組織プラスミノーゲンアクチベータを用いて選択的腎動脈線溶療法を施行した腎動脈塞栓症の2例

Abstract

組織プラスミノーゲンアクチベータにて選択的腎動脈線溶療法を施行した腎動脈塞栓症2例(74歳女, 66歳女)を報告した.1例は発症後3日目の治療にもかかわらず塞栓が溶解され腎機能が回復した

Two cases of renal artery embolism treated by selective intra-arterial infusion of tissue plasminogen activator (t-PA) are reported. A 74-year-old woman with atrial fibrillation presented with left flank pain of 54-hour duration. Selective renal angiography revealed embolic obstruction of multiple segmental arteries in the left kidney. She was treated by one-shot intra-arterial t-PA infusion (8, 000, 000 units) and intravenous heparinization (25, 000 units/3 days). Although fibrinolysis was successful except for most distal arterial branches, complete recovery of renal function was not obtained. A 66-year-old man presented with complete obstruction of left main renal artery. He had hyperthyroidism and atrial fibrillation. At 75 hours after onset of left flank pain, he was treated by one-shot intra-arterial t-PA infusion (18, 000, 000 units) and intravenous heparinization (4, 000 units/24 hours). His renal function was recovered completely. Selective intraarterial t-PA infusion is considered an effective treatment for renal artery embolism.