移植肾假性动脉瘤的诊断和治疗四例报告

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.     

移植肾动脉瘤五例报告

目的 探讨移植肾动脉瘤(RAA)的病因、诊断及治疗. 方法 1998年8月至2004年12月共行同种异体肾移植手术1251例,发生RAA 5例(0.4%).5例均为男性,平均年龄43岁,移植肾血管吻合方式均为移植肾动脉一髂内动脉端端吻合.患者主要临床表现为进行性肾功能减退,突发少尿或无尿,顽固性高血压及肾区疼痛,均经彩色多普勒超声、数字减影血管造影检查确诊为动脉瘤,动脉瘤大小1.8 cm×2.0 cm×2.0 cm～4.0 cm×4.0 cm×5.0 cm. 结果 移植肾动脉吻合口动脉瘤2例,1例发现动脉瘤后1个月内移植肾功能丧失,行移植肾切除术,术后规律透析治疗,随访1年后行二次肾移植;1例移植肾失功后1周内行对侧髂窝二次肾移植手术,保留原移植肾,术后随访2年肾功能正常.RAA合并近端移植肾动脉狭窄2例,1例行吻合口球囊扩张并放置支架后,以弹簧螺圈栓塞动脉瘤,术后随访1年肾功能稳定;1例行移植肾切除、二次.肾移植术,术后随访3年肾功能正常.吻合口髂内动脉侧粥样硬化斑块导致髂内动脉狭窄、移植肾动脉侧动脉瘤1例,行移植肾切除术,术后2 d因脑干栓塞死亡. 结论 移植肾动脉-髂内动脉端端吻合易诱发血管并发症,RAA治疗应谨慎采用开放手术切除,可选择近期行二次肾移植和血管内介入治疗.     

肾移植术后移植肾假性动脉瘤的诊断与治疗(附2例报告)

目的：为提高肾移植术后移植肾假性动脉瘤的诊断水平。方法：回顾性调查７７１例肾移植患者术后发生肾动脉吻合口假性动脉瘤２例,并复习有关文献对其形成的原因、诊断与治疗予以讨论。结果：２例均发生于供贤动脉与受体髂外动脉吻合术后１￣２个月,经彩色多普勒Ｂ超检查或动脉造影确诊。其中１例于移植肾髂总动脉造影后２４ｈ内突发假动脉瘤破裂,通过床旁紧急手术止血抢救成功。另１例通过手术挽救了移植肾。结论：移植肾假性动脉     

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。     

肾移植后血管并发症的诊治体会

目的探讨。肾移植术后血管并发症的特点和诊治方法。方法回顾34例术后并发血管疾病的。肾移植患者临床资料，对其发病特点和诊治方法进行分析总结。结果34例患者中，并发移植肾动脉梗阻13例，移植肾动脉出血8例，动脉吻合口破裂7例，移植肾静脉梗阻4例，髂外动脉瘤和髂外静脉栓塞各1例。21例经彩色多普勒血流显像（CDFI）作出诊断，其中10例进一步行磁共振血管成像（MRA）明确诊断。5例移植。肾动脉狭窄患者中，3例放置血管内支架扩张后肾功能恢复良好，分别随访8、10、14个月，血肌酐维持在115～135μmol／L；1例将与髂内动脉端端吻合的移植。肾动脉改为与髂外动脉端侧吻合，术后至今1个月，血肌酐降至正常水平；1例MRA显示不完全狭窄，给予保守治疗，至今观察21d，血肌酐持续降低。3例静脉梗阻患者经手术解除梗阻，其中1例死于心力衰竭，另2例随访13、36个月，肾功能恢复良好。1例髂外静脉栓塞患者术后死于移植肾破裂。其余患者均切除移植肾。结论。肾移植术后的血管并发症进展迅速，应根据具体情况及时采取相应治疗手段，处理不及时往往导致移植肾功能丧失，因此早期诊断非常重要，CDFI可作为首选筛查手段。     

