肾动脉瘤的临床特征及外科治疗

为了提高肾动脉瘤的诊治水平，报道罕见的肾动脉瘤８例，手术治疗６例，术后血压均恢复正常，血尿消失；保守治疗２例，其中１例肾动脉瘤破裂死亡。结合文献复习对肾动脉瘤的临床表现，诊断，手术指征及外科治疗等进行了讨论。     

动脉瘤192例外科治疗体会

总结我院１９８４－１９９７年治疗的动脉瘤１９２例临床经验，方法回顾性分析外科治疗周围动脉瘤１０６例和肾下脉主动脉８６例的手术方式和疗效。结果本组１７５例接受手术治疗，手术治愈率９１．４％，手术病列死率２．３％，其中腹主动脉瘤３例劲动脉瘤１例，手术并发症发生率６．３％，包括吻合口假性动脉瘤７例，肢体远端有缺血症状４例。     

肾动脉瘤治疗进展

肾动脉瘤是一种临床上少见的肾动脉疾病。随着手术技术的进步和大量随访研究的开展,肾动脉瘤治疗方法和治疗理念在最近几年发生了较大的变化。本文总结归纳了目前国内外关于肾动脉瘤的手术治疗及介入的文献报道,指出了肾动脉瘤在手术治疗及介入方面研究的主要变化点,讨论了肾动脉瘤的类型、发病机理、手术影响因素,在此基础上,对肾动脉瘤的治疗研究前景进行了展望。     

离体巨大肾动脉瘤切除、肾动脉成形和自体移植一例

肾动脉瘤是罕见的内脏动脉瘤，治疗巨大的肾动脉瘤的报道很少，我院采用肾切除后，在肾保护下行肾动脉瘤切除，肾动脉成形和自体肾移植的方法治疗右肾门处巨大肾动脉瘤1例，现报告如下。     

腹腔内脏动脉瘤的外科治疗——附46例分析

目的探讨腹腔内脏动脉瘤(VAAs)的合理治疗策略。方法回顾性分析我院2000～2012年间随访资料完整的46例VAAs病例的临床资料及其治疗效果。结果 46例患者中男性21例,女性25例,其中肾动脉瘤10例,肠系膜上动脉瘤8例,肝动脉瘤7例,脾动脉瘤16例,胃十二指肠上动脉瘤2例,多发性VAA3例。37例接受介入治疗,9例接受开放手术,一次手术技术成功率为95.9%,二次手术技术成功率为100%。术后1例并发肠瘘、腹腔感染和肾功能损害,经治疗后康复出院。随访5～120(平均47.5)个月,除1例大动脉炎患者因再发肾动脉瘤破裂死亡外其余患者均存活。结论介入治疗及开放手术相结合是治疗VAA的合理手段,应根据患者的具体情况选择相应的治疗方式。     

后腹腔镜取肾、离体肾动脉瘤切除及自体肾移植治疗复杂性肾动脉瘤1例并文献复习

目的：总结复杂性肾动脉瘤1例的诊治经验。
方法:报告采用后腹腔镜取肾、离体肾动脉瘤切除、肾动脉重建和自体肾移植治疗复杂性肾动脉瘤1例的治疗经过及结果，并复习文献。患者，男，27岁。术前彩超、CT及CTA示：动脉瘤体4.5 cm×4.0 cm×3.0 cm大小，靠近肾门，位于肾动脉主干远端分叉部，累及6根分支。采用后腹腔镜切取右肾后，离体肾脏采用4 ℃低温肾脏保存液灌注、离体行肾动脉瘤切除及自体大隐静脉肾动脉重建，然后通过原取肾切口将肾脏移植于右髂窝。
结果:手术顺利，时间为6.5 h，失血约50 mL，肾热、冷缺血时间分别为4 min和2.5 h。围手术期未出现并发症，术后肾功能正常。术后1个月CTA及2周和3个月彩超复查显示右髂窝移植形态正常，肾动脉及其分支血流通畅无狭窄，肾静脉血流通畅，输尿管无狭窄。
结论:后腹腔镜取肾、离体肾动脉瘤切除、肾动脉成形和自体肾移植用于治疗远段和/或累及分支的复杂性肾动脉瘤，微创、安全、有效、可行。

