Transarterial embolization of renal artery in dogs with experimental hydronephrosis

장동우,Chang, Dongwoo The Korean Society of Veterinary Science 2001 大韓獸醫學會誌 Vol.41 No.3

개에서 실험적으로 편측성 신수종증을 유발한 후, 이오헥솔-에탄올 용액을 신장동맥내로 주입하여 신수종증이 유발된 신장으로의 혈류를 차단하는 신동맥 색전술을 확립하고자 본 실험을 실시하였다. 실험적 수신증은 12두의 개의 편측 근위 요관을 이중결찰하여 유발하였다. 편측의 수뇨관을 결찰한 후, 초음파상으로 동측 신장의 장축길이가 유발전에 비하여 9일째(p<0.05)와, 17일째(p<0.005)에 유의적으로 증가하였으며, 동측 신장의 피질길이가 17일째에 유의적으로 감소하며, 아울러 확장된 신우내에 액체가 저류하는 것을 관찰할 수 있었다. BUN, creatinine, ALT, calcium, phosphorus는 변화하지 않았다. 이를 통하여 12두의 개에서 요관 결찰 17일째에 편측성 수신증이 유발되었음을 확인할 수 있었다. 신장동맥 색전술은 7두의 신수종증이 유발된 신장측의 신장동맥에 대퇴동맥을 통하여 선택적으로 카테터를 삽입한 후 이오헥솔-에탄올 용액을 주입하였으며, 시술 중 심전도, 산소포화도, 체온, 맥박, 호흡수는 모두 정상범위에 있었다. 주입한 평균 에탄올 용량은 $1.94{\pm}1.24ml/kg$였다. 신장동맥 색전술 후 사망한 개체는 없었으며, 색전물질의 유출로 인한 부작용도 관찰할 수 없었다. 색전술 직후 그리고 14일째에 실시한 선택적 동맥촬영술을 통하여 색전술을 시행한 7두의 개의 신장동맥에서 재맥관화가 발생하지 않았음을 확인할 수 있었다. 초음파 검사를 통하여 신장동맥 색전술을 시행한 7두의 개의 색전된 신장은 평균 장축길이가 반대편 정상 신장에 비하여 2달째와 3달째에 유의적으로 감소하였음을 확인할 수 있었다. 이오헥솔-에탄올 용액을 이용하여 실시한 신장동맥색전술은 개의 수신증을 치료하는 안전하며, 비교적 비침습적인 치료법으로 기존의 신장절제술의 대안이 될 수 있을 것으로 사료된다. This study was performed to validate the procedure of transarterial embolization of the renal artery (TAE-RA) using iohexol-ethanol solution in dogs with unilateral experimental hydronephrosis and to evaluate the embolized kidney using B-mode ultrasonography and selective angiography. Experimental hydronephrosis was induced by ligation of unilateral ureter in 12 dogs. Ultrasonographic findings revealed that size of the kidney was significantly increased at 9 days and 17 days and the length of renal cortex was significantly decreased at 17 days after ligation of the unilateral ureter and it was in accordance with dilation of ipsilateral renal pelvis. No significant change of BUN, creatinine, ALT, calcium, and phosphorus was found immediately after unilateral experimental hydronephrosis. Therefore, it was concluded that unilateral hydronephrosis was established in 12 dogs at 17 days after ligation of ureter. Renal artery embolization was performed using selective catheterization in the hydronephrotic kidney of seven dogs and EKG, $SpO_2$, body temperature, pulse, and respiratory rate were within normal ranges during procedures. Iohexol-ethanol solution was used as embolic material. Average ethanol dose for renal artery embolization was $1.94{\pm}1.24ml/kg$. There were no dogs expired after TAE-RA and no side effects associated with regurgitation of iohexol-ethanol solution. Revascularization of renal artery was not found in angiography in dogs treated by TAE-RA at immediately after TAE-RA and 14 days after TAE-RA. Ultrasonographically, the mean longitudinal length of the embolized kidney decreased significantly at 2 and 3 months after TAE-RA compared to that of contralateral normal kidney. In summary, marked shrinkage of the embolized kidney was observed in dogs with unilateral experimental hydronephrosis treated by TAE-RA with iohexol-ethanol and no adverse effects were observed throughout the observation period. It is concluded that TAE-RA with iohexol-ethanol solution is a viable alternative to nephrectomy in dogs with unilateral hydronephrosis.

