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[摘要] 目的 总结三维数字减影血管造影（3D-DSA）在移植肾动脉吻合口假性动脉瘤腔内修复中的应用体会。
方法 回顾性分析2012年4月—2020年10月在我院行腔内修复的4例移植肾动脉吻合口假性动脉瘤病人的3D-DSA影像资料，其中1例病人在二次手術时行第2次3D-DSA检查。
结果 5次3D-DSA经容积重建（VR）获得的三维图像均能清楚显示吻合口假性动脉瘤瘤颈及其与邻近血管的空间解剖关系，为腔内覆膜支架置入和球囊扩张提供最佳的工作角度。
结论 在移植肾动脉吻合口假性动脉瘤病人需要进行腔内介入手术干预时，3D-DSA可作为一项重要的诊疗技术。
[关键词] 肾移植;动脉瘤，假性;血管造影术，数字减影;成像，三维;图像处理，计算机辅助;血管成形术
[中图分类号] R654.3;R816.2
[文献标志码] B
[文章编号] 2096-5532（2021）05-0773-04
doi：10.11712/jms.2096-5532.2021.57.177
[开放科学（资源服务）标识码（OSID）]
[网络出版] https：//kns.cnki.net/kcms/detail/37.1517.R.20211029.1732.006.html;2021-11-01 10：52：01
PRELIMINARY EFFECT OF THREE-DIMENSIONAL DIGITAL SUBTRACTION ANGIOGRAPHY IN ENDOVASCULAR REPAIR OF PSEUDOANEURYSM AT THE ARTERIAL ANASTOMOSIS OF THE TRANSPLANTED KIDNEY
ZHANG Kunpeng， LIU Jingli， SANG Guifeng， YANG Mu
（Department of Catheterization Room， The Affiliated Yantai Yuhuangding Hospital of Qingdao University， Yantai 264000， China）
[ABSTRACT] Objective To summarize the experience in the application of three-dimensional digital subtraction angiography （3D-DSA） in endovascular repair of pseudoaneurysm at the arterial anastomosis of the transplanted kidney.
Methods A retrospective analysis was performed for the 3D-DSA imaging data of four patients with pseudoaneurysm at the arterial anastomosis of the transplanted kidney who underwent endovascular repair in our hospital from April 2012 to October 2020， among whom one patient underwent 3D-DSA examination for the second time during the second surgery.
Results The three-dimensional images obtained by volume reconstruction of the five times of 3D-DSA clearly displayed the aneurysm neck of pseudoaneurysm at the anastomosis and its spatial anatomical relationship with adjacent blood vessels， which provided the best working angle for endovascular covered stent implantation and balloon dilatation.
Conclusion 3D-DSA can be used as an important diagnosis and treatment technique in patients with pseudoaneurysm at the arterial anastomosis of the transplanted kidney who require intravascular intervention.
[KEY WORDS] kidney transplantation; aneurysm， false; angiography， digital subtraction; imaging， three-dimensional; image processing， computer-assisted; angioplasty
移植肾动脉吻合口假性动脉瘤是一种罕见的血管并发症，其发生率为0.3%[1]。该病具有潜在的破坏性，可能破裂而导致移植肾丢失[2]。其病因通常为缝合技术缺陷、术中血管壁损伤或局部感染引起的吻合口动脉破裂[3-4]。近年来，血管腔内修复已成为移植肾动脉吻合口假性动脉瘤的一种有效治疗方法[2，5-6]，最大程度避免了大血管重建手术创伤以及相关并发症的发生[7]。三维数字减影血管造影（3D-DSA）已被公认为神经介入放射学脑血管疾病诊断的金标准[8-11]，其检测能力明显优于三维计算机断层血管造影（3D-CTA）和二维数字减影血管造影（2D-DSA）[12-13]。我们将3D-DSA技术运用于4例移植肾动脉吻合口假性动脉瘤病人的诊疗中，本文总结其应用体会，探讨其可行性。 [23]THRON A， VOIGT K. Rotational cerebral angiography： Procedure and value[J]. American Journal of Neuroradiology， 1983，4（3）：289-291.
[24]SCHUMACHER M， KUTLUK K， OTT D. Digital rotational radiography in neuroradiology[J]. American Journal of Neuroradiology， 1989，10（3）：644-649.
[25]CARSIN M， CHABERT E， CROCI S， et al. The role of 3-dimensional reconstructions in the angiographic evaluation of cerebral vascular malformations：3D morphometry[J]. Journal De Neuroradiologie， 1997，24（2）：137-140.
[26]ANZALONE N， RIGHI C， SIMIONATO F， et al. Three-dimensional time-of-flight MR angiography in the evaluation of intracranial aneurysms treated with Guglielmi detachable coils[J]. American Journal of Neuroradiology， 2000，21（4）：746-752.
[27]SATO M， ENDO Y， MATSUMOTO M， et al. Three-dimensional CT angiography in acute cerebral aneurysm surgery[J]. Japanese Journal of Neurosurgery， 2001，10（1）：18-26.
[28]PEDICELLI A， ROLLO M， LELLA G M， et al. 3D rotational angiography for the diagnosis and preoperative assessment of intracranial aneurysms： preliminary experience[J]. La Radiologia Medica， 2007，112（6）：895-905.
[29]BECK J， ROHDE S， BERKEFELD J， et al. Size and location of ruptured and unruptured intracranial aneurysms measured by 3-dimensional rotational angiography[J]. Surgical Neurology， 2006，65（1）：18-25;discussion25-27.
