Caes Reports 양측쇄골하동맥및양측신동맥협착을동반한 Abstract Takayasu 동맥염 1 예 * 안선호 임수빈 오석규 이재홍 정진원박양규 박옥규 소병준 노병석 * A Case of Takayasu s Arteritis Associ

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1 Caes Reports 양측쇄골하동맥및양측신동맥협착을동반한 Abstract Takayasu 동맥염 1 예 * 안선호 임수빈 오석규 이재홍 정진원박양규 박옥규 소병준 ** 노병석 *** A Case of Takayasu s Arteritis Associated with Stenosis of Both Subclavian Arteries and Both Renal Arteries Seon-Ho Ahn, M.D., Su-Bin Lim, M.D., Seok-Kyu Oh, M.D., Jae-Hong Lee, M.D., Jin-Won Jeong, M.D., Yang-Kyu Park, M.D., Ock-Kyu Park, M.D., Byung-Jun So, M.D.,** Byung-Seok Rho, M.D.*** Department of Internal Medicine, General Surgery** and Radiology,*** Wonkwang University, School of Medicine, Iksan, Korea Takayasu s arteritista is a nonspecific areritis of unknown etiology affecting segmentally the aorta and its main branches, which result in stenosis, occlusion or aneurysm of involved arteries. The clinical manifestations present with a variety of symptoms such as headache, dyspnea on exertion, pain and weakness of extremities, pulse deficit, and hypertension according to involved arteries. Usually it can be managed by medical or surgical treatment, and recently by percutaneous transluminal balloon angioplasty. The type classified by Lupi-Herrena and associates is the most frequent variety of TA. However the case of type III involving both subclavian arteries and both renal arteries has rarely been reported. We experienced a case of TA involving both subcalvian arteries, and both renal arteries presented with paroxysmal hypertension and right flank pain, in which the stenosis of both subclavian arteries were managed by percutaneous transluminal balloon angioplasty and the stenosis and occlusion of both renal arteries were successfully managed by aortorenal bypass surgery with autogenous right iliac artery and synthetic vesselgortex. The patient was discharged uneventfully. KEY WORDSTakayasu s arteritista Renal artery Subclavian artery Hypertension. 서 론 887

2 증례 Fig. 1. The abdominal CT shows wedge shaped noncontrast enhanced portion in midpole area of the right kidney,which suggest renal infaction. 888

Fig. 2. Angiogram of the right subclavian artery shows each severe narrowing at 3cm distal and mild narrowing at 10cm distal to its origin. Fig. 4.

5cm떨어진 부위에 약 50%협착이 있었다 (Fig. 3). 우측 신동맥은 기시부로 보이는 팽대부가 관찰되었으나 원위부위는 보이지 않고(Fig. 4), 좌측 신동맥은 기시부로부터 1cm떨어진 부위에서 90% 이 상의 협착이 있었다(Fig. 5).

우측 대퇴동맥을 천자한 다 음 Seldinger Technique을 이용하여 260cm RADI -FOCUS 0.

3 Fig. 2. Angiogram of the right subclavian artery shows each severe narrowing at 3cm distal and mild narrowing at 10cm distal to its origin. Fig. 4. The abdominal aortogram shows irregualr caliber and tortusity of the aorta, not showing origin site of the right renal artery. 로부터 1.5cm떨어진 부위에 약 50%협착이 있었다 (Fig. 3). 우측 신동맥은 기시부로 보이는 팽대부가 관찰되었으나 원위부위는 보이지 않고(Fig. 4), 좌측 신동맥은 기시부로부터 1cm떨어진 부위에서 90% 이 상의 협착이 있었다(Fig. 5). 하대정맥 및 신정맥에서 채취한 renin활성도로 구한 지수는 우측 0.15, 좌측 0.038이고 그 비율은 1.2였다. 치료 및 경과 양측 쇄골하동맥의 협착부위는 상지의 운동시 쇄약 감 및 저린감의 허혈증상을 호소하여, 경피적 경혈관 혈관성형술을 시행하였다. 우측 대퇴동맥을 천자한 다 음 Seldinger Technique을 이용하여 260cm RADI -FOCUS 0.035" guide-wire(terumo, Japan)를 쇄골하동맥의 협착부위를 통과시킨후 직경 8mm PTA balloon catheter(meditech, France)를 이용하 여 우측 쇄골하동맥은 4 5기압으로 2회 확장을 시도 Fig. 3. Angiogram of the left subclvian artery shows mild narrowing at 1.5cm distal to its origin. 한 후 혈관 내피의 부분파열이 있어 부분적 혈관 확장 을 시행하였고(Fig. 6), 좌측 쇄골하동맥은 4 5기압 889

으로 3회 확장을 시도하여 10%정도의 잔여 협착이 과 양측 신동맥의 협착 원위부를 연결하였고, 장골동맥 있는 성공적인 혈관 확장을 시행하였다(Fig. 7).

환자는 술후 혈압 하 신동맥의 협착은 우측 장골 동맥을 이용하여 대동맥 강과 임상적 호전을 보였고 현재 왜래 추적 관찰 중이다. Fig. 7.

4 으로 3회 확장을 시도하여 10%정도의 잔여 협착이 과 양측 신동맥의 협착 원위부를 연결하였고, 장골동맥 있는 성공적인 혈관 확장을 시행하였다(Fig. 7). 양측 은 Gortex로 대치하였다(Fig. 8). 환자는 술후 혈압 하 신동맥의 협착은 우측 장골 동맥을 이용하여 대동맥 강과 임상적 호전을 보였고 현재 왜래 추적 관찰 중이다. Fig. 7. Angiogram of the left subclavian artery after balloon angioplasty shows successful dilatation. Fig. 5. The seleted angiogram of the left renal artery shows severe narrowing at 1cm distal to its origin. Fig. 6. Angiogram of the right subclavian artery after balloon angioplasty shows partial dilatation and irregular collection of contrast media suggestive of intimal tearing. Fig. 8. Follow-up angiogram of the abdominal aorta after aortorenal bypass surgery with autogenous right iliac artery and gortex shows good patency. 890

5 고찰 891

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637 Peripheral Arterial Disease Yong Bok Koh, M.D. Department of General Surgery The Catholic University of Korea, College of Medicine, Kangnam St. Mary s Hospital E mail : ybkoh@catholic.ac.kr Abstract Peripheral