Surgical Management of Suprarenal Aortic Occlusion with Takayasu’s Arteritis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

李震 ¹ , 汪忠鎬 ² , 王雷永 ¹ , 霍小森 ¹ , 卞策 ³

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Keywords：

大動脈炎; 腹主動脈; 腎動脈; 閉塞; 手術

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目的探討大動脈炎所致腎動脈上腹主動脈閉塞的手術治療方法。方法回顧性分析1例腎動脈上腹主動脈閉塞行腹主動脈-雙股動脈人工血管搭橋手術治療的患者的臨床資料,并進行文獻復習。結果術后患者頭痛明顯好轉，血壓由術前的220/110 mm Hg(1 mm Hg=0.133 kPa)降至160/100 mm Hg,雙下肢踝肱指數由0.50升至1.19。術后2周復查CTA示人工血管通暢，術后3個月復查彩超示人工血管通暢，血壓在(140～150)/(80～95) mm Hg間波動，雙眼視力1.0左右，已恢復正常生活。結論大動脈炎所致腎動脈上腹主動脈閉塞常會影響多個重要臟器的供血，病變復雜，手術時機及方法的正確選擇及長期抗炎治療可以提高患者的治療效果。

Citation： 李震,汪忠鎬,王雷永,霍小森,卞策. Surgical Management of Suprarenal Aortic Occlusion with Takayasu’s Arteritis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(6): 613-614. doi: Copy

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2.	苑超, 吳慶華, 王仕華, 等. 手術治療近腎動脈腹主動脈閉塞癥 [J]. 中華外科雜志， 1996； 34（7）： 388-390.
3.	劉永民，孫立忠，胡盛壽，等. 大動脈炎外科治療的經驗和新進展（附236例報告） [J]. 中國醫刊， 2004； 39（8）： 27-29.
4.	Ryan SV, Calligaro KD, McAffee-Bennett S, et al. Management of juxtarenal aortic aneurysms and occlusive disease with preferential suprarenal clamping via a midline transperitoneal incision: technique and results [J]. Vasc Endovascular Surg, 2004; 38(5): 417-422.
5.	Walsh SR, Boyle JR, Lynch AG, et al. Suprarenal endograft fixation and medium-term renal function: systematic review and meta-analysis [J]. J Vasc Surg, 2008; 47(6): 1364-1370.
6.	Rigberg D, Jimenez JC, Lawrence P, et al. A combined endovascular and open “reverse hybrid” technique for repair of complex juxtarenal inflammatory aortic aneurysms [J]. Vasc Endovascular Surg, 2009; 43(5): 494-496.
7.	Yeung KK, Jongkind V, Coveliers HM, et al. Routine continuous cold perfusion of the kidneys during elective juxtarenal aortic aneurysm repair [J]. Eur J Vasc Endovasc Surg, 2008; 35(4): 446-451.
8.	Yeung KK, Tangelder GJ, Fung WY, et al. Open surgical repair of ruptured juxtarenal aortic aneurysms with and without renal cooling: observations regarding morbidity and mortality [J]. J Vasc Surg, 2010; 51(3): 551-558.
9.	Kksal C, Sarikaya S, Zengin M. Thoracofemoral bypass for treatment of juxtarenal aortic occlusion[J]. Asian Cardiovasc Thorac Ann, 2002; 10(2): 141-144.
10.	Pearce JD, Edwards MS, Stafford JM, et al. Open repair of aortic aneurysms involving the renal vessels [J]. Ann Vasc Surg, 2007; 21(6): 676-686.
11.	Patel R, Conrad MF, Paruchuri V, et al. Balloon expandable st-ents facilitate right renal artery reconstruction during complex open aortic aneurysm repair [J]. J Vasc Surg, 2010; 51(2): 310-315.
12.	符偉國，吳元兵. 腎動脈狹窄的腔內治療 [J]. 中國普外基礎與臨床雜志， 2006; 13（6）： 634-635.
13.	Krauss T, Pfammatter T, Mayer D, et al. Hybrid-repair of thoraco-abdominal or juxtarenal aortic aneurysm: what the radiologist should know [J]. Eur Radiol, 2010; 20(4): 1011-1022.
14.	Nordon IM, Hinchliffe RJ, Holt PJ, et al. Modern treatment of juxtarenal abdominal aortic aneurysms with fenestrated endografting and open repair-a systematic review [J]. Eur J Vasc Endovasc Surg, 2009; 38(1): 35-41.
15.	van de Mortel RH, Vahl AC, Balm R, et al. Collective experience with hybrid procedures for suprarenal and thoracoabdominal aneurysms[J]. Vascular, 2008; 16(3): 140-146.

