Baptista-Silva J C, de Figueiredo L F, Castro M J, Veríssimo M J, Camara A L
Hospital: Beneficência Portuguesa, Universidade Federal de São Paulo, Brazil.
Sao Paulo Med J. 1997 May-Jun;115(3):1444-7. doi: 10.1590/s1516-31801997000300008.
The development of the postnephrectomy arteriovenous fistula (PNAVF) between the renal vessels stumps is rare. Here we present a case report of PNAVF, and review the diagnosis, treatment and prevention. The most common clinical features include a loud murmur over the previous nephrectomy scar, and heart failure resistant to common medical treatment. A 58-year-old white woman was admitted to the hospital for a complete evaluation of an unexplained congestive heart failure with no response to common medical treatment. She had had a right nephrectomy for pyonephrosis 13 years before. The diagnosis of PNAVF was suspected because over the right lumbar region a definite trill was palpated, and on auscultation a harsh, machinery-like murmur was heard. The diagnosis was confirmed by aortogram and selective renal arteriography. In May 1989, the right arteriovenous was excised through a right subcostal transperitoneal approach. The renal vessel stumps were individually ligated and sutured separately close to aorta and vena cava. The patient's postoperative course was entirely uneventful in the following seven years. We conclude that during nephrectomy, the renal vessels should be ligated separately, and the transfixation in mass of the stumps avoided to prevent arteriovenous fistula.
肾切除术后肾血管残端之间动静脉瘘（PNAVF）的形成较为罕见。本文报告一例PNAVF病例，并对其诊断、治疗及预防进行综述。最常见的临床特征包括在既往肾切除瘢痕处可闻及响亮杂音，以及对常规药物治疗耐药的心力衰竭。一名58岁白人女性因不明原因的充血性心力衰竭入院，对常规药物治疗无反应，进行全面评估。她13年前因肾积脓接受了右肾切除术。因在右腰区可触及明确震颤，听诊闻及粗糙的机器样杂音，怀疑为PNAVF。主动脉造影和选择性肾动脉造影确诊。1989年5月，经右肋下经腹途径切除右动静脉。肾血管残端分别结扎并在靠近主动脉和腔静脉处分别缝合。患者术后七年病程完全平稳。我们得出结论，肾切除术中，肾血管应分别结扎，避免残端整块贯穿缝合以预防动静脉瘘。
