超选择性动脉栓塞治疗顽固性鼻出血

目的 评价超选择性动脉栓塞治疗顽固性鼻出血的临床应用价值.方法 27例经常规治疗无效的顽固性鼻出血患者,采用Seldinger技术,将导管超选择性插管至颈外动脉分支内,造影证实出血部位后,采用明胶海绵颗粒或/和聚乙烯醇(PVA)颗粒行动脉栓塞治疗.结果 27例顽固性鼻出血患者均发现出血动脉,栓塞治疗全部成功,术后即刻拔除鼻腔填塞物,出血停止,未见严重并发症.结论 超选择性动脉栓塞术治疗顽固性鼻出血是一种安全有效的治疗方法,值得临床推广应用.     

应用Embosphere微球栓塞治疗难治性鼻出血

目的研究Embosphere微球在颈外动脉栓塞治疗难治性鼻出血中的价值。方法 2009年12月至2011年12月对27例难治性鼻出血患者行Embosphere微球栓塞治疗,在予选择性颈外动脉造影后,用导管超选择插至病变动脉,注入Embosphere微球栓塞病变区供血动脉血管床,观察治疗有效率及并发症情况。结果 27例患者均栓塞成功,栓塞后出血停止或明显减少,治疗成功率100%,其中即刻止血22例(81.48%),1～3 d出血停止5例(18.52%)。27例中15例(55.56%)术后出现颜面部麻木、肿痛、张口受限等轻度并发症,无严重并发症发生,随访2～26个月,2例(7.41%)复发出血。结论 Embosphere微球在颈外动脉栓塞治疗难治性鼻出血安全、有效。     

超选择性颈外动脉分支栓塞术在头颈部疾病中的应用

目的探讨超选择性颈外动脉分支栓塞术在头颈部疾病中的应用。方法对41例头颈部疾病患者进行DSA检查,行超选择性颈外动脉分支栓塞治疗。结果12例鼻出血栓塞后即刻无活动性出血,随访6～12个月未再复发;7例鼻咽纤维血管瘤栓塞后手术出血量明显减少;1例外伤动脉出血栓塞后即刻止血,无复发;14例血管畸形栓塞后随访6～12个月,明显好转3例,好转6例,无变化5例;7例头颈部恶性肿瘤姑息性治疗后存活时间2年以上者3例。结论超选择性颈外动脉栓塞术治疗头颈部疾病安全、有效。     

鼻出血血管内栓塞治疗后短期复发的原因与对策

目的 分析重症鼻出血患者行颈外动脉栓塞治疗后短期复发的原因,并探讨预防措施.方法 62例重症鼻出血患者,其中16例行栓塞治疗后2周内复发,第1周内鼻出血复发9例,第2周鼻出血复发7例,均再行选择性动脉造影并行栓塞治疗,复习所有病例首次造影及栓塞经过,分析鼻出血复发原因.结果 再次造影显示原栓塞之颈外动脉分支再通、致鼻出...     

颈外动脉分支栓塞治疗顽固性鼻衄的临床应用(附67例报告)

目的:研究颈外动脉分支栓塞治疗顽固性鼻衄的临床应用价值。方法:67例难治性鼻衄患者,行颈外动脉分支栓塞治疗。结果:一次性治愈63例(94%),3例行2次治疗治愈(4.5%),1例未成功(1.5%)。未出现严重并发症。结论:颈外动脉分支栓塞治疗顽固性鼻衄安全、疗效明显、并发症发生率低。     

鼻咽部血管纤维瘤术前动脉栓塞的临床应用价值

目的 评价超选择性颈外动脉栓塞术在鼻咽部血管纤维瘤经鼻内镜切除术前的临床应用价值.方法 对20例鼻咽部血管纤维瘤患者经鼻内镜切除术前1 ～ 3 d行超选择性颈外动脉分支,供血动脉栓塞术,回顾性分析术中出血、手术时间及并发症等情况.结果 20例患者均成功接受超选择性颈外动脉栓塞术,1 ～ 3 d后行经鼻内镜切除术,平均术中出血155 ml,平均手术时间为75 min,栓塞术后6例发生轻度并发症,经对症治疗后消失.切除术后无严重并发症发生,术后平均住院时间为3.5 d.结论 超选择性颈外动脉栓塞术可明显减少鼻咽部血管纤维瘤术中出血和术后并发症,有效缩短手术时间,联合经鼻内镜切除术是鼻咽部血管纤维瘤微创、有效的治疗手段.     

