经动脉栓塞治疗肾内动静脉畸形后血管再通的治疗

目的探讨经动脉栓塞治疗肾内动静脉畸形后畸形血管再通的原因和治疗。方法回顾性分析4例肾内动静脉畸形经动脉栓塞治疗,术后畸形血管发生血管再通患者的临床资料。本组共4例,男1例,女3例,年龄19~70岁。左肾2例,右肾2例;1支肾动脉2例,2支肾动脉2例。经动脉造影明确诊断,并应用明胶海绵栓塞治疗,术中见栓塞确实,出血停止。术后1~24 h再次出现血尿,发生畸形血管再通。结果行二次动脉造影证实原动静脉畸形处血管再通,应用弹簧圈超选择性栓塞治愈。随诊未发现畸形血管再通。结论经动脉栓塞治疗先天性肾内动静脉畸形应采用超选择性动脉栓塞技术,用明胶海绵栓塞易发生血管再通。应用合适大小的弹簧圈超选择性肾动脉栓塞治疗肾内动静脉畸形可以取得确实疗效。

Therapy of recanalization after the transarterial embolization treatment of renal arteriovenous malformation

Objective To explore the causes and treatment of recanalization after the transarterial embolization treatment of hematuria caused by renal arteriovenous malformation.Methods The diagnosis and treatment of recanalization in 4 cases of renal arteriovenous malformation after the transarterial embolization treatment were retrospectively reviewed.The 4 cases included 1 male and 3 female,whose age ranged from 19 to 70 years.2 cases had one malformed artery and anether 2 cases had 2 malformed arteries.All were confirmed by renal arterial angiography and underwent gelatin sponge embolization.The existence of embolus was checked and no bleeding occurred during intraoperation.1~24 hours after surgery,recanalization in malformation and hematuria were found again.Results Recanalization in malformation was confirmed by secondary renal arteriography.After treatment of embolization with coils,the cases were cured and no recanalizaiton occurred.Conclusion The superselective renal arterial embolization treatment is effective but the method of gelatin sponge embolization is prone to recanalizaiton.The application of appropriate size of coils can solve this problem with a better efficacy.