PDF(Pubmed)
Abstract：
Renal arteriovenous anomalies are uncommon. They are characterized by an abnormal vascular connection that usually bypasses the capillary bed. Most are acquired arteriovenous fistulas (AVF) while the rest are congenital or idiopathic arteriovenous malformations (AVM). AVF are usually caused by renal interventions, trauma, or neoplastic processes. They can lead to hypertension, heart failure, hematuria, and renal insufficiency. A 69-year-old woman presented with arrhythmia, tachycardia, mild ankle edema, and increasing fatigue. Right kidney color Doppler ultrasound confirmed the presence of a huge AVM with a blood flow of 9 L/minute and a dilated, 35 mm in diameter, right renal vein. Two months later, an attempt to embolize the AVM failed as the Amplatzer™ Vascular Plug II (Abbott Laboratories, Chicago, Illinois, United States) migrated to the pulmonary circulation and was later removed. Complete embolization was achieved by implanting two Amplatzer Vascular Plug IIs, various embolization coils, histoacryl glue, and lipiodol. Control angiography revealed significant stenosis in the right subclavian artery endovascular access, which was managed with BeGraft (Bentley InnoMed GmbH, Hechingen, Germany) and Zilver (Cook Group Incorporated, Bloomington, Indiana, United States) stents. The patient was discharged on the third postoperative day, all her symptoms resolved, and she reported eventual recovery. Three months later, the patient was operated on due to a 40x58 mm pseudoaneurysm at the right femoral access site. Thus, renal AVMs should be included as a potential alternative diagnosis for various symptoms such as hematuria and hypertension resistant to medication. Endovascular embolization is a less-invasive, safer, and more effective option than open surgery but has a risk of complications. Success requires fully occluding the shunted vessel, preventing embolic material migration, and preserving normal arterial branches. It depends on selecting adequate techniques and embolic materials individually, based on etiology and precise vascular anatomy assessment.
摘要：
肾动静脉异常并不常见。它们的特征在于通常绕过毛细血管床的异常血管连接。大多数是获得性动静脉瘘（AVF），其余是先天性或特发性动静脉畸形（AVM）。AVF通常是由肾脏干预引起的，创伤,或者肿瘤过程。它们会导致高血压，心力衰竭,血尿,和肾功能不全。一名69岁的女性出现了心律不齐,心动过速,轻度踝关节水肿,增加疲劳。右肾彩色多普勒超声证实存在巨大的AVM，血流量为9升/分钟，扩张，直径35毫米，右肾静脉.两个月后,作为Amplatzer™血管栓塞II(雅培实验室,芝加哥,伊利诺伊州,美国）迁移到肺循环，后来被移除。通过植入两个Amplatzer血管塞IIs实现完全栓塞，各种栓塞线圈，组织丙烯酸胶，和碘油。对照血管造影显示右锁骨下动脉血管内通路明显狭窄，由BeGraft管理(BentleyInnoMedGmbH，赫辛根,德国)和齐尔弗(库克集团有限公司，布卢明顿,印第安纳州,美国)支架。病人在术后第三天出院,她所有的症状都消失了,她报告了最终的康复。三个月后,患者因右侧股骨入路部位有40x58mm假性动脉瘤而接受手术治疗.因此，肾AVM应包括作为各种症状的潜在替代诊断，例如血尿和对药物耐药的高血压。血管内栓塞是一种侵入性较小的，更安全,和更有效的选择比开放手术，但有并发症的风险。成功需要完全阻塞分流的血管，防止栓塞物质迁移，保留正常的动脉分支.这取决于单独选择适当的技术和栓塞材料，基于病因和精确的血管解剖评估。
