移植肾假性动脉瘤的诊断和治疗四例报告

Diagnosis and treatment of transplanted kidney pseudoaneurysm： a report of 4 cases

目的总结移植肾假性动脉瘤的诊治体会。方法首次接受肾移植者4例，其供肾动脉均为单支，肾动脉无损伤，也未行动脉修补成形术。供肾动脉均与受者的髂外动脉行端侧吻合，术中发现受者髂外动脉有粥样斑块或动脉分层者2例。术后4例均未出现移植肾周感染，亦未行移植肾穿刺活检或其他有创检查。依据临床表现、彩色多普勒超声检查、多层螺旋CT血管成像和数字减影血管造影诊断移植肾假性动脉瘤。结果分别在术后1．5个月、2个月、5个月和7个月诊断移植肾假性动脉瘤，其临床表现缺乏特异性，3例经数字减影血管造影、1例经多层螺旋CT血管成像确诊。1例移植肾假性动脉瘤突发破裂，急诊切除假性动脉瘤和移植肾；1例因瘤体短期迅速增大，行带膜支架置入及栓塞术；2例行移植肾动脉瘤切除及动脉裂口修补术。结论移植肾假性动脉瘤是肾移植术后的少见并发症，其临床表现缺乏特异性，多层螺旋CT血管成像和数字减影血管造影有助于本病的诊断。对于移植肾假性动脉瘤的治疗，可选择手术切除或介入栓塞术，关键在于是否保留移植肾，并需考虑移植肾血管重建方式。

Objective To summarize the diagnosis and treatment of transplanted kidney pseudoaneurysm. Methods Four cases received renal transplantation for the first time. Donor＇s renal arteries were all single branch with no damages and arterial repair angioplasty. The end-to-side anastomosis was done between renal arteries and the external iliac artery. External iliac artery in 2 patients had atherosclerosis plaque or arterial stratified. There was no perirenal infection in all 4 cases after renal transplantation, and none of the 4 cases received kidney transplant biopsy or other invasive inspections. Diagnosis of transplant renal pseudoaneurysm was made according to clinical manifestations, color Doppler ultrasonography, multi-slice spiral CT angiography, and digital subtraction angiography. Results Transplanted renal pseudoaneurysm was diagnosed on the postoperative month 1.5, 2. 0, 5.0 and 7. 0. All the patients were lack of typical clinical symptoms, and 3 of them were definitely diagnosed by digital subtraction angiography, and one by multi-slice spiral CT angiography. Renal pseudoaneurysm in one patient was suddenly ruptured, and the pseudoaneurysm and transplanted kidney were resected; The size of pseudoaneurysm was increased rapidly in a short term, and endovascular stent graft and embolization were performed; The rest 2 patients were subjected to artery pseudoaneurysm resection and renal artery repair. Conclusion Transplanted renal pseudoaneurysm is an unusual complication, which is lack of typical clinical symptoms. Multi slice spiral CT angiograpby and digital subtraction angiography contribute to the diagnosis of transplanted renal pseudoaneurysm. To do surgical resection or embolization intervention depends on whether to retain transplanted renal and the transplanted renal artery reconstruction methods.