超选择性肾动脉栓塞治疗医源性肾假性动脉瘤及动静脉瘘的临床研究

目的探讨超选择性肾动脉栓塞治疗医源性肾假性动脉瘤及动静脉瘘的有效性及安全性。方法 29例经保守治疗无效的医源性肾假性动脉瘤及动静脉瘘患者经DSA检查,明确出血部位、特点后行超选择性肾动脉栓塞治疗。监测栓塞后病情变化,评估栓塞效果,评价栓塞前后肾功能变化,记录并发症。结果 29例患者中23例单纯使用弹簧圈栓塞,6例应用弹簧圈+PVA颗粒进行栓塞,首次肾动脉栓塞技术成功率为100%(29/29),临床成功率为96.55%(28/29)。患者栓塞前后肌酐分别为(93.26±28.79)mmol/L和(91.51±27.68)mmol/L,差异无统计学意义(t=1.28,P=0.22)。无肾脓肿、肾功能衰竭等严重并发症出现。结论超选择介入栓塞治疗医源性肾假性动脉瘤及动静脉瘘技术成功率高、临床有效,并且对肾功能无明显影响,是一种安全有效的治疗方法。

Super-selective renal artery embolization in treatment of iatrogenic renal pseudoaneurysm and arteriovenous fistula

Objective To evaluate the efficacy and safety of super-selective renal artery embolization in treatment of iatrogenic renal pseudoaneurysm and arteriovenous fistula. Methods Twenty-nine patients with iatrogenic renal pseudoaneurysm and arteriovenous fistula underwent renal angiography after ineffective conservative treatment. After identifying the location and characteristic of lesions by DSA, super-selective renal artery embolization was performed. Symptoms and signs, renal function changes before and after embolization and complications were recorded to evaluate the therapeutic effect. Results The technical success rate of super-selective renal artery embolization was 100% (29/29), and clinical success rate was 96.55% (28/29). The serum creatinine level before and after embolotherapy was (93.26±28.79) mmol/L and (91.51±27.68) mmol/L respectively, and there were no significant differences (t=1.28, P=0.22). No serious complications such as nephrapostasis or renal failure occurred in the study. Conclusion Super-selective renal artery embolization has technically and clinically high success rate with limited effect on renal function. It is a safe and effective therapy method in patients with iatrogenic renal pseudoaneurysm and arteriovenous fistula.