     

肾移植术后肾外型假性动脉瘤2例

目的:探讨肾移植术后肾外型假性动脉瘤诊治方法。方法:对2例肾移植术后肾外型假性动脉瘤患者资料进行回顾性分析。结果:1例栓塞后动脉瘤逐渐缩小。4 年后复查彩超,示左髂内动脉瘤为4.8 cm×4.1cm×4.8 cm,动脉瘤内部回声不均,有少许的液性暗区,无血流信号。1 例因瘤口无法修补,移植肾缺血,行动脉瘤及移植肾切除。结论:磁共振血管造影有助于本病的诊断。肾外型假性动脉瘤一旦确诊应尽早处理。手术治疗对保留肾脏最为理想,但由于再次手术发生动脉瘤的血管壁一般水肿严重,无法修补或重建,大多数行动脉瘤及移植肾切除。     

内脏动脉瘤手术治疗临床分析

目的 总结内脏动脉瘤(VAAs)的诊断与治疗经验.方法 2003年6月至2008年12月共收治8例VAAs;男性2例,女性6例;年龄30～72岁,平均49岁.8例患者共有9个动脉瘤,包括脾动脉瘤4例,肠系膜上动脉瘤2例,肾动脉瘤2例(3个).均经彩色超声、CTA或DSA明确诊断.6例行经腹动脉瘤切除,其中3例行血管重建.1例伴门静脉高压患者,行脾动脉瘤切除、脾切除和脾肾静脉分流术.1例双侧肾动脉瘤患者,左肾动脉瘤较大,且接近肾门,行动脉瘤切除和肾摘除术,右肾动脉瘤直径1.2 cm,密切随访.2例经股动脉行动脉瘤栓塞治疗.结果 本组8例VAAs患者,无论是动脉瘤切除、两端动脉结扎;还是端端吻合,人工血管间置血流重建;以及经股动脉病灶栓塞治疗,多取得了满意的效果.没有死亡和严重并发症发生.随访2～60个月,平均26.5个月,效果良好.结论 VAAs一旦明确诊断,应积极采取治疗措施.选择性手术或栓塞术足安全和有效的治疗方法.直径<2 cm且无症状的VAAs可考虑密切随访.     

内脏动脉瘤的外科治疗

目的 探讨内脏动脉瘤的外科治疗方法。方法 回顾性分析2002年2月至2010年6月收治的19例内脏动脉瘤患者外科治疗的临床资料,包括脾动脉瘤7例、肝右动脉瘤1例、胃左动脉瘤1例、胰十二指肠动脉瘤3例、胃十二指肠动脉瘤2例、肠系膜上动脉瘤、结肠中动脉瘤和左结肠动脉瘤各1例、肾动脉瘤2例。其中破裂12例。按照手术方式分为两组,介入栓塞治疗组13例,开放手术组6例。结果 4例栓塞后再出血,2例行手术探查止血、2例行二次栓塞后都得以成功止血。8例动脉瘤破裂伴休克患者术后均停止出血。1例胰十二指肠动脉瘤栓塞后出现十二指肠不全梗阻。2例脾动脉瘤患者术后出现部分脾梗死。术后随访18例,随访2 ～ 103个月,无动脉瘤复发。结论 以支配脏器和动脉解剖的特点作为内脏动脉瘤选择手术方案的主要依据。腔内治疗和开放手术在治疗内脏动脉瘤方面均有效,而对于假性动脉瘤破裂患者,腔内治疗效果满意。     

内脏动脉瘤诊治经验

目的　探讨内脏动脉瘤的诊断和治疗方法。方法　对 71例内脏动脉瘤的诊断和治疗进行回顾性总结。结果　 71例内脏动脉瘤中包括脾动脉瘤 2 2例 ,肝动脉瘤 16例 ,腹腔干动脉瘤 4例 ,胃、胰十二指肠动脉瘤 13例 ,肠系膜上、下动脉瘤分别为 6例和 1例 ,网膜动脉瘤 3例 ,肾动脉瘤 6例。本组自发性破裂大出血 2 9例 ,其中破裂入胆道 14例 ,上消化道 10例 ,腹腔及腹膜后 5例。术前经内脏动脉造影确诊 (包括DSA) 4 2例 ,螺旋CT血管造影 (SCTA)证实 14例 ,经核磁共振血管造影 (MRA)确诊 4例。手术治疗 5 8例 ,死亡 9例 ;动脉栓塞治疗 7例。结论　内脏动脉瘤术前临床诊断极为困难。DSA、SCTA和MRA具有诊断价值。一旦确诊 ,应尽早手术治疗。     

