Takayasu's Arteritis with Aortoaortic Bypass Graft and Renal Autotransplantation: Report of One Case

接受主動脈繞道手術和自體賢臟移植的高安氏動脈炎：一病例報告

蘇文鉁(Wen-Jen Su) ； 梁啓迪(Chi-Di Liang) ； 莊正鏗(Cheng-Keng Chuang) ； 張昭雄(Chao-Hsiung Chang)

《Acta Paediatrica Sinica》 33卷6期 (1992/12) Pp. 428-434

摘要

本文報告一現年20歲患有高安氏動脈炎之女性病患，在10年因長期發燒約一個月及全身疲倦而至本院求診，當時上肢血壓爲130/80 mmHg,下肢爲100/70 mmHg，而上肢左右兩側壓力並無差別。心臓導管及攝影檢查發現左側鎖骨下動脈完全阻塞，而下行主動脈在第八胸椎至第一腰椎之間有縮窄現象。病人接受上行主勸脈至腎臟下方下行主動脈之繞導手術，術後病人生活正常。最近一年來因呼吸不適及胸悶而再度入院檢查。此時血壓右上肢爲164/54 mmHg，左上肢107/72 mmHg，而下肢均爲173/79 mmHg，動脈血管攝影上次手術之主動脈分流其功能良好，但發現左側之腎動脈有明顯的阻塞。血漿腎素(plasma rennin)在右腎靜脈，左腎靜脈及腎下方之下腔靜脈分別爲2.01, 2.76及1.89 ng/ml/hr，病人於民國79年10月8日接受左側腎臓自體移植手術。目前病人可不須服藥而維持正常血壓。

並列摘要

Takayasu's arteritis is a rare inflammatory disease of the aorta and its major branches which occurs predominantly in young women. The clinical course has been described as two stages. 1) initial phase, with inflammatory process and systemic manifestations; and later 2) pulseless phase, with multiple arterial occlusions. A 20- year-old female came to visit this hospital for the first time at 10 years of age with occlusion of the left subclavian artery and of the thoracoabdominal aorta. Aortoaortic bypass surgery was performed using a 14 mm woven graft from the ascending aorta to the descending aorta on the infrarenal portion. The postoperative course was uneventful. Exertional dyspnea and hypertension progressively developed. However, in the past year, angiograms have shown a marked stenosis on the proximal portion of the left renal artery. Autotransplantation for the left-sided kidney was performed. The patient did well, and remained free of symptoms until this time of writing, 12 months after the operation.

並列關鍵字

Takayasu's arteritis ； coarctation of aorta ； aortòaortic bypass ； renovascular hypertension ； renal autotransplantation