肾动静脉瘘的腔内治疗
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摘要
目的评估腔内治疗肾动静脉瘘(RAVF)的安全性及有效性。方法回顾性分析13例接受腔内治疗的RAVF患者资料。结果对13例RAVF患者行腔内治疗的技术成功率为100%(13/13),栓塞病变动脉共23条,治疗应用弹簧圈共78个。腔内治疗对RAVF患者血尿的有效率为100%(11/11),腰部疼痛有效率为85.71%(6/7),高血压有效率为100%(3/3)。RAVF患者术前血肌酐平均值[(94.50±29.82)μmol/L]与术后血肌酐平均值[(94.25±28.85)μmol/L]差异无统计学意义(P>0.05)。术后无严重并发症,仅3例出现低热,2例患侧腰部不适。术后平均随访(37.23±16.78)个月。2例失访,余11例患者均无复发症状。结论腔内治疗对RAVF患者安全、有效且并发症较少。
Objective To evaluate the safety and efficacy of endovascular treatment for renal arteriovenous fistula(RAVF).Methods Data of 13 patients with RAVF were analyzed retrospectively.All the patients underwent angiography and endovascular treatment.Results The technical success rate of endovascular treatment was 100%(13/13).A total of23 arteries received selective arterial embolization with 78 coils.After treatment,the clinical symptom remission rate of hematuria,back pain and hypertension was 100%(11/11),85.71%(6/7)and 100%(3/3),respectively.There was no statistical difference of serum creatinine before([94.50±29.82]μmol/L)and after treatment([94.25±28.85]μmol/L,P>0.05).No serious complication was found.There were only 3cases of low fever and 2cases complained of lower back pain postoperatively.The mean follow-up time was(37.23±16.78)months.And 2cases were lost follow up,while the rest of11 cases had no recurrence of symptoms.Conclusion As the safe and effective procedure,endovascular treatment can be used for the treatment of RAVF.
Objective To evaluate the safety and efficacy of endovascular treatment for renal arteriovenous fistula(RAVF).Methods Data of 13 patients with RAVF were analyzed retrospectively.All the patients underwent angiography and endovascular treatment.Results The technical success rate of endovascular treatment was 100%(13/13).A total of23 arteries received selective arterial embolization with 78 coils.After treatment,the clinical symptom remission rate of hematuria,back pain and hypertension was 100%(11/11),85.71%(6/7)and 100%(3/3),respectively.There was no statistical difference of serum creatinine before([94.50±29.82]μmol/L)and after treatment([94.25±28.85]μmol/L,P>0.05).No serious complication was found.There were only 3cases of low fever and 2cases complained of lower back pain postoperatively.The mean follow-up time was(37.23±16.78)months.And 2cases were lost follow up,while the rest of11 cases had no recurrence of symptoms.Conclusion As the safe and effective procedure,endovascular treatment can be used for the treatment of RAVF.
引文
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[3]王茂强,李生,谢春明,等.创伤性肾动静脉瘘的介入治疗.中华创伤杂志,2004,20(5):20-23.
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[7]Leiter E,Gribetz D,Cohen S.Arteriovenous fistula after percutaneous needle biopsy—surgical repair with preservation of renal function.N Engl J Med,1972,287(19):971-972.
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[9]Omoloja AA,Racadio JM,Mcenery PT.Post-biopsy renal arteriovenous fistula.Pediatr Transplant,2002,6(1):82-85.
[10]Huang WC,Levey AS,Serio AM,et al.Chronic kidney disease after nephrectomy in patients with renal cortical tumours:A retrospective cohort study.Lancet Oncol,2006,7(9):735-740.
[11]Lesaux N,Paulhac P,Bouillet P,et al.Post-traumatic renal arteriovenous fistula discovered after 28years.Prog Urol,2005,15(2):306-308.
[12]Shimamura Y,Sakurai Y,Takizawa H.Renal arteriovenous fistula.Clin Exp Nephrol,2015,19(2):326-327.
[13]Zelenak K,Sopilko I,Svihra J,et al.Successful embolization of a renal artery pseudoaneurysm with arteriovenous fistula and extravasations using Onyx after partial nephrectomy for renal cell carcinoma.Cardiovasc Intervent Radiol,2009,32(1):163-165.
