肾移植患者外周血管疾病的治疗

Treatment of peripheral vascular diseases in renal transplant recipients

目的总结肾移植术患者外周血管疾病的治疗方法与临床疗效。方法回顾性分析天津市第一中心医院收治的6例肾移植合并外周血管疾病患者的临床资料。其中1例右髂外动脉假性动脉瘤，l例移植肾-髂内动脉吻合口处假性动脉瘤，均行覆膜支架腔内隔绝术；1例右下肢动脉硬化闭塞症，行右下肢动脉球囊扩张、支架植入术；3例右下肢深静脉血栓形成，均给予抗凝治疗，其中1例髂股静脉血栓，行下腔静脉滤器植入＋导管溶栓。结果2例肾移植合并假性动脉瘤患者术中造影可见假性动脉瘤消失；术后随访9—12个月，彩超示覆膜支架通畅，吻合口处动脉瘤无复发。1例下肢动脉硬化闭塞症患者，术后右下肢间歇性跛行消失，随访10个月，彩超未见支架内再狭窄。3例下肢深静脉血栓形成，其中1例导管接触性溶栓48h后造影可见右髂静脉、股静脉血栓大部分再通；术后血肌酐水平逐步下降，随访14个月，血肌酐维持150μmol／L；余2例下肢深静脉血栓形成分别随访3、6个月，无深静脉血栓复发。结论肾移植合并外周血管疾病患者，应采用个性化治疗，腔内治疗是一种可行的治疗选择。

Objective To investigate the treatment and clinical efficacy of peripheral vascular disease in renal transplant recipients. Methods The clinical data of six renal transplant patients concurrent with peripheral vascular diseases were retrospectively studied. Among the 6 patients, there was 1 case of pseudoaneurysm（PA） in transplanted renal artery-internal iliac artery anastomosis, 1 case of right external iliac artery PA. Endovascular stent-graft exclusion was performed in these 2 cases of PA. 1 case of right lower extremity arteriosclerosis obliterans underwent balloon dilatation and stent placement. 3 cases of right lower extremity deep venous thrombosis （DVT） were given anticoagulant therapy, among those, inferior vena cava filter and catheter-directed thrombolysis was performed in 1 case of iliofemoral vein thrombosis. Results Intraoperative angiography revealed PA cavities disappeared in 2 cases of renal transplant recipients combined PA. 9 - 12 months following-up, by ultrasonic Doppler showed covered stem was open. Intermittent claudication disappeared after interveutional therapy in 1 case of right lower extremity arteriosclerosis obliterans. There was no in-stent restenosis by ultrasonic Doppler during postoperative follow- up of 10 months. Intraoperative angiography after 48 hours＇ catheter-directed thrombolysis showed iliofemoral vein was mostly reopened in 1 case of iliofemoral vein thrombosis. Serum creatinine level gradually declined after interventional therapy. Serum creatinine maintained at 150μmol/L during 14 months. 3 - 6 month follow-up in other 2 cases found no recurrence. Conclusions Renal transplant recipients combined with peripheral vascular diseases should undergo therapy individually. Interventional therapy is a feasible treatment.