创伤性肾动静脉瘘的介入治疗

目的 评价用介入技术治疗创伤性肾动静脉瘘(RAVFs)的安全性和疗效。方法 对8例不适宜做外科治疗的RAVFs患者进行了介入治疗，其中外伤性损伤4例，医源性损伤4例。6例行经导管超选择性肾动脉内钢丝圈栓塞术，2例行被覆膜支架置入患侧肾动脉内封闭瘘口。结果 血管造影显示肾内型动静脉瘘4例，累及肾动脉段-亚段级分支；主干(肾外)型动静脉瘘4例。治疗均获成功，治疗结束时复查血管造影显示瘘口被封闭。轻微并发症1例。医源性RAVFs患者术后失血症状迅速改善，肉眼血尿消失；4例术前存在心脏负荷过度症状患者，闭塞动静脉瘘后症状迅速改善，血管杂音消失。术后肾功能测定均属正常范围，其中2例肾动脉被覆膜支架置入患者，同位素肾扫描显示患侧肾脏形态、功能正常。术后随访10～42个月，2例分别于术后10，18个月死于与RAVFs无关的疾病。6例仍然生存，一般情况良好，未再针对RAVFs进行外科或介入治疗。结论 介入技术，包括经导管超选择性肾动脉内栓塞术和被覆膜支架置入术，是治疗创伤性、复杂型RAVFs的安全、有效的方法。

Interventional minimally invasive techniques for traumatic renal arteriovenous fistulas

Objective To evaluate the efficacy and safety of the interventional minimally invasive techniques (IMIT) for treatment of traumatic renal arteriovenous fistulas (RAVFs). Methods Eight cases (not suitable for surgical operation) with traumatic RAVFs including four with penetrating trauma and four with iatrogenic injury were treated with IMIT. Six cases underwent transcatheter selective renal arterial coils embolization and two stent-graft placement in the involved renal arteries. Results Angiography confirmed four cases with intra-renal AVF and four with fistula involved in the main renal artery and vein. The interventional treatment succeeded in all cases. Completion angiography documented complete obliteration of the fistulas. Minor complications occurred in one case without significant consequence. The cases with iatrogenic RAVFs experienced immediate relief of their blood loss-related symptoms and gross hematuria. The four cases with cardiac overload conditions were improved significantly with no bruit after RAVFs were obstructed. Renal function were normal in all cases posterior to the procedures. Radioactive isotopic scan revealed that the function was normal in term of the morphology and function of the kidney in two cases with stent-graft placement in the renal arteries. During the follow-up for 10-42 months,two cases were died at 10th and 18th months respectively after the treatment,unrelated to RAVFs diseases. Six cases were still alive under good condition and treated with no further intervention. Conclusions IMIT including transcatheter selective renal arterial embolization and stent-graft exclusion is safe and effective in the treatment of complicated traumatic RAVFs.