Renal hemodynamics in dogs with experimental hydronephrosis treated with transarterial embolization of renal artery

장동우,Chang, Dongwoo The Korean Society of Veterinary Science 2001 大韓獸醫學會誌 Vol.41 No.3

개에서 실험적으로 편측성 신수종증을 유발한 후, 이오헥솔-에탄올 용액을 신장동맥내로 주입하여 신수종증이 유발된 신장으로서의 혈류를 차단하는 신동맥 색전술을 실시한 후, 컬러 도플러 초음파상을 이용하여 색전술이 실시된 신수종증의 신장과 반대편 정상신장을 평가하고자 본 실험을 실시하였다. 수뇨관 결찰 후, 유발 전에 비하여 혈관저항지수가 4일, 9일, 17일째에 유의적으로 증가하였으며, BUN, creatinine, ALT, calcium, phosphorus는 변화하지 않았다. 이를 통하여 12두의 개에서 요관 결찰 17일째에 편측성 수신증이 유발되었음을 확인할 수 있었다. 신장동맥 색전술은 7두의 신수종증이 유발된 신장측의 신장동맥에 대퇴동맥을 통하여 선택적으로 카테터를 삽입한 후 이오헥솔-에탄올 용액을 주입하였으며, 시술 중 심전도, 산소포화도, 체온 맥박, 호흡수는 모두 정상범위에 있었다. 신장동맥 색전술 후 사망한 개체는 없었으며, 색전물질의 유출로 인한 부작용도 관찰할 수 없었다. 색전술 실시 후 시행한 칼라도플러 초음파 검사에서는 7두 모두에서 실험 전 기간에 걸쳐 색전된 신장에서 혈관신호를 관찰할 수 없었으나, 색전술을 실시하지 않은 5두에서는 신장내에서 혈관신호를 관찰할 수 있었다. 그리고 색전술을 실시한 7두의 정상신장의 평균 혈관저항지수는 정상견의 혈관저항지수와 유의적인 차이가 없음을 확인할 수 있었다. 칼러 도플러 초음파 검사법은 개의 수신증에 실시한 신장동맥 색전술 후의 신장동맥의 재맥관화를 평가할 수 있는 간편하며, 비침습적인 검사법으로 사료된다. This study was performed to evaluate the renal hemodynamics using color Doppler ultrasonography in dogs with unilateral experimental hydronephrosis treated with transarterial embolization of the renal artery (TAE-RA). Experimental hydronephrosis was induced by ligation of unilateral ureter in 12 dogs. The mean resistive index (RI) value of kidney was significantly increased at 4, 9, 17 days after ligation of ureter. Unilateral hydronephrosis was established in 12 dogs at 17 days after ligation of ureter. Renal artery embolization was performed using selective catheterization in the hydronephrotic kidney of seven dogs and EKG, $SpO_2$body temperature, pulse, and respiratory rate were within normal ranges during procedures. There were no dogs expired after TAE-RA and no side effects associated with regurgitation of iohexol-ethanol solution. In color Doppler ultrasonographic findings, there was no blood flow into the embolized kidneys treated by TAE-RA, however, blood flow signal was found in contralateral normal kidney of dogs treated with TAE-RA compared to that of normal kidney in normal control group. It is concluded that TAE-RA does not affect the hemodynamics of contralateral normal kidney in dogs with experimental hydronephrosis and color Doppler ultrasonography is simple and non-invasive modality for the monitoring of the revascularization of the renal artery after TAE-RA.

