コイルを用いた塞栓術により治療しえた広頸の腎動脈瘤

Wide neck renal artery aneurysm treated by coil embolization：A case report

　53歳の男性。主訴は右側腹部痛で，CTで右腎門部に径2cm大，壁の不完全石灰化を伴う腎動脈瘤を認めた。血管造影で，瘤は腎動脈前枝の屈曲部頂点に存在し，流入部が広頸であった。有症状で，径の大きさと不完全石灰化から，コイル塞栓術の適応とした。広頸のためコイルが瘤外に逸脱し，腎梗塞を起こす危険性があるため，まずneck plastyを試みたが，動脈前枝の屈曲が強く，施行できなかった。このため，2回目は瘤より中枢側でバルーン付きカテーテルを用いて血流を遮断し，長い着脱式コイルを挿入しフレーミングを行った。次に血流を再開し，短いコイルで瘤の内腔をパッキングした。短時間の阻血で，末しょうに梗塞を起こすことなく瘤のみに塞栓を施行しえた。術後経過は良好で，症状も消失した。1年経過後も，腎動脈前枝の血流も良好に保たれている。

　A 53-year-old man with a complaint of right flank pain visited our hospital. Computed tomography（CT）revealed a right renal artery aneurysm（2×2 cm）with incomplete wall calcification. Selective renal arteriogram showed a wide neck renal artery aneurysm located at the top of the curve of the anterior segmental artery. From these findings coil embolization was indicated. Since the aneurysm had wide neck,coil embolization appeared to be difficult because of a risk of renal infarction by coil migration. Therefore,neck plasty by a microcatheter with balloon was tried,but after the occlusion of the segmental artery at the proximal side of the aneurysm by inflating a balloon,we performed a framing method with long-type interlocking detached coils（IDCs）. Then a packing method was performed with short-type IDCs after deflation of balloon. An ischemic time of the anterior segmental artery was 2 minites. The embolization was successfully performed without renal infarction. The course after the embolization was uneventful and the flank pain was diminished. The blood flow of the anterior branch of renal artery is well-maintained one year after the embolization.