腹腔镜胆囊切除术后假性动脉瘤的诊治

目的:探讨腹腔镜胆囊切除术(LC)后假性动脉瘤的诊治方法。方法:对4例LC术后假性动脉瘤患者的临床资料进行分析,对其诊治要点及预防措施进行探讨。结果:4例患者主要临床表现包括右上腹痛、上消化道出血、黄疸等,彩色多普勒超声检查提示诊断,选择性血管造影明确诊断并同时行栓塞治疗成功,均治愈。结论:彩色多普勒超声和选择性血管造影是本病的主要诊断方法。介入栓塞治疗应作为假性动脉瘤治疗的首选方法。假性动脉瘤的形成与手术操作有关,应重在预防。     

注射毒品所致假性股动脉瘤18例的外科治疗

目的 探讨注射毒品所致假性股动脉瘤的外科疗法。方法 对18例注射毒品所致辞假性动脉瘤患者的临床资料进行回顾分析。13例直接采用ePTFE人工血管行旁路髂外动脉和股浅动脉端侧吻合术；3例采用自体大隐静脉间置移植术，其中１例吻合口破裂出血改用ePTFE人工血管行旁路髂外动脉和股浅端侧吻合术；2例股动脉结扎术。结果 全部病例保肢成功。血管移植术后复查彩色多普勒超声显示移植血管通畅。结论 在患者不能提供合适的自体大隐静脉移植时，人工血管移植仍是治疗假性股动脉瘤的有效方法。术中彻底清创及避免污染是预防术后人工血管并发感染的最主要措施     

带膜支架动脉置人治疗肾移植后假性动脉瘤2例报告

移植肾假性动脉瘤(renal transplant pseudo aneurysm)是肾移植术后较为少见的血管并发症之一.由于可造成移植肾功能减退乃至丧失,易破裂致大出血危及生命,应引起足够重视,以争取早期诊断和及时治疗.我们在临床采用带膜支架血管内植入治疗2例移植肾假性动脉瘤,取得满意效果,现报道如下.     

带膜支架动脉置入治疗肾移植后假性动脉瘤2例报告

移植肾假性动脉瘤（renal transplant pseudo aneurysm）是肾移植术后较为少见的血管并发症之一。由于可造成移植肾功能减退乃至丧失，易破裂致大出血危及生命，应引起足够重视，以争取早期诊断和及时治疗。我们在临床采用带膜支架血管内植人治疗2例移植肾假性动脉瘤，取得满意效果，现报道如下。     

注射毒品所致假性股动脉瘤治疗体会(附34例)

目的探讨注射毒品所致假性股动脉瘤的外科疗法。方法对34例注射毒品所致假性股动脉瘤病人的临床资料进行回顾分析。结果13例直接采用ePTFE人造血管行旁路髂外动脉和股浅动脉端侧吻合术,3例采用自体大隐静脉原位移植术,其中1例术后吻合口破裂出血改行ePTFE人造血管行旁路髂外动脉动脉和股浅端侧吻合术,18例股动脉结扎术。全部病例保肢成功。血管移植者术后复查彩色多普勒显示移植血管通畅。结论在患者不能采用合适的自体大隐静脉移植及人造血管移植时,运用结扎股动脉术是治疗注射毒品所致假性股动脉瘤的有效方法。     

Mycotic Pseudoaneurysm After Kidney Transplantation: Two Case Reports

Background

Vascular complications after kidney transplantation may cause allograft loss. Here, we describe 2 patients with extrarenal mycotic pseudoaneurysm after kidney transplantation.