허리둘레-신장비와 관상동맥석회화

김정아,강성구,송상욱,신보라,최연경 대한비만학회 2016 The Korean journal of obesity Vol.25 No.3

Background: Many studies have demonstrated that the waist-to-height ratio (WHtR) is more correlated with coronary artery disease (CAD) than the body mass index (BMI). Coronary artery calcification (CAC) is an independent risk factor of atherosclerotic heart disease. However, the association between the WHtR and the coronary artery calcification score (CACS) still needs to be studied. The purpose of this study was to investigate the relationship between WHtR and CACS in healthy adults. Methods: A total of 1,111 adults without a history of cardiovascular disease who visited the Health Promotion center at the University Hospital were included in this study. All subjects hadtheir CACS measured via multi-detector computed tomography (MDCT). Results: Participants with a CACS > 0 had a greater WHtR than those with a CACS of 0 (0.535±0.006 vs 0.517±0.005, P<0.001). After adjusting for risk factors that affect CAC, WHtR was an independent predictor of CAC (odds ratio: 1.04, P=0.019, 95% CI: 1.01-1.07). Male sex and systolic blood pressure are associated with 2.53- and 1.02-fold increases in CAC, respectively (P<0.001, 95% CI: 1.53-4.19; P=0.007, 95% CI: 1.01-1.04). Conclusion: In this study of adults without heart disease, WHtR was an independent predictor of CAC. These results suggest that WHtR may be a useful marker of CAD. 배경: 허리둘레-신장비가 체질량지수보다 관상동맥질환의 위험요인들과 더 높은 관련성을 보인다는 것이 여러 연구들을 통해 증명되었다. 그러나 관상동맥질환의 독립적인 위험인자로 알려진 관상동맥석회화와 허리둘레-신장비의 관련성에 대한 연구는 아직 부족하다. 본 연구에서는 건강한 성인에서 허리둘레-신장비와 관상동맥석회화의 관련성에 대해 알아보고자 하였다. 방법: 경기도 소재 일개 대학병원 건강검진센터에 내원하여 Coronary artery MDCT를 시행한 성인 중 심혈관계질환의 과거력이 없는 1,111명을 연구 대상으로 하였다. 결과: Coronary artery calcification score (CACS)가 0인 군과 그 이상인 군으로 피험자를 나누었을 때, 허리둘레-신장비는 CACS >0인 군에서 CACS=0인 군보다 더 높은 값을 보였다(0.535±0.006 vs 0.517±0.005, P<0.001). 관상동맥석회화에 영향을 미치는 다른 위험요인들을 보정하였을 때, 허리 둘레-신장비는 관상동맥석회화에 대한 독립적인 예측인자인 것을 알 수 있었다(OR 1.04; 95% CI, 1.01-1.07; P=0.019). 또한 성별이 남성일 때, 수축기 혈압이 증가할 때 관상동맥석회화의 위험은 각각 2.53배, 1.02로 증가하였다(95% CI, 1.53-4.19, P<0.001; 95% CI, 1.01-1.04, P=0.007). 결론: 건강한 성인을 대상으로 한 본 연구에서, 허리둘레-신장비가 증가할수록 관상동맥석회화가 발생할 위험이 높아졌다.

신혈관성 고혈압 및 장골동맥 폐쇄에 대한 수술

유경민,류재욱,박성식,강태수,김석곤,서필원 대한흉부외과학회 2007 Journal of Chest Surgery (J Chest Surg) Vol.40 No.8

A 48-year old male patient visited our hospital with uncontrolled hypertension and pain of the left leg. CT angiography shows atherosclerotic occlusion of both renal artery orifices and the left common iliac artery. Despite of medical treatment for 2 months, the clinical condition of the patient worsened. We performed the surgical revascularization with both renal arteries and aorto-left femoral artery bypass with using an 8 mm artificial vascular graft. He lived well without hypertension with using only angiotensin receptor blocker and an anticoagulant for 10 postoperative months. Using surgical revascularization for renovascular hypertension has decreased due to the development of intervention technology and medication, but this surgery is indicated in cases of renovascular hypertension with extensive atherosclerotic lesions. We report here on a case of surgical revacularization for medically intractable atherosclerotic renovascular hypertension together with left common iliac artery occlusion. 48세 남자 환자가 조절되지 않는 고혈압 및 좌측 하지통증을 주소로 내원하였다. 컴퓨터 단층 혈관 조영술에서 동맥경화에 의한 양쪽 신장동맥 폐쇄와 좌측 총장골동맥 폐쇄가 관찰되었으며, 2개월간의 내과적 치료로도 호전되지 않아 수술을 시행하였다. 수술은 8 mm 인공도관을 이용하여 대동맥-양측 신동맥간 우회수술 및 대동맥-좌측 대퇴동맥간 우회수술을 시행하였다. 수술 후 10개월간 1종류의 항고혈압제(안지오텐신 수용체 억제제)와 항응고제만 사용하면서 정상적인 혈압을 유지하고 있다. 수술을 통한 신혈관성 고혈압의 치료는 중재적 시술기법 및 약물치료의 발달 및 최근 감소하는 경향이나, 광범위한 동맥경화가 동반된 경우에는 수술치료가 필요하다. 본 증례는 광범위한 동맥경화에 의한 신혈관성 고혈압 및 좌측장골동맥 폐쇄 환자에 대한 수술치료로 좋은 결과를 얻었기에 보고하는 바이다.