（本文編辑 马伟平）
方法 回顾性分析2012年4月—2020年10月在我院行腔内修复的4例移植肾动脉吻合口假性动脉瘤病人的3D-DSA影像资料，其中1例病人在二次手術时行第2次3D-DSA检查。
结果 5次3D-DSA经容积重建（VR）获得的三维图像均能清楚显示吻合口假性动脉瘤瘤颈及其与邻近血管的空间解剖关系，为腔内覆膜支架置入和球囊扩张提供最佳的工作角度。
结论 在移植肾动脉吻合口假性动脉瘤病人需要进行腔内介入手术干预时，3D-DSA可作为一项重要的诊疗技术。
[关键词] 肾移植;动脉瘤，假性;血管造影术，数字减影;成像，三维;图像处理，计算机辅助;血管成形术
[中图分类号] R654.3;R816.2
[文献标志码] B
[文章编号] 2096-5532（2021）05-0773-04
doi：10.11712/jms.2096-5532.2021.57.177
[开放科学（资源服务）标识码（OSID）]
[网络出版] https：//kns.cnki.net/kcms/detail/37.1517.R.20211029.1732.006.html;2021-11-01 10：52：01
PRELIMINARY EFFECT OF THREE-DIMENSIONAL DIGITAL SUBTRACTION ANGIOGRAPHY IN ENDOVASCULAR REPAIR OF PSEUDOANEURYSM AT THE ARTERIAL ANASTOMOSIS OF THE TRANSPLANTED KIDNEY
ZHANG Kunpeng， LIU Jingli， SANG Guifeng， YANG Mu
（Department of Catheterization Room， The Affiliated Yantai Yuhuangding Hospital of Qingdao University， Yantai 264000， China）
[ABSTRACT] Objective To summarize the experience in the application of three-dimensional digital subtraction angiography （3D-DSA） in endovascular repair of pseudoaneurysm at the arterial anastomosis of the transplanted kidney.
Methods A retrospective analysis was performed for the 3D-DSA imaging data of four patients with pseudoaneurysm at the arterial anastomosis of the transplanted kidney who underwent endovascular repair in our hospital from April 2012 to October 2020， among whom one patient underwent 3D-DSA examination for the second time during the second surgery.
Results The three-dimensional images obtained by volume reconstruction of the five times of 3D-DSA clearly displayed the aneurysm neck of pseudoaneurysm at the anastomosis and its spatial anatomical relationship with adjacent blood vessels， which provided the best working angle for endovascular covered stent implantation and balloon dilatation.
Conclusion 3D-DSA can be used as an important diagnosis and treatment technique in patients with pseudoaneurysm at the arterial anastomosis of the transplanted kidney who require intravascular intervention.
[KEY WORDS] kidney transplantation; aneurysm， false; angiography， digital subtraction; imaging， three-dimensional; image processing， computer-assisted; angioplasty
移植肾动脉吻合口假性动脉瘤是一种罕见的血管并发症，其发生率为0.3%[1]。该病具有潜在的破坏性，可能破裂而导致移植肾丢失[2]。其病因通常为缝合技术缺陷、术中血管壁损伤或局部感染引起的吻合口动脉破裂[3-4]。近年来，血管腔内修复已成为移植肾动脉吻合口假性动脉瘤的一种有效治疗方法[2，5-6]，最大程度避免了大血管重建手术创伤以及相关并发症的发生[7]。三维数字减影血管造影（3D-DSA）已被公认为神经介入放射学脑血管疾病诊断的金标准[8-11]，其检测能力明显优于三维计算机断层血管造影（3D-CTA）和二维数字减影血管造影（2D-DSA）[12-13]。我们将3D-DSA技术运用于4例移植肾动脉吻合口假性动脉瘤病人的诊疗中，本文总结其应用体会，探讨其可行性。 [23]THRON A， VOIGT K. Rotational cerebral angiography： Procedure and value[J]. American Journal of Neuroradiology， 1983，4（3）：289-291.
[24]SCHUMACHER M， KUTLUK K， OTT D. Digital rotational radiography in neuroradiology[J]. American Journal of Neuroradiology， 1989，10（3）：644-649.
[25]CARSIN M， CHABERT E， CROCI S， et al. The role of 3-dimensional reconstructions in the angiographic evaluation of cerebral vascular malformations：3D morphometry[J]. Journal De Neuroradiologie， 1997，24（2）：137-140.
[26]ANZALONE N， RIGHI C， SIMIONATO F， et al. Three-dimensional time-of-flight MR angiography in the evaluation of intracranial aneurysms treated with Guglielmi detachable coils[J]. American Journal of Neuroradiology， 2000，21（4）：746-752.
[27]SATO M， ENDO Y， MATSUMOTO M， et al. Three-dimensional CT angiography in acute cerebral aneurysm surgery[J]. Japanese Journal of Neurosurgery， 2001，10（1）：18-26.
[28]PEDICELLI A， ROLLO M， LELLA G M， et al. 3D rotational angiography for the diagnosis and preoperative assessment of intracranial aneurysms： preliminary experience[J]. La Radiologia Medica， 2007，112（6）：895-905.
[29]BECK J， ROHDE S， BERKEFELD J， et al. Size and location of ruptured and unruptured intracranial aneurysms measured by 3-dimensional rotational angiography[J]. Surgical Neurology， 2006，65（1）：18-25;discussion25-27.
（本文編辑 马伟平）