肾移植术后动脉并发症的介入治疗

目的总结肾移植术后动脉性并发症介入治疗的经验及价值评估。方法回顾分析肾移植患者中进行血管造影检查者52例，介入治疗方法包括动脉内血管成形术治疗动脉狭窄，动脉内用尿激酶溶栓治疗急性血栓栓塞和假性动脉瘤的栓塞治疗。结果12例移植肾动脉基本正常，21例显示动脉吻合13狭窄，2例吻合13处动脉瘤形成(其中1例合并吻合13狭窄)，14例为移植肾动脉内血栓形成，3例为移植肾内动脉稀少。单纯移植。肾动脉狭窄中，16例行经动脉内血管成形术(单纯球囊扩张12例，血管内支架4例)治疗，其中14例肾功能逐渐恢复正常，2例术后肾功能恢复不良，移植肾切除。13例动脉血栓患者接受溶栓治疗(1例溶栓后放置支架)，其中3例溶栓失败，1例血管通畅后肾功能未见明显恢复，余9例。肾功能恢复正常。1例假性动脉瘤合并吻合口狭窄接受吻合口球囊扩张及支架治疗，动脉瘤栓塞治疗，造影复查动脉瘤消失，临床症状改善。结论血管内介入治疗为肾移植术后并发症提供进一步治疗，可及早挽救移植肾。

Interventional treatment of arterial complications in post renal transplantation

Objective To report our experience of interventional procedure for arterial complications in post renal transplantation and to evaluate its clinical value.Methods In a retrospective analysis of renal transplantations in our center,52 cases of renal allograft artery abnormalities had taken angiography.Interventional procedure included transluminal angioplasty of arterial stenoses,treatment of arterial occlusion,and embolization of pseudoaneurysm.Results Renal allograft artery abnormalities included artery stenosis (n=21),artery thrombosis (n=13) and embolision (n=1),renal artery pseudoaneurysms (n=2),and decrease of renal artery flow (n=3).Of the 21 artery stenosis,2 grafts with artery stenosis were lost because the stenosis could not be corrected,and 3 with mild stenosis received no treatment.Another 16 accepted renal artery angioplasty (balloon dilation,n=12,and stent implantation,n=4).14 achieved long-term allograft function.1 graft was lost because renal function failed to recover.Restenosis occurred in one stent implantation,and lost the allograft function after secondary dilation.13 cases received thrombolytic therapy through artery catheter for thrombosis and 9 achieved long-term allograft function.Thrombolyses failed in 3 cases,and renal function failed to recover in 1 case.One pseudoaneurysm received stent implantation after embolization,and got a short-term allograft function.The other one received allograft excision.Conclusion Intravascular interventional therapy will be the first-line therapy for any indications of complication in post renal transplantation,and it can surely save the kidney in a majority of instances.