Schneider J R, Cronenwett J L
Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
J Vasc Surg. 1993 Mar;17(3):613-7.
A patient with a large abdominal aortic aneurysm was noted to have a congenital pelvic kidney. The patient also had bilateral iliac aneurysms that required repair. The blood supply of the congenital pelvic kidney was not apparent from preoperative studies but was found at the time of surgery to be from the area of the aortic bifurcation. Pelvic renal ischemia was limited by a "double proximal clamping" technique and by placement of a temporary shunt from the body of the aortic graft into the pelvic renal artery during completion of two distal anastomoses. The patient's renal function remained normal during the perioperative period, and the reconstruction was demonstrated to be patent more than one year after surgery. Although simple clamping and expeditious reconstruction are appropriate in most cases of aortic surgery in the presence of congenital or transplant pelvic kidney, more complex anatomy, including iliac aneurysms, may require longer periods of ischemia. Pelvic renal ischemia may be limited with the technique described.
一名患有巨大腹主动脉瘤的患者被发现有先天性盆腔肾。该患者还患有双侧髂动脉瘤，需要进行修复。术前检查未明确先天性盆腔肾的血供情况，但在手术时发现其血供来自主动脉分叉区域。通过“双近端钳夹”技术以及在完成两个远端吻合期间从主动脉移植物主体向盆腔肾动脉放置临时分流管，限制了盆腔肾缺血。患者围手术期肾功能保持正常，术后一年多重建血管显示通畅。虽然在大多数存在先天性或移植盆腔肾的主动脉手术病例中，简单钳夹和快速重建是合适的，但包括髂动脉瘤在内的更复杂解剖结构可能需要更长的缺血时间。采用所述技术可限制盆腔肾缺血。