Management of femoral artery pseudoaneurysm due to addictive drug injection

Objective: To study surgical management for patients with femoral pseudoaneurysm resulting from addictive drug injection. Methods： Clinical data of 34 patients with femoral pseudoaneurysm resulting from addictive drug injection were retrospectively reviewed. Results: Thirteen patients underwent bypass graft ( end to side) of external iliac artery and superficial femoral artery using expanded polytetrafluoroethylene (ePTFE). Three patients who had an autogenous saphenous vein graftin situs, one of whom was then performed an ePTFE graft when rupture and bleeding occurred at the anastomotic site. Color Doppler image showed patent grafted blood vessels in all the patients after operation. Eighteen patients had their femoral arteries ligated. Limbs of all the 34 patients were saved. Conclusions： Ligating femoral artery is an effective way to treat femoral artery pseudoaneurysm if autogenous saphenous vein graft or artificial vessel graft is not applicable.     

Angioplasty and stenting of arterial stenosis affecting renal transplant function

PURPOSE: To evaluate the efficacy of percutaneous angioplasty and stenting in cases of artery stenosis of the transplanted kidney or proximal iliac artery stenosis causing transplant dysfunction and/or increase of the arterial blood pressure. MATERIALS AND METHODS: Between January 1999 and June 2007, we evaluated 24 patients who had undergone renal transplantation and subsequently were diagnosed with refractory hypertension and transplant dysfunction for signs of possible renal transplant artery stenosis. Color Doppler ultrasonography and magnetic resonance angiography preceded the intrarterial angiographic investigation, with false-negative results in 18.2% and 13.6% of patients, respectively. In 2 of the 24 patients, angiography did not reveal arterial stenosis affecting the transplanted kidney. Two patients had severe ipsilateral iliac artery stenosis and the remaining 20 had transplant artery stenosis. Successful angioplasty and stenting were performed in these 22 patients. RESULTS: The method was technically feasible in 100%. The procedure-related morbidity was 0%. During the follow-up period (range: 3 to 104 months), two patients died with normal transplant function, two suffered transplant failure, and the remaining 18 still have normal transplant function and easily controlled hypertension. CONCLUSION: Percutaneous angioplasty and stenting in cases of arterial stenosis affecting the renal transplant function are safe and effective procedures. Even more, the strong clinical suspicion must lead to angiographic investigation regardless of the results of other imaging approaches.     

Vascular complications of allograft nephrectomy.

OBJECTIVES: To identify risk factors that predisposes patients to vascular complications from allograft nephrectomy and to determine the safe management of this group of patients. DESIGN: This is a retrospective review of 1543 renal transplants performed in our institution between January 1990 and January 2002. PATIENTS AND METHODS: During this period, 161 (10.4%) transplant nephrectomies were performed, of which we identified nine patients (5.6%) who sustained significant vascular complications. RESULTS: Seven patients required ligation of external iliac artery for control of haemorrhage. Immediate vascular reconstructions (femoral-femoral cross-over bypass in two cases and one vein patch to an external iliac artery defect) were performed in three patients. Two patients had endovascular stenting of their external iliac artery pseudoaneurysm. No patient suffered limb loss. However, three patients died-two died from overwhelming sepsis and one patient died of an intra-cerebral haemorrhage. CONCLUSIONS: While vascular complications associated with transplant nephrectomy are relatively rare, they are associated with a significantly poor outcome. Immediate attempts to reconstruct the vascular supply to the lower limb are associated with a high complication rate. We advocate that where possible, vascular reconstruction should be deferred and that external iliac artery ligation can be performed safely with surprisingly low limb ischaemia rate.     

