覆膜支架植入术治疗肾动脉及肾移植术后假性动脉瘤

Endovascular covered stenting for the treatment of renal pseudoaneurysm after renal transplantation

目的探讨多种原因所致肾动脉假性动脉瘤的血管内覆膜支架治疗术。方法 2008年8月至2012年9月收治6例肾动脉损伤及肾移植术后假性动脉瘤患者,因不适宜常规介入栓塞而采用血管内覆膜支架治疗。其中外伤1例,医源性损伤1例,肾移植术后并发假性动脉瘤4例。术中支架植入时开始给予抗血小板聚集药,术后给予3 d抗凝治疗并同时口服氯吡格雷、阿司匹林半年,之后持续口服阿司匹林。结果 6例中,2例出血患者术后出血停止且患肾血流灌注保持良好,4例假性动脉瘤获完全隔绝。随访2～34个月,平均19个月。其中2例移植肾动脉吻合口假性动脉瘤行髂内动脉覆膜支架植入术后移植肾失功能,1例术后出现感染,又行移植肾切除术,余均取得满意效果,无症状复发、瘘及狭窄。结论对于不适合常规介入栓塞的肾动脉及肾移植术后假性动脉瘤患者,覆膜支架植入不失为一种可选择的、有效治疗方法,但远期疗效尤其是支架内再狭窄情况有待进一步观察。

Objective To discuss the endovascular covered stenting for the treatment of renal pseudoaneurysms due to a variety of causes. Methods During the period from August 2008 to September 2012, six patients with renal pseudoaneurysm caused by renal artery injury or renal transplantation were admitted to the hospital. As the patients were not suitable for conventional embolization therapy, endovascular implantation of covered stent was carried out. The cause of pseudoaneurysm included trauma （n = 1）, iatrogenic injury （n = 1 ） and renal transplantation （n = 4）. During stent implantation procedure, anti-platelet aggregation medication was given, and after the procedure anticoagulation therapy was used for 3 days, and oral administration of plavix and aspirin was conducted for half a year, which was followed by continuous oral administration of aspirin. Results In 2 patients the bleeding stopped after the endovascular implantation of covered stent and the renal blood perfusion was well maintained, and in the remaining four patients the pseudoaneurysm was completely isolated. During the following-up period lasting 2 - 34 months （mean 19 months）, loss of renal function was seen in two patients, who had suffered from pseudoaneurysm at transplanted renal artery anastomotic stoma and had received covered stent implantation of internal iliac artery. One patient developed infection of unknown cause, and removal of transplanted kidney had to be performed. Excellent results were achieved in the remaining patients. No recurrence of symptoms, fistula or artery stenosis occurred. Conclusion For renal pseudoaneurysm patiefits who are not suitable for conventional renal artery embolization therapy, endovascular implantation of covered stent may after all be accepted as an effective and proper treatment although its long-term efficacy needs to be further evaluated.