경동맥 내막-중막 비후 여부와 심장동맥우회술 후 급성 신손상 발생과의 관계

김민영 ( Min Young Kim ),김윤정 ( Yoon Jung Kim ),김수민 ( Soo Min Kim ),허우성 ( Woo Seong Huh ),김대중 ( Dae Joong Kim ),김윤구 ( Yoon Goo Kim ),오하영 ( Ha Young Oh ),이영탁 ( Young Tak Lee ),이정은 ( Jung Eun Lee ) 대한신장학회 2008 춘계학술대회 초록집 Vol.28 No.1

급성 대동맥 박리가 대동맥 분지혈관을 침범한 경우 경피적 시술로 치료한 2예

최진희 ( Jin Hee Choi ),엄중섭 ( Jung Seop Eom ),이혜원 ( Hye Won Lee ),전혜경 ( Hye Kyung Jeon ),이한철 ( Han Cheol Lee ),송승환 ( Seunghwan Song ),김해규 ( Hae Kyu Kim ) 대한내과학회 2012 대한내과학회지 Vol.82 No.1

The involved area is an important guide to the treatment of an acute aortic dissection. Generally, a Stanford type A aortic dissection requires surgery, whereas an uncomplicated Stanford type Baortic dissection is managed medically. However, managing a Stanford type Baortic dissection involving the visceral, renal, or iliac arteries is controversial because surgical perioperative mortality is higher than that for medically managed patients. Some researchers have attempted endovascular treatment to reduce perioperative mortality and protect vital organs. We experienced two cases of descending aortic dissection with compromised visceral, renal, and iliac arteries that were successfully treated by percutaneous stent insertion. (Korean J Med 2012;82:78-84)

신장기능이 저하된 급성 관상동맥 증후군 환자에서 조영제 유발 신증의 발생 예측인자

김주한 ( Ju Han Kim ),박종춘 ( Jong Chun Park ),조정관 ( Jeong Gwan Cho ),안영근 ( Young Keun Ahn ),홍영준 ( Young Joon Hong ),김계훈 ( Kye Hun Kim ),강정채 ( Jung Chaee Kang ),박수환 ( Soo Hwan Park ),정명호 ( Myung Ho Jeong ) 대한내과학회 2012 대한내과학회지 Vol.82 No.2

Background/Aims: Contrast-induced nephropathy (CIN) is an important complication of diagnostic coronary angiography (CAG) and percutaneous coronary intervention (PCI). We investigated the incidence and predictors of the development of CIN in acute coronary syndrome (ACS) patients with renal dysfunction undergoing PCI. Methods: From January 2005 to June 2010, we evaluated the clinical, laboratory, and angiographic data of 406 patients with ACS who had a serum creatinine ≥ 1.3 mg/dL and underwent CAG or PCI. The patients were divided into two groups according to the development of CIN (CIN, n=92; no CIN, n=314). Results: Of the 406 patients, 92 (22.7%) developed CIN. The development of CIN was associated with a lower baseline body mass index (p=0.001), decreased left ventricular ejection fraction (LVEF) (p<0.001), decreased creatinine clearance (CrCl) (p<0.001), lower albumin (p<0.001), lower hemoglobin (p=0.003), higher N-terminal pro B type natriuretic peptide (p=0.001), and greater contrast medium volume (CMV) (p=0.021). On multiple logistic regression analysis, LVEF<40% (OR, 4.080; 95% CI, 2.087-7.977; p<0.001), albumin<3.5 g/dL (OR, 2.042; 95% CI, 1.211-3.440; p=0.007), and CMV/CrCl ≥ 3.5 (OR, 1.964; 95% CI, 1.243-3.101; p=0.004) were independent predictors of CIN. The cut-off value for CMV/CrCl was 3.5, and that for albumin was 3.55 g/dL. Conclusions: CIN occurred in 22.7% of the patients with ACS and renal dysfunction who underwent CAG or PCI. Independent predictors of CIN were decreased LVEF, decreased albumin, and increased CMV/CrCl ratio. (Korean J Med 2012;82:185-193)

신장이식 수술 후 7일 차에 발생한 이식신 동맥협착을 저압력 풍선 혈관성형술로 성공적으로 치료한 1예

김두엽,정현도,이진호,김한새,이동열,오준석,김성민,신용훈,김중경,허길,박종현,정규식 대한이식학회 2016 Korean Journal of Transplantation Vol.30 No.2

