대한신장학회

논문분류	춘계학술대회 초록집
제목	Nine Cases of Spontaneous Lumbar Artery Rupture: single center experience
저자	Nakyoung Hwang*, Harin Rhee1, Eun Young Seong1, Ihm Soo Kwak1, Jong Man Park1, Jin Suk Kang1, Eun Young Park1, Sang Heon Song1
출판정보	2016; 2016(1):
키워드	anticoagulant, lumbar artery, spontaneous retroperitoneal hematoma
초록	Background: Lumbar artery rupture is a rare vascular complication and we experienced nine cases retroperitoneal hematoma caused by spontaneous lumbar artery rupture. This study reviewed the clinical characteristics and outcomes of patients with spontaneous lumbar artery rupture in our hospital and explored the possible risk factors related with that. Methods: A retrospective chart review was conducted to determine patient demographics, laboratory findings, presenting symptoms, anticoagulant/antiplatelet agent use and patient outcome during last 16 years (2000~2016). Results: Male to female ratio was 5:4 and the mean age was 64.8±14.3 years old. Overall, eight of nine patients were receiving an anticoagulant/antiplatelet medication at the time of spontaneous lumbar artery rupture. Four patients were on anticoagulant therapy, two patients were on antiplatelet therapy and two patients were on both anticoagulant and antiplatelet therapy. Three patients (33.3%) were on maintenance hemodialysis and one patient had acute kidney injury. One of chronic renal failure patient was not taking anticoagulant/antiplatelet agent, but he was being treated with hemodialysis using heparin when the retroperitoneal bleeding occurred. The most presenting symptom was hypotension. Laboratory values on initial presentation included; mean hemoglobin 6.9±1.75 g/dL, serum creatinine 2.11±1.73 mg/dL, blood urea nitrogen 30.14±17.87 mg/dL, PT INR 2.5±2.8, aPTT 72.7±48.5 seconds. The retroperitoneal hematoma was controlled successfully by trans-catheter arterial embolization in all patients, but four patients developed multiple organ failure with hypovolemia, and died (mean age 71.5±11.4 years). Conclusion: We suggest that spontaneous lumbar artery rupture could be develope especially in patient with maintenance hemodialysis or oral anticoagulant/antiplatelet agent. So, clinician should suspect lumbar artery rupture in patient with unstable vital sign and rapid onset of anemia because early diagnosis and appropriate intervention could be necessary for life saving.
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