腹部大動脈解離を合併した左腎動静脈瘤・左腎動静脈瘻

A case of ex vivo renal artery reconstruction and autotransplantation for renal artery aneurysm and renal arteriovenous fistula with aortic dissection

　症例は54歳，男性。高血圧，心不全で加療中，両側下肢疼痛を自覚し，CTで広範な腹部大動脈解離を伴う左腎動脈瘤，左腎動静脈瘻と診断された。腹部大動脈解離は血圧調節による保存的加療とした後に，破裂の危険性を有する左腎動脈瘤と心不全を呈する左腎動静脈瘻に対する加療目的で当科に紹介となった。左腎摘出後，体外で腎血管形成術を行ったうえで自家腎移植術を施行した。術後のカラードプラエコーでは，腎血流は良好であった。

　A 54-year-old male patient complaining intermittent claudication was admitted to our department because of a left renal artery aneurysm（RAA）and renal arteriovenous fistula（AVF）with dissection of the descending aorta,detected by a CT scan. The diameter of the aneurysm was 52×53×50 mm. A 3-dimensional（3D）-CT image revealed a saccular renal aneurysm in the left main renal artery and AVF at lower pole kidney. Because of the risk of rupture,autotransplantation of the left kidney to the left iliac fossa was performed after resecting the aneurysm and reconstructing the left renal artery and vein,under bench surgery. Post operative color Doppler ultrasonography revealed no stenosis. This ex-vivo technique and autotransplantation into ipsilateral iliac fossa are both effective and safe for the treatment of RAA and AVF with dissection of the descending aorta.