术后即刻及随访期间均未观察到肾功能紊乱。结论 NBCA可作为一种安全的栓塞剂，为医源性肾血管损伤提供快速有效的治疗。通过超选择性技术可将肾实质损失降至最低。