Renal cell carcinoma with renal artery aneurysm treated by extracorporeal surgery and autotransplantation--a report of 2 cases]

We experienced two cases of renal cell carcinoma with renal artery aneurysm in the contralateral kidney. These cases have not been reported in the literatures which we have so far explored. In our cases, firstly tumor was resected, and then extracorporeal surgery and autotransplantation were performed on the renal artery aneurysm of the opposite side. Their postoperative courses were uneventful. Only a few instances of extracorporeal surgery and autotransplantation for renal artery aneurysm in a solitary kidney have been reported in the literature. However, no report of a case treated by extracorporeal surgery and autotransplantation for renal artery aneurysm in the contralateral kidney after surgical treatment of renal cell carcinoma has been made. Regarding the treatment of renal artery aneurysm, extracorporeal surgery and autotransplantation appeared satisfactory in our experience. It was a safe and assured surgical procedure. We recommend extracorporeal surgery and autotransplantation for renal artery aneurysm when management in situ is considered difficult.     

Renal artery aneurysm causing hydronephrosis

A 42-year-old man presented with left hydronephrosis incidentally discovered on abdominal echogram during a routine health examination. Color Doppler ultrasonography, intravenous pyelography and angiography revealed a non-calcified renal artery aneurysm of 30 mm in size compressing the pyeroureteral junction and causing hydronephrosis. Three-dimensional computed tomography (3-D CT) using spiral CT clearly displayed the aneurysm located at the first bifurcation of the left renal artery and involving the anterior segmental artery. Decompression was successfully obtained via in situ revascularization of the renal artery after aneurysmectomy. A literature search revealed 12 cases of renal artery aneurysm causing hydronephrosis reported in Japan, although only three cases were documented in other countries, and these reports are reviewed. Use of 3-D CT for evaluation of renal artery aneurysm is advocated.     

Renal artery aneurysm.

More and more renal artery aneurysms are being diagnosed, especially after the introduction of selective arteriography for the evaluation of renovascular hypertension. However, renal artery aneurysm still remains a rare entity. The pathogenesis of renal artery aneurysm is identical to the pathogenesis of arterial aneurysm in other arteries. Symptoms of aneurysm of the renal artery are dependent on a variety of factors, the most important of which are the size of the aneurysm, its location, and whether or not rupture has occurred. The indication for operation on renal artery aneurysm is rupture or threat of rupture. Herein we present a review of the literature and a report of 2 cases which exemplify the capabilities of the surgeon in dealing with such cases.     

Ruptured renal artery aneurysm in a pregnant uninephric patient: successful ex vivo repair and autotransplantation

Renal artery aneurysm rupture during pregnancy is a rare event, with only 22 cases recorded in the literature. Maternal and fetal mortality rates have been high, and renal salvage with in situ repair of the renal artery has been documented in only three cases. We present here a case report of renal artery aneurysm rupture in a pregnant patient with congenital absence of the contralateral kidney, which was treated successfully with ex vivo renal artery reconstruction and autotransplantation. The literature on renal artery aneurysm rupture in pregnancy is reviewed and technical aspects of renal artery reconstruction and autotransplantation are presented.     

Endovascular treatment of splenic and renal aneurysms

Four cases (three women and one man) of embolization of visceral artery aneurysms are presented, of which two affected the splenic artery and two the renal artery. The two renal aneurysms were related to hypertension; one of the splenic aneurysms was diagnosed in the context of hypertension, and the other affected a woman of a fertile age. Microguides, microcatheters, and Guglielmi platinum coils, liberated by electrolysis, with different lengths and characteristics, were used. Also, one of the renal aneurysm cases was related to the placing of a stent due to the existence of a stenosis of the renal artery adjacent to the aneurysmatic neck. Immediate occlusion of the aneurysm was achieved in the four cases. Evaluation with nuclear magnetic resonance angiography carried out 3 months later confirmed the sealing of the aneurysm and the patency of the native artery. Currently available devices provide a good therapeutic option for the embolization of visceral aneurysms with low morbidity and mortality rates.     

