Treatment of Renal Artery Aneurysm by ex situ Repair and Autotransplantation: A Nationwide Cohort Study.

IF 1.7 4区医学 Q2 SURGERY

European Surgical Research Pub Date : 2024-01-01 Epub Date: 2024-10-04 DOI:10.1159/000541814

Yitian Fang, Hendrikus J A N Kimenai, Ron W F de Bruin, Dorottya K de Vries, Bart-Jeroen Petri, Michiel C Warlé, Ignace F J Tielliu, Jorinde van Laanen, Mirza M Idu, Robert A Pol, Robert C Minnee

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引用次数: 0

Abstract

Introduction: Renal artery aneurysm (RAA) is a rare vascular disease with a mortality rate of up to 80% upon rupture. This study aimed to investigate the safety and efficacy of ex situ repair and autotransplantation for endovascularly untreatable RAA.

Methods: A retrospective nationwide cohort study was conducted in RAA patients undergoing ex situ repair and autotransplantation in the Netherlands. Surgical techniques, postoperative complications, and graft outcomes were assessed.

Results: Ex situ repair was performed in 9 patients with 11 RAAs. Eight RAAs were located at the first bifurcation, one on the main trunk, one on the first branch, and one on the second branch. Nephrectomy was performed via laparoscopy (n = 7), robotic-assisted laparoscopy (n = 1), and laparotomy (n = 1). Postoperative complications were recorded in 4 patients, including bowel obstruction, delirium, pneumonia, and hydronephrosis due to double-J dislocation. The median estimated glomerular filtration rate was 83 mL/min/1.73 m2 pretransplant and 88 mL/min/1.73 m2 posttransplant. By an average follow-up of 32 months, 2 patients had died due to lung adenocarcinoma and stroke, while all autotransplanted kidneys had good patency and remained functional.

Conclusions: Ex situ repair and autotransplantation are safe and feasible for endovascularly untreatable RAA cases. Larger cohorts with longer follow-up periods are necessary to further evaluate the role of this surgical approach.

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通过原位修复和自体移植治疗肾动脉瘤：一项全国性队列研究。

导言：肾动脉瘤（RAA）是一种罕见的血管疾病，破裂后死亡率高达 80%。本研究旨在探讨原位修复和自体移植治疗无法通过血管内治疗的 RAA 的安全性和有效性。方法在荷兰对接受原位修复和自体移植的 RAA 患者进行了一项全国性回顾性队列研究。对手术技术、术后并发症和移植物效果进行了评估。结果对 9 名患者的 11 个 RAA 进行了原位修复。其中 8 例 RAA 位于第一分叉处，1 例位于主干，1 例位于第一分支，1 例位于第二分支。肾切除术通过腹腔镜（7 例）、机器人辅助腹腔镜（1 例）和开腹手术（1 例）进行。四名患者出现了术后并发症，包括肠梗阻、谵妄、肺炎和双J脱位导致的肾积水。移植前估计肾小球滤过率（eGFR）中位数为 83 毫升/分钟/1.73 平方米，移植后为 88 毫升/分钟/1.73 平方米。在平均 3 年的随访中，两名患者因肺癌和中风死亡，而所有自体移植的肾脏都具有良好的通畅性并保持功能。结论对于血管内无法治疗的 RAA 病例，原位修复和自体移植是安全可行的。为了进一步评估这种手术方法的作用，有必要进行更大规模、更长时间的随访。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Surgical Research 医学-外科

CiteScore

2.30

自引率

6.20%

发文量

审稿时长

>12 weeks

期刊介绍： ''European Surgical Research'' features original clinical and experimental papers, condensed reviews of new knowledge relevant to surgical research, and short technical notes serving the information needs of investigators in various fields of operative medicine. Coverage includes surgery, surgical pathophysiology, drug usage, and new surgical techniques. Special consideration is given to information on the use of animal models, physiological and biological methods as well as biophysical measuring and recording systems. The journal is of particular value for workers interested in pathophysiologic concepts, new techniques and in how these can be introduced into clinical work or applied when critical decisions are made concerning the use of new procedures or drugs.