经导管肾动脉节段性栓塞治疗肾动静脉畸形

目的：探讨经导管肾动脉节段性栓塞治疗肾动静脉畸形的栓塞材料及其效果。方法：9例因肾动静脉畸形（先天性者8例，获得性者1例）引起大量血尿患者，施行经导管肾动脉节段性栓塞治疗10次，栓塞材料为无水乙醇、聚乙烯醇颗粒、异丁基-2-氰基丙烯酸酯和弹簧圈。9例患者术后随访观察10-56个月。结果：9例患者栓塞术后肾动脉造影显示畸形血管完全闭塞，3d内血尿消失。随访期间，9例患者中，只有1例单纯应用弹簧圈栓塞患者术后6个月血尿复发，血管造影证实为侧支血管形成导致畸形血管再通，改行无水乙醇及弹簧圈栓塞，术后18个月血尿未再复发。9例患者均无严重并发症发生。结论：经导管肾动脉节段性栓塞是治疗肾动静脉畸形的安全有效的方法，栓塞材料以无水乙醇和弹簧 圈联合栓塞为最佳。

Transcatheter segmental renal arterial embolization for renal arteriovenous malformations

Objective To evaluate the embolic materials and efficacy of transcatheter segmental renal arterial embolization (TAE) for renal arteriovenous malformations (AVM). Methods Nine patients with renal AVM ( congenital 8 cases, acquired 1 case )causing massive hematuria underwent 10 procedures of segmental TAE. The embolic agents included ethanol, PVA, IBCA, and steel coils. 9 patients were followed up for 10 to 56 months after TAE. Results Total occlusion of the renal AVM was accomplished in all 9 patients after TAE. Hematuria ceased within 3 days after TAE. During the follow-up period, hematuria recurred in one patient 6 months after TAE who was treated by coils alone. Renal arterial angiography demonstrated total recanalizations of renal AVM supplied by collateral pathways in the patient. The patient was treated with combined ethanol and steel coils embolization, and no hematuria recurred within 18 months. None of 9 patients had serious complications. Conclusion Segmental TAE is a safe and effective method in the treatment of renal AVM. Among the various embolic agents, combined ethanol with steel coils is the first choice.