鼻咽部纤维血管瘤血管造影及术前超选择栓塞治疗

目的探讨鼻咽部纤维血管瘤术前超选择栓塞的临床价值方法14例经CT和MRI诊断并为手术病理证实的鼻咽部纤维血管瘤患者,术前全部行双侧颈内外动脉及椎动脉血管造影肿瘤颈外系统供血动脉术前使用100～300μm明胶海绵颗粒或聚乙烯醇(PVA)颗粒超选择性栓塞治疗,栓塞后1～3d行手术切除结果14例患者,颌内动脉分支供血9例,颌内动脉和咽升动脉分支供血4例,颌内动脉、咽升动脉和颈内动脉分支供血1例所有患者颈外动脉供血分支微导管超选择性栓塞均获得成功栓塞后,8例肿瘤染色完全消失,6例肿瘤染色大部分消失手术全切率92.8%(13/14),手术平均出血约420m,l手术时间平均150min所有患者栓塞后均未发生严重并发症结论使用微导管术前血管内超选择栓塞鼻咽部纤维血管瘤,是一种安全有效的辅助治疗方法     

DSA超选择性动脉栓塞治疗难治性鼻出血

目的：探讨介入治疗鼻出血的临床意义。方法：23例难治性鼻出血患者因常规止血方法无效后,采用数字减影血管造影加超选择性动脉栓塞手术治疗。结果：23例栓塞成功,22例患者出现头痛和栓塞灶同侧牙疼痛,1例出现对侧脑梗死及偏瘫。结论：DSA超选择性动脉栓塞治疗难治性鼻出血疗效好,但需注意预防严重并发症。     

动脉栓塞治疗顽固性鼻出血8例分析

目的探讨鼻出血介入治疗的临床效果、并发症及注意事项。方法采用介入治疗技术及数字减影血管造影（DSA）技术,对8例顽固性鼻出血患者进行超选择性颌内动脉和/或面动脉栓塞。结果8例患者达到立即止血目的,所有患者均出现程度不同的头痛症状,无严重并发症发生。结论在数字减影技术和介入治疗技术下,对顽固性鼻出血进行超选择性动脉栓塞是安全、有效、快捷的止血方法。     

超选择性动脉栓塞治疗肝脾损伤出血

目的探讨经导管超选择性动脉栓塞治疗肝脾损伤出血的方法、疗效及安全性。方法本组肝损伤出血7例,脾损伤出血11例,采用股动脉穿刺插管技术,将导管超选择性插管至肝或脾动脉出血分支内,缓慢注射明胶海绵颗粒行栓塞治疗。动脉分支有假性动脉瘤形成者4例,在明胶海绵栓塞治疗后以弹簧圈栓塞出血分支近端。术后密切观察患者生命体征、有无再出血征象及术后反应、并发症发生等情况。结果18例均成功实施超选肝脾动脉分支栓塞治疗,术后患者无再出血发生,病情好转。治疗后患者均无明显不良反应,无严重并发症发生。结论超选择性动脉栓塞治疗肝脾损伤出血是一种安全、易行、有效的治疗方法,可尽量避免外科手术,保留了患者的脏器及功能。     

损伤性鼻腔大出血的介入治疗

目的 探讨经导管动脉栓塞术治疗损伤性鼻腔大出血的临床应用价值.方法 回顾性分析15例外伤或手术后鼻出血患者,经药物及鼻腔填塞治疗失败后,采用经股动脉穿刺置入导管后先行颈外动脉造影明确出血点,再超选择插管至责任动脉以明胶海绵或聚乙烯醇(PVA)颗粒栓塞治疗.结果 15例患者中9例为外伤后鼻出血,6例为鼻窦或副鼻窦手术后出血.14例用明胶海绵颗粒栓塞,1例用PVA颗粒栓塞,均1次栓塞成功,2～3 d后成功去除填塞物,无严重并发症.结论 经导管动脉栓塞术是控制保守治疗失败的鼻腔大出血的安全有效的方法,对于损伤性鼻腔大出血明胶海绵是首选的栓塞剂.     

Endovascular therapy of intractable epistaxis complicated by carotid artery occlusive disease.

Three cases of intractable spontaneous posterior epistaxis refractory to nasal packing and complicated by ipsilateral carotid artery occlusive disease were successfully treated with internal maxillary artery occlusion with microcoils. There were no complications and no recurrent episodes of epistaxis at a mean follow-up of 12 months. The presence of ipsilateral carotid artery disease requires modification of standard distal internal maxillary artery embolization because of the recruitment of external carotid to internal carotid and external carotid to ophthalmic artery collateral pathways, with subsequent risk of particle embolization of these arterial distributions. Proximal internal maxillary artery microcoil embolization eliminates this risk and is equivalent to surgical internal maxillary artery ligation. This procedure also provides additional information about the internal carotid artery collateral circulation.     