1. 中華醫學會風濕病學分會. 大動脈炎診治指南(草案) [J]. 中華風濕病學雜志， 2004； 8(8)： 502-504.
2. 苑超, 吳慶華, 王仕華, 等. 手術治療近腎動脈腹主動脈閉塞癥 [J]. 中華外科雜志， 1996； 34（7）： 388-390.
3. 劉永民，孫立忠，胡盛壽，等. 大動脈炎外科治療的經驗和新進展（附236例報告） [J]. 中國醫刊， 2004； 39（8）： 27-29.
4. Ryan SV, Calligaro KD, McAffee-Bennett S, et al. Management of juxtarenal aortic aneurysms and occlusive disease with preferential suprarenal clamping via a midline transperitoneal incision: technique and results [J]. Vasc Endovascular Surg, 2004; 38(5): 417-422.
5. Walsh SR, Boyle JR, Lynch AG, et al. Suprarenal endograft fixation and medium-term renal function: systematic review and meta-analysis [J]. J Vasc Surg, 2008; 47(6): 1364-1370.
6. Rigberg D, Jimenez JC, Lawrence P, et al. A combined endovascular and open “reverse hybrid” technique for repair of complex juxtarenal inflammatory aortic aneurysms [J]. Vasc Endovascular Surg, 2009; 43(5): 494-496.
7. Yeung KK, Jongkind V, Coveliers HM, et al. Routine continuous cold perfusion of the kidneys during elective juxtarenal aortic aneurysm repair [J]. Eur J Vasc Endovasc Surg, 2008; 35(4): 446-451.
8. Yeung KK, Tangelder GJ, Fung WY, et al. Open surgical repair of ruptured juxtarenal aortic aneurysms with and without renal cooling: observations regarding morbidity and mortality [J]. J Vasc Surg, 2010; 51(3): 551-558.
9. Kksal C, Sarikaya S, Zengin M. Thoracofemoral bypass for treatment of juxtarenal aortic occlusion[J]. Asian Cardiovasc Thorac Ann, 2002; 10(2): 141-144.
10. Pearce JD, Edwards MS, Stafford JM, et al. Open repair of aortic aneurysms involving the renal vessels [J]. Ann Vasc Surg, 2007; 21(6): 676-686.
11. Patel R, Conrad MF, Paruchuri V, et al. Balloon expandable st-ents facilitate right renal artery reconstruction during complex open aortic aneurysm repair [J]. J Vasc Surg, 2010; 51(2): 310-315.
12. 符偉國，吳元兵. 腎動脈狹窄的腔內治療 [J]. 中國普外基礎與臨床雜志， 2006; 13（6）： 634-635.
13. Krauss T, Pfammatter T, Mayer D, et al. Hybrid-repair of thoraco-abdominal or juxtarenal aortic aneurysm: what the radiologist should know [J]. Eur Radiol, 2010; 20(4): 1011-1022.
14. Nordon IM, Hinchliffe RJ, Holt PJ, et al. Modern treatment of juxtarenal abdominal aortic aneurysms with fenestrated endografting and open repair-a systematic review [J]. Eur J Vasc Endovasc Surg, 2009; 38(1): 35-41.
15. van de Mortel RH, Vahl AC, Balm R, et al. Collective experience with hybrid procedures for suprarenal and thoracoabdominal aneurysms[J]. Vascular, 2008; 16(3): 140-146.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Surgical Management of Suprarenal Aortic Occlusion with Takayasu’s Arteritis

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