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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 5 2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 ,2 1例显示动脉吻合口狭窄 ,2例吻合口处动脉瘤形成 (其中 1例合并吻合口狭窄 ) ,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
Objective To summarize the experience and value of interventional treatment of arterial complications after renal transplantation. Methods Fifty-two patients undergoing renal angiography were retrospectively analyzed. Interventional therapy included intra-arterial angioplasty for arterial stenosis and intra-arterial embolization with urokinase thrombolysis for acute thromboembolism and pseudoaneurysm. Results 12 cases of renal artery graft were normal, 21 cases showed arterial anastomotic stenosis, 2 cases of anastomotic aneurysm formation (including 1 case with anastomotic stenosis), 14 cases of renal artery thrombosis and 3 cases of transplantation Renal artery sparse. In renal transplant recipients with simple renal artery stenosis, 16 cases underwent trans-arterial angioplasty (simple balloon dilatation in 12 cases and endovascular stent in 4 cases), of which 14 cases returned to normal, 2 cases had poor postoperative renal function recovery, Transplant nephrectomy. Thirteen patients with arterial thrombosis underwent thrombolytic therapy (one stent was placed after thrombolysis). Three patients failed thrombolysis. One patient had no significant recovery of renal function and the other nine returned to normal. One case of pseudoaneurysm with anastomotic stenosis received anastomotic balloon dilatation and stent treatment, aneurysm embolization, angiography review aneurysm disappeared, clinical symptoms improved. Conclusions Endovascular interventional therapy provides further treatment for postoperative complications of renal transplantation, which can save the graft kidney as soon as possible