注射毒品所致假性股动脉瘤的外科治疗（附12例病例分析）

目的探讨注射毒品所致假性股动脉瘤外科治疗的手术方式和疗效。方法对12例注射毒品所致假性股动脉瘤病人的临床资料进行回顾性分析。12例病人均接受手术治疗，瘤体切除并清创后，其中8例行股动脉结扎术，均为急性出血病人，4例采用ePTFE人造血管行髂外动脉和股浅动脉端端吻合术。结果术后10d及3个月复查彩色多普勒超声显示人造血管血流通畅，以及评估患肢有无缺血、坏死。结论：彻底清创、股动脉结扎及必要时的血管重建是对注射毒品所致假性股动脉瘤外科治疗的有效方法。     

Indication, surgical technique and outcome of orthotopic renal transplantation

PURPOSE: We review the indication, surgical technique and outcome of orthotopic renal transplantation. MATERIALS AND METHODS: The medical records of 1,000 patients who underwent renal transplantation at our institution between August 24, 1993 and August 1, 2000, as well as orthotopic renal transplantation were reviewed. RESULTS: Orthotopic renal transplantation was performed in 4 males and 1 female with severe iliac atherosclerosis or retained bilateral iliac fossa kidney transplant. Mean patient age was 56 years. There were 2 patients who received kidneys from living related donors, and 3 underwent cadaveric renal transplantation. Left orthotopic renal transplantation was successful in 4 cases, and 1 was converted to iliac fossa renal transplant because of a pulseless splenic artery and renal artery thrombosis after native renal endarterectomy. Orthotopic renal revascularization was done with splenic artery in 2, native renal artery in 2 and left renal vein in all 4 patients. Urinary tract reconstruction was performed with stented (2) or nonstented (2) ureteroureterostomy. Antibody induction, purine antagonists, calcineurin inhibitors and glucocorticoids were used for immunosuppression. Mean preoperative and 1-month postoperative serum creatinine was 7.9 and 1.3 mg./dl., respectively. Patient and graft survival was 100% during followup, which ranged from 6 months to 5 years. CONCLUSIONS: Despite the technical challenges, orthotopic renal transplantation in patients with unsuitable pelvic vessels can result in excellent patient and graft survival.     

Reconstruction of a Transplant Recipient’s External Iliac Artery Using Donor’s Inferior Vena Cava in Renal Transplantation: 2 Case Reports

Iliac atherosclerosis is common in renal transplant recipients. In severe cases, it affects intraoperative renal arterial anastomosis and increases the risk of postanastomosis complications. At present, safe and efficient vascular replacement methods are relatively limited. In the 2 renal transplant cases at our center, described here, the donors’ iliac arteries were unavailable. We therefore attempted to replace the recipients’ diseased external iliac artery with the donors’ inferior vena cava and then performed an end-to-side grafting with the attachment in arterial reconstruction. One patient received a single kidney transplantation, while the other received a dual kidney transplantation. Antiplatelet/anticoagulation drug application was avoided, and both patients were observed for more than 6 months. Stable renal graft function was achieved without any vascular complications. During this study, all procedures were in compliance with the Helsinki Congress and the Declaration of Istanbul. For end-stage renal disease patients with severe iliac atherosclerosis who are waiting for kidney transplantation, a donor’s vena cava graft could potentially be a promising replacement option to restore external iliac artery patency and reconstruct renal blood flow, without the necessity of harvesting a recipient’s autologous vessels or looking for costly artificial ones.     

颈外静脉移植治疗注射毒品所致的假性股动脉瘤

目的探讨注射毒品致假性股动脉瘤的临床特点及颈外静脉移植治疗的可行性。方法2002年6月~2006年2月,对注射毒品所致的20例假性股动脉瘤行手术治疗,并移植颈外静脉重建股动脉缺损。结果所有病例均成功保存肢体,无缺血坏死及小腿骨筋膜室综合征发生。伤口一期愈合9例,余11例出现淋巴漏,二期愈合4例,再次手术行局部皮瓣转移修复7例。1例因吻合口破裂出血而结扎股动脉,1例有股神经损伤的表现。16例随访1~24个月,无复发,足背动脉可扪及搏动,10例术后血管彩超显示移植的颈外静脉通畅。结论手术是治疗注射毒品所致的假性股动脉瘤唯一有效的方法;在瘤体切除后大隐静脉往往因炎症而不能利用,移植颈外静脉修复重建股动脉缺损是可行的。