CAJ | 학술논문

目的：探讨液体医用胶结合微导管超选择插管技术栓塞治疗肾脏假性动脉瘤的安全性及有效性。方法回顾性分析2009年10月至2014年1月肾动脉造影诊断为肾脏假性动脉瘤并接受福爱乐医用胶栓塞出血血管的23例患者临床资料。23例患者有28枚肾脏假性动脉瘤（18例医源性损伤患者有21枚，5例外伤患者有7枚），均经3 F微导管超选择插管至肾脏假性动脉瘤载瘤动脉，造影明确后在减影下经微导管向假性动脉瘤内注入福爱乐医用胶－碘化油1∶1混合液栓塞出血血管。观察假性动脉瘤栓塞成功率、术后血尿及肾功能。结果23例28枚肾脏假性动脉瘤均栓塞成功，福爱乐医用胶平均用量0．4 ml（0．2～1 ml）。3例患者载瘤动脉邻近3级分支血管出现异位栓塞，无2级分支血管及肾动脉主干血管异位栓塞。1例假性动脉瘤直径＞2 cm患者术后2 d持续存在血尿，再次造影后于载瘤动脉补充塔形弹簧圈1枚，出血停止。其余患者在3个月随访期间均未再出现血尿情况。4例术后血清肌酐有轻度升高。结论福爱乐医用胶结合微导管超选择插管栓塞肾脏假性动脉瘤迅速，栓塞成功率高，术后再出血发生率低，疗效确切。
목적：탐토액체의용효결합미도관초선택삽관기술전새치료신장가성동맥류적안전성급유효성。방법회고성분석2009년10월지2014년1월신동맥조영진단위신장가성동맥류병접수복애악의용효전새출혈혈관적23례환자림상자료。23례환자유28매신장가성동맥류（18례의원성손상환자유21매，5예외상환자유7매），균경3 F미도관초선택삽관지신장가성동맥류재류동맥，조영명학후재감영하경미도관향가성동맥류내주입복애악의용효－전화유1∶1혼합액전새출혈혈관。관찰가성동맥류전새성공솔、술후혈뇨급신공능。결과23례28매신장가성동맥류균전새성공，복애악의용효평균용량0．4 ml（0．2～1 ml）。3례환자재류동맥린근3급분지혈관출현이위전새，무2급분지혈관급신동맥주간혈관이위전새。1례가성동맥류직경＞2 cm환자술후2 d지속존재혈뇨，재차조영후우재류동맥보충탑형탄황권1매，출혈정지。기여환자재3개월수방기간균미재출현혈뇨정황。4례술후혈청기항유경도승고。결론복애악의용효결합미도관초선택삽관전새신장가성동맥류신속，전새성공솔고，술후재출혈발생솔저，료효학절。
Objective To assess the clinical safety and effectiveness of transcatheter arterial embolization by using liquid medical glue ( FLA ) and super-selective catheterization technique in treating renal artery pseudoaneurysm. Methods During the period from Oct. 2009 to Jun. 2014, a total of 23 patients with angiography-proved renal pseudoaneurysm were treated with transcatheter arterial FLA embolization at authors’ hospital. The clinical data were retrospectively analyzed. A total of 28 pseudoaneurysms were detected in the 23 patients, which was caused by iatrogenic injury(18 cases, 21 lesions) or trauma(5 cases, 7 lesions). Super-selective catheterization with 3F micro-catheter was carried out. The micro-catheter was inserted into the parent artery of the pseudoaneurysm, which was followed by angiography. Once the pseudoaneurysm was confirmed by angiography, the mixture of FAL and iodized oil (1 ∶ 1) was injected into the pseudoaneurysm through the micro-catheter. The technical success rate, postoperative hematuria and renal function were determined. Results Successful embolization was achieved for all 28 pseudoaneurysms in 23 patients. The average volume of FAL used in embolization was 0.4 ml (0.2-1 ml). Ectopic embolization of the third-level vessel branches near the parent artery occurred in three cases , while no embolization of second-level vessel branch was observed. Persistent hematuria was seen in one patient even at two days after the treatment, whose pseudoaneurysm’s diameter was >2 cm, and embolization treatment with steel coil had to be performed, and bleeding stopped after the second treatment. During the follow-up period lasting for 3 months, no recurrence of hematuria was seen in the remaining patients. Mild elevation of serum creatinine after the treatment was observed in 4 patients. Conclusion The results of this study indicate that FAL together with the help of micro-catheter super-selective catheterization can effectively and reliably obstruct renal pseudoaneurysm with higher technical success rate and lower re-bleeding rate.