経皮的血管形成術が奏功した外傷性両側腎動脈閉塞の1例

抄録

A 21-year-old man admitted with shock due to severe pelvic fracture after a motorcycle accident was found in contrastenhanced computed tomography (CT) to have no renal visualization except for the upper pole of the right kidney and only part of the left kidney. Aortography showed complete occlusion of the right renal artery and a circumferential intimal defect of the left renal artery. Fearing that surgical exploration would increase retroperitoneal hemorrhage, we conducted percutaneous transluminal angioplasty (PTA) and placed a Palmaz stent in the left main renal artery 18 hours after injury, after which urine output progressively increased. Hemodialysis was needed until hospital day 29, after which renal function gradually improved. Repeated renal scintigraphy was useful in determining renal function. On hospital day 160, aortography showed the left main renal artery to be patent and stenosis-free. The man was discharged on hospital day 165. Traumatic bilateral renal arterial occlusion is rare, with only 21 cases reviewed in the literature. Early diagnosis and treatment are essential to avoid permanent by impaired renal function. We found that PTA is a viable alternative to surgical revascuralization, especially in patients who are hypotensive without a need for surgical exploration for further abdominal injury.