[14]Huang TC,Hsieh KS,Lin CC,et al.Clinical results of percutaneous closure of large secundum atrial septal defects in children using the Amplatzer septal occluder.Heart Vessels,2008,23(3):187-192.
[15]Perkov D,Novacic K,Novosel L,et al.Percutaneous embolization of idiopathic renal arteriovenous fistula using Amplatzer vascular plugⅡ.Int Urol Nephrol,2013,45(1):61-68.
[16]Areste N,Moyano MJ,Naranjo D,et al.Endovascular treatment with"covered stent"of arteriovenous fistula secondary to percutaneous renal biopsy.Nefrologia,2005,25(4):449-450.
[17]伍筱梅,赖清,梁荣光.非获得性肾动静脉瘘的血管造影诊断和介入治疗.实用放射学杂志,2001,17(9):641-643.
[2]Khawaja AT,Mclean GK,Srinivasan V.Successful intervention for high-output cardiac failure caused by massive renal arteriovenous fistula-a case report.Angiology,2004,55(2):205-208.
[3]王茂强,李生,谢春明,等.创伤性肾动静脉瘘的介入治疗.中华创伤杂志,2004,20(5):20-23.
[4]Ghoneim TP,Thornton RH,Solomon SB,et al.Selective arterial embolization for pseudoaneurysms and arteriovenous fistula of renal artery branches following partial nephrectomy.J Urol,2011,185(6):2061-2065.
[5]Chen KJ,Chen CH,Cheng CH,et al.Renal arteriovenous malformation in a young woman presenting with haematuria and hypertension.Nephrology(Carlton),2006,11(5):482-483.
[6]Osawa T,Watarai Y,Morita K,et al.Surgery for giant highflow renal arteriovenous fistula:Experience in one institution.BJU Int,2006,97(4):794-798.
[7]Leiter E,Gribetz D,Cohen S.Arteriovenous fistula after percutaneous needle biopsy—surgical repair with preservation of renal function.N Engl J Med,1972,287(19):971-972.
[8]Bookstein JJ,Goldstein HM.Successful management of postbiopsy arteriovenous fistula with selective arterial embolization.Radiology,1973,109(3):535-536.
[9]Omoloja AA,Racadio JM,Mcenery PT.Post-biopsy renal arteriovenous fistula.Pediatr Transplant,2002,6(1):82-85.
[10]Huang WC,Levey AS,Serio AM,et al.Chronic kidney disease after nephrectomy in patients with renal cortical tumours:A retrospective cohort study.Lancet Oncol,2006,7(9):735-740.
[11]Lesaux N,Paulhac P,Bouillet P,et al.Post-traumatic renal arteriovenous fistula discovered after 28years.Prog Urol,2005,15(2):306-308.
[12]Shimamura Y,Sakurai Y,Takizawa H.Renal arteriovenous fistula.Clin Exp Nephrol,2015,19(2):326-327.
[13]Zelenak K,Sopilko I,Svihra J,et al.Successful embolization of a renal artery pseudoaneurysm with arteriovenous fistula and extravasations using Onyx after partial nephrectomy for renal cell carcinoma.Cardiovasc Intervent Radiol,2009,32(1):163-165.
[14]Huang TC,Hsieh KS,Lin CC,et al.Clinical results of percutaneous closure of large secundum atrial septal defects in children using the Amplatzer septal occluder.Heart Vessels,2008,23(3):187-192.
[15]Perkov D,Novacic K,Novosel L,et al.Percutaneous embolization of idiopathic renal arteriovenous fistula using Amplatzer vascular plugⅡ.Int Urol Nephrol,2013,45(1):61-68.
[16]Areste N,Moyano MJ,Naranjo D,et al.Endovascular treatment with"covered stent"of arteriovenous fistula secondary to percutaneous renal biopsy.Nefrologia,2005,25(4):449-450.
[17]伍筱梅,赖清,梁荣光.非获得性肾动静脉瘘的血管造影诊断和介入治疗.实用放射学杂志,2001,17(9):641-643.