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首页> 外文期刊>Acta Radiologica >Management of isolated non-traumatic renal artery dissection: Report of four cases
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Management of isolated non-traumatic renal artery dissection: Report of four cases

机译：孤立性非创伤性肾动脉夹层的处理：四例报告

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Background: Isolated non-traumatic renal artery dissection (RAD) is a rare disorder with uncertain natural history. The management may be surgical reconstruction, endovascular repair, or conservative medical treatment, yet no official consensus had been established. Purpose: To report the management of four cases of isolated non-traumatic RAD, emphasizing the beneficial role of conservative medical treatment. Material and Methods: From the year 2000 till 2011, four male patients with mean age of 42.5 years (range 34-48 years) presented with isolated non-traumatic RAD and were initially treated with medical therapy. Transcatheter in situ thrombolysis was performed in a case with thrombotic occlusion. Results: Isolated non-traumatic RAD in four patients involving at least seven branches progressed to thrombotic occlusion in two branches, luminal narrowing in five, dual lumens in two, and aneurysmal dilatation in three. Medical treatment was efficacious in three patients, who showed persistent preserved renal function, controlled blood pressure, and favorable arterial remodeling. After failure of medical therapy, the fourth patient was referred to surgery. Thrombolysis was successful to dissolute an occluding thrombotic dissection. Conclusion: Conservative therapy is safe and effective when the renal artery is patent and blood pressure is controlled: we propose it as the first line of treatment, reserving interventional management for refractory cases.
机译：背景：孤立的非创伤性肾动脉夹层动脉瘤（RAD）是一种罕见的疾病，自然史不确定。管理可能是外科手术重建，血管内修复或保守治疗，但尚未建立正式共识。目的：报告4例孤立的非创伤性RAD病例的治疗，强调保守治疗的有益作用。材料与方法：从2000年至2011年，四名平均年龄为42.5岁（范围34-48岁）的男性患者出现孤立的非创伤性RAD，并接受了药物治疗。经血栓闭塞的患者行经导管原位溶栓治疗。结果：4例涉及至少7个分支的非创伤性RAD进展为2个分支血栓闭塞，5个腔狭窄，2个双腔和3个动脉瘤扩张。三名患者的药物治疗有效，他们表现出持续的肾功能得以维持，血压得到控制以及良好的动脉重构。在药物治疗失败后，第四名患者被转介手术。溶栓成功地消除了阻塞性血栓夹层。结论：在肾动脉未闭，血压可控的情况下，保守治疗是安全有效的：我们建议将其作为治疗的第一线，保留难治性病例的介入治疗。

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