Deininger Susanne, Törzsök Peter, Lusuardi Lukas, Deininger Sebastian Hubertus Markus, Freude Thomas, Wichlas Florian, Deininger Christian
Department of Urology and Andrology, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria.
No Limit Surgery e.V. (NLS), 5020 Salzburg, Austria.
J Clin Med. 2023 Oct 4;12(19):6362. doi: 10.3390/jcm12196362.
To report a series of three patients with traumatic renal AV fistulas after blunt renal laceration.
We retrospectively analyzed the renal trauma cases treated in the Department of Urology of Salzburg University Clinic during a time period of 10 years concerning traumatic AV fistula formation and other clinical parameters.
In total, 3 cases of traumatic AV fistula formation were identified in 106 blunt renal trauma patients (2.8%), with a mean age of 39 (17-56) years. All renal traumas were classified as American Association for the Surgery of Trauma (AAST) grade IV. Two patients were primarily treated with ureteral stent; one was managed conservatively. All AV fistulas were diagnosed after a mean time of 7 (1-13) days. Two patients were symptomatic with gross hematuria, and the mean time between trauma and onset of symptoms was 11 (9-13) days. All cases were managed via coil embolization after a mean of 10 (8-13) days. Two patients received a second intervention after a mean of 18 (11-25) days. The mean AV fistula size was 18.7 (12-24) mm. Mean hemoglobin loss was 3.6 g/dL. One patient received one erythrocyte concentrate. Discharge was after a mean time of 13.3 (7-12) days, with the mean time of intensive care treatment being 2.3 (1-3) days.
Traumatic renal AV fistula is a rare but severe complication associated with higher-grade renal trauma. It can become evident through hematuria or blood loss several days after the initial trauma. The availability of coil embolization in a trauma center can help kidney preservation management.
报告3例钝性肾裂伤后创伤性肾动静脉瘘患者。
我们回顾性分析了萨尔茨堡大学诊所泌尿外科10年间治疗的肾创伤病例，涉及创伤性动静脉瘘形成及其他临床参数。
在106例钝性肾创伤患者中，共发现3例创伤性动静脉瘘形成（2.8%），平均年龄39岁（17 - 56岁）。所有肾创伤均被分类为美国创伤外科学会（AAST）IV级。2例患者最初接受输尿管支架治疗；1例采用保守治疗。所有动静脉瘘在平均7天（1 - 13天）后被诊断出来。2例患者出现肉眼血尿症状，创伤与症状出现之间的平均时间为11天（9 - 13天）。所有病例在平均10天（8 - 13天）后通过弹簧圈栓塞治疗。2例患者在平均18天（11 - 25天）后接受了二次干预。动静脉瘘平均大小为18.7毫米（12 - 24毫米）。平均血红蛋白损失为3.6克/分升。1例患者接受了1单位红细胞浓缩液。平均13.3天（7 - 12天）后出院，重症监护治疗平均时间为2.3天（1 - 3天）。
创伤性肾动静脉瘘是一种与较高级别肾创伤相关的罕见但严重的并发症。它可在初始创伤数天后通过血尿或失血表现出来。创伤中心具备弹簧圈栓塞技术有助于肾脏保留管理。