彩色多普勒超声诊断肾动脉瘤

目的探讨彩色多普勒超声诊断肾动脉瘤的价值。方法回顾性分析经CTA或手术证实的5例肾动脉瘤超声表现,评价病变大小、边界、位置、内部回声及血流特点。结果 4例经超声检查获得准确定位及诊断,1例误诊为胰尾囊肿;灰阶超声显示动脉局限性扩张呈球形或梭形,内部均匀无回声,其中1例瘤壁附着血栓,呈低回声;CDFI显示瘤体内部血流为涡流;PWD显示瘤体内部为动脉血流频谱。结论肾动脉瘤超声表现具有特征性,灰阶超声结合CDFI及PWD对于诊断肾动脉瘤具有重要价值。     

Renal Artery Aneurysm Secondary to Fibromuscular Dysplasia in a Young Patient

An 8-year-old male was found on routine physical examination to have a blood pressure of 220/110. Renal angiography demonstrated bilateral renal artery stenosis and an aneurysm of the distal left renal artery with branch involvement. At operation, the left renal artery stenosis and aneurysm was repaired by ex vivo arterial reconstruction and autotransplantation of the kidney. Pathologic evaluation of the resected aneurysm confirmed the diagnosis of fibromuscular dysplasia. Fibromuscular dysplasia is the most common cause of renal artery stenosis in children over 1 year of age and can in rare cases be associated with the development of renal artery aneurysms. In complex cases of renal artery stenosis with involvement of renal artery branches, ex vivo repair and orthotopic autotransplantation is an excellent approach for surgical management.Presented at the Twenty-second Annual Meeting of the Southern California Vascular Surgery Society, La Jolla, CA, April 30-May 2, 2004.     

A case of giant renal artery aneurysm

A 72-year-old woman consulted our hospital for a cystic mass in the right kidney. Ultrasonography and drip infusion pyelography revealed a right renal cystic mass 10 cm in diameter and right hydronephrosis. Computed tomography (CT) and magnetic resonance imaging revealed a giant mass with partial calcification in the right renal hilus. The mass was diagnosed the fusiform aneurysm 10 cm in diameter occurring in the main stem of right renal artery by selective abdominal angiography and 3-dimensional CT. We performed total nephrectomy and the histological finding was atherosclerosis. A total of 485 cases of renal artery aneurysm have been reported in Japan. These cases and 15 cases of renal artery aneurysm more than 5.0 cm in diameter are herein reviewed.     

Preservation of renal function in reimplantation of renal artery of abdominal aortic aneurysm

Intraoperative administration of diuretics and renal hypothermia with cold (4 degrees C) heparinized Ringer's lactate were useful methods for preserving renal function during warm ischemia time. 54-year and 74-year-old men were diagnosed as abdominal aortic aneurysm. Their left renal and accessory left renal arteries originated from the border zone of the aneurysm. We reported two cases of reimplantation of the renal artery in abdominal aortic aneurysm without deterioration of renal function.     

Aneurysms of the renal artery

Renal artery aneurysm is a disease not frequently encountered. Authors revealed this abnormality in 6 cases out of more than 1000 renal angiographies; in one case the aneurysm was bilateral combined with arteriovenous fistula. No specific symptom of renal artery aneurysm could be detected although arterial hypertension was present in all 6 cases. Renal scanning may also be suitable for diagnosis but only in case of large intrarenal aneurysms. At present the diagnosis of renal artery aneurysm must rely on radiological methods. Renal angiography seems to be the method of choice of all radiological methods available now since it permits to determine whether the lesion is unilateral or bilateral affection, the size, number and location of aneurysms to be established and the diameter of the renal artery to be measured proximal and distal to the aneurism. Renal angiography performed in hypotension induced by arphonad and in the oblique and upright position has been shown to considerably facilitate diagnosis. The radiological characteristics of renal artery aneurysms are discussed.