Transplant renal artery stenosis (TRAS) is an important cause of hypertension, allograft dysfunction, and graft loss. Patient and allograft survival rates are lower in patients with TRAS. Causes of TRAS include acute rejection, cytomegalovirus infection, calcineurin inhibitor toxicity, atherosclerosis of recipient, and/or donor. Technical problems due to surgery are a common cause of early TRAS. A 62-year-old male in end stage renal disease received kidney transplant surgery. There was 5/6 mismatch of human leukocyte antigen and the panel reactive antibody of patient was class I 0% and class II 0%. End to side anastomosis was done between the graft’s renal artery and the patient’s common iliac artery. His serum creatinine was measured at 6.4 mg/dL before transplantation but his serum creatinine level did not fall below 2.6 mg/dL at 5 days postoperative. His blood pressures was 160/90∼180/100 mmHg. There was a significant TRAS (about 80% luminal narrowing) at the arterial anastomosis site on the renal magnetic resonance angiography. We performed percutaneous transluminal angioplasty (PTA) for the stenotic lesion. The balloon angioplasty was done with a 5 mm balloon and low pressure (8 mmHg, nominal pressure was 10 mmHg) at the stenotic lesion. The arterial pressure gradient was 8 mmHg (recipient’s common iliac arterial pressure, 147/73 mmHg; poststenotic segmental renal arterial pressure, 139/70 mmHg) just before the balloon angioplasty. After PTA, the arterial pressure gradient became 3 mmHg (recipient’s common iliac arterial pressure, 157/66 mmHg; poststenotic segmental renal arterial pressure, 154/65 mmHg). The arterial size and blood flow recovered to within normal range and serum creatinine level was normal after PTA. PTA using low pressure and a small balloon was safe and effective modality in treating early TRAS.

관상동맥질환의 위험예측인자로서의 허리둘레/신장 비의 유용성

고지영,이효리,박신애,박월미,이상화,이홍수 대한가정의학회 1998 Korean Journal of Family Medicine Vol.19 No.9

급성 세포성 거부반응과 이식후 신동맥협착이 동시 발병한 신이식 환자의 치료 1예

김희연,윤정희,김동한,이진호,오준석,김성민,신용훈,김중경,김용진 대한이식학회 2015 Korean Journal of Transplantation Vol.29 No.3

Transplant renal artery stenosis (TRAS) is a common surgical complication after kidney transplantation (KTP) and is the cause of allograft dysfunction. TRAS is a potentially curable cause of refractory hypertension and allograft dysfunction which accounts for approximately 1% to 5% of cases of post-transplant hypertension. Acute cellular rejection (ACR) is also common after KTP, which is the main cause of allograft dysfunction. Although the incidence of ACR has declined with the advent of new immunosuppressive drugs, it is still around 15% worldwide. Although each disease is frequently seen individually, seeing both together is rare. A 42-year-old man with end stage renal disease underwent KTP, and the donor was his younger brother. Four months after KTP, his serum creatinine was increased to 2.1 mg/dL, and renal biopsy showed interstitial lymphocytic infiltration and tubulitis. With the diagnosis of acute T-cell mediated rejection, steroid pulsing therapy was started, but it was resisted. Therefore thymoglobulin 60 mg (1 mg/kg/day) was administered for 6 days, but serum creatinine was 1.8 mg/dL. Abdomen magnetic resonance angiography showed TRAS, stenosis at the anastomosis site and lobar artery in the lower pole. Percutaneous transluminal angiography was performed successfully. After balloon angioplasty, the stenotic lesion showed a normal size and blood flow. The patient's renal function returned to normal levels and he is currently being followed up for 9 months. 신이식 후 급성 거부반응의 발생은 이식신 소실의 중요한 원인 중 하나로 이식신의 단기 생존율에 영향을 주는대표적인 인자로 알려져 있다(1,2). 급성거부반응의 발생빈도는 새로운 면역억제제의 등장으로 감소되고 있으나세계적으로 볼 때 15% 정도로 보고되고 있다(3). 급성 거부반응의 발생빈도가 감소함에 따라 이식신에 이전 질병의 발현, 약물 독성과 혈관 문제 등 조기 이식 실패의 다른원인들이 점차 부각되고 있다(4). 이러한 합병증 중 하나인 이식신 동맥협착의 보고는 방사선 기술의 발전에 힘입어 점차 증가하고 있다(5). 이식신 소실의 주요 원인 중하나인 이식신 동맥협착은 협착 정도의 정의 및 진단법에따라 1%∼23%까지 보고되고 있다(4,6). 이식신 동맥협착의 빠른 진단과 효과적인 치료는 이식신과 환자의 생존율에 매우 중요한 부분이다. 이렇듯 이식신에 영향을 끼치는각각의 질환은 자주 볼 수 있으나 두 가지가 같이 병발되는 경우는 흔하지 않다. 이에 본 증례에서는 신이식 3개월 차에 급성 세포성 거부반응과 이식신 동맥협착이 함께 병발된 환자를 스테로이드 충격요법, thymoglobulin 치료, 그리고 혈관조영술과풍선성형술을 시행하여 호전된 1예를 보고하고자 한다.