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

Authors：

李震 ¹ , 汪忠镐 ² , 王雷永 ¹ , 霍小森 ¹ , 卞策 ³

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Keywords：

大动脉炎; 腹主动脉; 肾动脉; 闭塞; 手术

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目的探讨大动脉炎所致肾动脉上腹主动脉闭塞的手术治疗方法。方法回顾性分析1例肾动脉上腹主动脉闭塞行腹主动脉-双股动脉人工血管搭桥手术治疗的患者的临床资料,并进行文献复习。结果术后患者头痛明显好转，血压由术前的220/110 mm Hg(1 mm Hg=0.133 kPa)降至160/100 mm Hg,双下肢踝肱指数由0.50升至1.19。术后2周复查CTA示人工血管通畅，术后3个月复查彩超示人工血管通畅，血压在(140～150)/(80～95) mm Hg间波动，双眼视力1.0左右，已恢复正常生活。结论大动脉炎所致肾动脉上腹主动脉闭塞常会影响多个重要脏器的供血，病变复杂，手术时机及方法的正确选择及长期抗炎治疗可以提高患者的治疗效果。

Citation： 李震,汪忠镐,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

1.	中华医学会风湿病学分会. 大动脉炎诊治指南(草案) [J]. 中华风湿病学杂志， 2004； 8(8)： 502-504.
2.	苑超, 吴庆华, 王仕华, 等. 手术治疗近肾动脉腹主动脉闭塞症 [J]. 中华外科杂志， 1996； 34（7）： 388-390.
3.	刘永民，孙立忠，胡盛寿，等. 大动脉炎外科治疗的经验和新进展（附236例报告） [J]. 中国医刊， 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.	符伟国，吴元兵. 肾动脉狭窄的腔内治疗 [J]. 中国普外基础与临床杂志， 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. 中华医学会风湿病学分会. 大动脉炎诊治指南(草案) [J]. 中华风湿病学杂志， 2004； 8(8)： 502-504.
2. 苑超, 吴庆华, 王仕华, 等. 手术治疗近肾动脉腹主动脉闭塞症 [J]. 中华外科杂志， 1996； 34（7）： 388-390.
3. 刘永民，孙立忠，胡盛寿，等. 大动脉炎外科治疗的经验和新进展（附236例报告） [J]. 中国医刊， 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. 符伟国，吴元兵. 肾动脉狭窄的腔内治疗 [J]. 中国普外基础与临床杂志， 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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