Ex Vivo Surgeryによる腎血管性高血圧の治療

Abstract

This is a case report of renovascular hypertension cured by ex vivo surgery. The patient, 40-year-old woman, was admitted to the Jikei University Hospital on 1977. 7. 25 because of headache. The blood pressure was 170/110 mmHg, and the plasma renin activity of the peripheral blood was 4.2 ng/ml/hr at rest and 19.5 ng/ml/hr after loading the erect position. The plasma renin activity of the renal vein blood was 3.0 ng/ml/hr on the right side and 2.2 ng/ml/hr on the left side, the right to left ratio being 1.4. The excretory urograms showed contraction of the right kidney, the longitudinal diameter being shorter by 2.5 cm than that of the left kidney. The renal arteriography demonstrated the rosary-like stricture from the trunk to the first blanches. The artery to the upper pole initiated at the proximal part' of the stenotic lesion. A diagnosis was made as renovascular hypertension due to fibromuscular dysplasia of the renal artery on the right side. Vascular reconstruction surgery in situ was judged to be extremely difficult because of extent of the stenotic lesion. The ex vivo surgery was performed on 1977. 9. 24. The extirpated kidney was placed in the cold immersion extracorporeally. The pathological area was resected. The two main arteries were anastomosed side-to-side after making the longitudinal incision of 1.5 cm length on each median side, finally forming one ostium. The kidney was auto transplanted into the iliac fossa on the right side with the upper pole down. The renal vein was first anastomosed to the common iliac vein in the end-to-side fashion and the main renal artery already having one ostium was then anastomosed to the internal iliac artery in the end-to-end fashion. The kidney circulation was begun after the total ischemic time of two hours and twenty-five minutes. The artery supplying the upper pole was anastomosed to the external iliac artery in the end-to-side fashion. The ureter was neither divided nor anastomosed. It was simply displaced in a tortuous way. The renal arteriogram On the 21st postoperative day showed patency of the reconstructed and anastomosed sites of the renal artery without stricture. The excretory pyelography on the third months showed good function of the auto transplanted kidney. There was no hydronephrosis nor hydroureter. The blood pressure is stable at 120/80 on the fifth month postoperatively. She is doing well without any complaints.