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首页> 外文期刊>Sao Paulo Medical Journal >Postnephrectomy arteriovenous fistula
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Postnephrectomy arteriovenous fistula

机译：肾切除术后动静脉瘘

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The development of the postnephrectomy arteriovenous fistula (PNAVF) between the renal vessels stumps is rare. Here we present a case report of PNAVF, and review the diagnosis, treatment and prevention.The most common clinical features include a loud murmur over the previous nephrectomy scar, and heart failure resistant to common medical treatment. A 58-year-old white woman was admitted to the hospital for a complete evaluation of an unexplained congestive heart failure with no response to common medical treatment. She had had a right nephrectomy for pyonephrosis 13 years before. The diagnosis of PNAVF was suspected because over the right lumbar region a definite trill was palpated, and on auscultation a harsh, machinery-like murmur was heard.The diagnosis was confirmed by aortogram and selective renal arteriography. In May 1989, the right arteriovenous was excised through a right subcostal transperitoneal approach. The renal vessel stumps were individually ligated and sutured separately close to aorta and vena cava. The patient's postoperative course was entirely uneventful in the following seven years. We conclude that during nephrectomy, the renal vessels should be ligated separately, and the transfixation in mass of the stumps avoided to prevent arteriovenous fistula.
机译：肾血管残端之间的肾切除术后动静脉瘘（PNAVF）的发展很少。在此我们提供PNAVF的一例病例报告，并对其诊断，治疗和预防进行回顾。最常见的临床特征包括先前的肾切除术疤痕发出较大的杂音，以及对常规药物有抗药性的心力衰竭。一名58岁的白人妇女入院，对原因不明的充血性心力衰竭进行了全面评估，对普通药物没有反应。她在13年前因肾盂积水进行了右肾切除术。怀疑PNAVF的诊断是因为在右侧腰部区域触诊了一定的tri子，听诊时听到了刺耳的机械性杂音。通过主动脉造影和选择性肾动脉造影证实了该诊断。 1989年5月，通过右肋下经腹膜入路切除了右动静脉。分别结扎肾血管残端，并分别缝合在主动脉和腔静脉附近。在随后的七年中，患者的术后过程完全平稳。我们得出的结论是，在肾切除术中，应分别结扎肾血管，避免树桩块的固定，以防止动静脉瘘。

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