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Balloon Angioplasty in a Pediatric Renal Artery Occlusion

소아 신장 동맥 폐색에서의 풍선 혈관성형술

  • Song, Hwayoung (Department of Radiology, Hallym University Sacred Heart Hospital) ;
  • Jung, Hye Doo (Department of Radiology, Human Medical Imaging and Intervention Center) ;
  • Kim, Jeong-Eun (Department of Radiology, Hallym University Sacred Heart Hospital) ;
  • Lee, Sang Min (Department of Radiology, Hallym University Sacred Heart Hospital) ;
  • Hong, Wonju (Department of Radiology, Hallym University Sacred Heart Hospital) ;
  • Lee, Kwanseop (Department of Radiology, Hallym University Sacred Heart Hospital)
  • 송화영 (한림대학교 성심병원 영상의학과) ;
  • 정혜두 (휴먼영상의학센터 영상의학과) ;
  • 김정은 (한림대학교 성심병원 영상의학과) ;
  • 이상민 (한림대학교 성심병원 영상의학과) ;
  • 홍원주 (한림대학교 성심병원 영상의학과) ;
  • 이관섭 (한림대학교 성심병원 영상의학과)
  • Received : 2018.06.01
  • Accepted : 2018.06.29
  • Published : 2018.12.01

Abstract

Renal artery injury is a rare complication in blunt trauma, but can cause devascularization of the kidney, leading to renal failure. It requires early diagnosis and management. The treatment of renal artery injury still remains controversial, but recent studies have reported the successful treatment outcome with endovascular stent placement. Nevertheless, there is no standard treatment strategy in cases of pediatric patients. We report a case of a 16-year-old girl with right renal artery occlusion associated with a grade IV liver laceration. She was treated with only balloon angioplasty, and the kidney showed marked improvement of parenchymal perfusion with normalized renal function. Treatment with only balloon angioplasty can be a treatment option in pediatric patients with renal artery injury.

신장 동맥 손상은 둔상의 드문 합병증이나, 신장의 혈류 차단을 일으켜 신부전증을 일으킬 수도 있어 조기 진단과 치료가 필요하다. 신장 동맥 손상의 치료 방법은 아직 논란이 남아 있기는 하지만, 최근 연구들에서 혈관 내 스텐트를 이용한 성공적인 치료 결과가 보고 되었다. 그러나 아직 소아 환자에 대해서는 표준 치료법이 정해지지 않았다. 우리는 16세 여자 환아에서 발생한 4등급 간 열상과 동반된 우측 신장 동맥 폐색 증례를 보고하고자 한다. 환아는 풍선 혈관형성술만을 이용한 치료를 시행 받았고, 후에 신장의 실질 혈류 관류가 뚜렷하게 개선되었으며 신기능이 정상화 되었다. 따라서 소아 환자에서 신장 동맥 손상이 발생했을 경우, 풍선 혈관형성술을 이용한 시술이 치료의 한가지 방법이 될 수 있다.

Keywords

References

  1. Bruce LM, Croce MA, Santaniello JM, Miller PR, Lyden SP, Fabian TC. Blunt renal artery injury: incidence, diagnosis, and management. Am Surg 2001;67:550-554
  2. Abu-Gazala M, Shussman N, Abu-Gazala S, Elazary R, Bala M, Rozenberg S, et al. Endovascular management of blunt renal artery trauma. Isr Med Assoc J 2013;15:210-215
  3. Brown SL, Elder JS, Spirnak JP. Are pediatric patients more susceptible to major renal injury from blunt trauma? A comparative study. J Urol 1998;160:138-140 https://doi.org/10.1016/S0022-5347(01)63071-4
  4. Dinchman KH, Spirnak JP. Traumatic renal artery thrombosis: evaluation and treatment. Semin Urol 1995;13:90-93
  5. Haas CA, Dinchman KH, Nasrallah PF, Spirnak JP. Traumatic renal artery occlusion: a 15-year review. J Trauma 1998;45:557-561 https://doi.org/10.1097/00005373-199809000-00024
  6. Spirnak JP, Resnick MI. Revascularization of traumatic thrombosis of the renal artery. Surg Gynecol Obstet 1987;164:22-26
  7. Cass AS. Renovascular injuries from external trauma. Diagnosis, treatment, and outcome. Urol Clin North Am 1989;16:213-220
  8. Flye MW, Anderson RW, Fish JC, Silver D. Successful surgical treatment of anuria caused by renal artery occlusion. Ann Surg 1982;195:346-353 https://doi.org/10.1097/00000658-198203000-00016
  9. Breyer BN, Master VA, Marder SR, McAninch JW. Endovascular management of trauma related renal artery thrombosis. J Trauma 2008;64:1123-1125 https://doi.org/10.1097/01.ta.0000246195.13078.8d
  10. Yokoyama S, Sekioka A, Utsunomiya H, Shimada K. Traumatic renal artery occlusion associated with a grade III hepatic injury in an 11-year-old boy: a case report. J Pediatr Surg Case Rep 2014;2:126-129 https://doi.org/10.1016/j.epsc.2014.02.014