Embolization in the external carotid artery

The technical skill set of peripheral interventional radiologists is well-suited to the performance of most transcatheter embolization procedures in the external carotid artery (ECA). These procedures center in large part on hypervascular tumors, epistaxis, and trauma. ECA embolization in the trauma patient is well-defined, albeit in small patient series. The transcatheter treatment of epistaxis is still mostly reserved for cases that are intractable to conservative therapy. Preoperative embolotherapy for vascular tumors remains popular, although it is somewhat controversial in terms of its risk-benefit ratio. The purpose of this review is to highlight pertinent anatomy, selected technical procedural aspects, and the available literature to better characterize the role of ECA embolization in the hands of the practicing peripheral interventionist.     

Arterial injuries in transsphenoidal surgery for pituitary adenoma; the role of angiography and endovascular treatment.

PURPOSETo define the role of angiography and embolization in the treatment of patients who have arterial injuries during transsphenoidal surgery.METHODSWe retrospectively studied the arterial hemorrhagic complications, their management, and the clinical outcomes that occurred in 21 of the more than 1800 patients who had transsphenoidal surgery for pituitary adenomas.RESULTSOf the 21 patients who had complications, 17 had internal carotid injuries and four had injuries of the sphenopalatine artery. Angiography was performed in 18 patients. Bleeding occurred and was controlled during surgery in 16 cases. Delayed epistaxis occurred in 10 patients, including five whose surgery was uneventful. After internal carotid injury, the most frequent angiographic findings were carotid occlusion (eight patients), stenosis (five patients), and false aneurysms (three patients). Internal carotid balloon occlusion was performed in five patients. No rebleeding occurred in patients who had complete carotid occlusion either from surgical packing or balloon embolization. Two of the patients who had carotid stenosis after surgical packing had delayed epistaxis necessitating balloon occlusion. Injuries to the sphenopalatine artery were successfully treated by surgery (one patient) or by endovascular treatment (three patients) without complication. Three deaths and five permanent deficits were directly related to the arterial injury or its treatment.CONCLUSIONProfuse bleeding during and after transsphenoidal surgery should be investigated by angiography. Lesions of the sphenopalatine arteries are effectively treated by embolization. Internal carotid injuries are best treated by carotid infusion to prevent life-threatening epistaxis.     

微创经皮肾镜取石术后严重出血的DSA诊断和介入治疗

目的 探讨肾结石微创经皮肾镜取石术(MPCNL)术后出血的肾动脉造影表现及超选择性肾动脉栓塞止血的价值.方法 回顾性分析48例肾结石MPCNL术后出血患者的临床与动脉造影资料,分析其肾动脉造影表现、栓塞治疗效果及并发症等.结果 肾动脉造影结果显示MPCNL后出血的原因:单纯假性动脉瘤25例(52.1%)、假性动脉瘤伴动静脉瘘6例(12.5%)、假性动脉瘤伴对比剂外渗1例(2.1%)、肾动静脉瘘11例(22.9%)、血管破裂对比剂外渗2例(4.2%)和包膜动脉曲张1例(2.1%),未发现异常2例(4.2%).46例接受了栓塞治疗,并达到了栓塞治疗成功的DSA标准和临床标准,其中采用聚乙烯醇颗粒(PVA)栓塞18例、PVA+钢圈栓塞5例、明胶海绵栓塞10例、明胶海绵+钢圈栓塞11例、PVA+明胶海绵+钢圈栓塞2例.栓塞后均出现不同程度的栓塞后综合征;术后血清肌酐较术前轻度升高12例.结论 超选择性肾动脉栓塞能有效止血和保存肾脏功能,是MPCNL术后严重出血的首选治疗方法.     

Percutaneous puncture of the external carotid artery or its branches after surgical ligation.

PURPOSETo describe the technique and results of percutaneous puncture of the external carotid artery or one of its branches distal to a surgical arterial ligation.METHODSForty-three patients underwent 64 embolization attempts by percutaneous arterial puncture distal to an external carotid artery ligation. The punctured arteries were the trunk of the external carotid artery in 31 patients, the internal maxillary artery in nine, the facial artery in nine, the lingual artery in eight, the occipital artery in four, and the superficial temporal artery in three.RESULTSIn 64 attempts 57 were successful in one session, six were successful in two sessions, and one failed. Puncture-related complications were eight spontaneously resolving hematomas and six asymptomatic punctures of the internal carotid artery.CONCLUSIONAfter surgical ligation of the external carotid artery or its branches, arterial puncture above the ligation allowed selective catheterization and endovascular occlusion of vascular lesions.     

Interventional radiology of the extracranial head and neck

The topic of interventional radiology of the extracranial head and neck is reviewed. Knowledge of functional vascular anatomy and recognition of the “dangerous anastomoses” between the external carotid artery and the intracranial circulation are stressed. Technical aspects of embolization are surveyed. The authors' approach to some of the more common lesions such as paragangliomas, congenital vascular lesions, epistaxis, juvenile angiofibromas, and arteriovenous fistulas are described. Illustrative cases are presented. Proper training and experience are needed in order to safely and effectively perform embolization procedures of the head and neck.