毒品注射致股动脉假性动脉瘤破裂出血的诊治

目的探讨注射毒品引起股动脉假性动脉瘤形成并破裂出血的诊断与治疗方法。方法回顾性分析2003年3月—2009年12月收治的22例因反复注射毒品致股动脉假性动脉瘤形成并破裂出血患者的临床资料。结果 22例患者均接受手术治疗,术中行瘤体切除、清创后,8例行股动脉破口修补术;4例行破口两侧股动脉结扎术;10例行髂外动脉-股动脉人工血管移植术。22例均手术成功,手术后早期出现人工血管与股动脉吻合口破裂出血1例,急诊手术重新吻合,随后出现切口感染,经换药后切口愈合。术后患侧下肢功能均好。随访6个月至7年,平均3年。1例患者术后2年出现人工血管感染,1例出院后14d发生吻合口出血,均经再次血管吻合治愈;2例股动脉结扎患者遗留轻间歇性跛行。结论治疗股动脉假性动脉瘤形成并破裂出血的手术方式,以股动脉假性动脉瘤切除+清创+股动脉修补术最为简单、安全有效;人工血管移植术疗效确定,能最大限度保证患肢血供;股动脉修补或结扎术在选择病例中也是有效的治疗方法。     

感染性股动脉假性动脉瘤的外科治疗

目的 探讨感染性股动脉假性动脉瘤的外科治疗方法.方法 回顾性分析2003年1月至2008年6月期间我院收治的45例感染性股动脉假性动脉瘤行外科治疗患者的资料.43例感染性股动脉假性动脉瘤采用瘤体切除及彻底清创后行人工血管旁路移植治疗; 另2例由于感染严重及瘤体巨大被迫采用瘤体切除并行近、远端动脉结扎.结果 随访3～12个月,平均7.82个月,人工血管旁路移植病例全部保肢成功,切口均二期愈合,无间歇性跛行; 行动脉结扎的2例中,1例因缺血坏疽行膝上高位截肢; 另1例保肢成功,但有间歇性跛行.结论 动脉瘤切除及彻底清创后行人工血管旁路移植是感染性股动脉假性动脉瘤安全、有效的治疗方法.     

彩色多普勒超声在毒品注射所致感染性假性股动脉瘤诊断和随访中的作用

目的探讨彩色多普勒超声在毒品注射所致感染性假性股动脉瘤的诊断和随访中的作用。方法对97例(102条患肢)感染性假性股动脉瘤患者的超声诊断及术后超声随访进行回顾性分析。结果 96例(101条肢体)行髂股动脉结扎术,其中1例同时行左下肢膝上截肢术。术后75例(78条患肢)获得随访,随访率为77%(75/96),随访时间3个月至5年,平均27个月。随访期间10例(12条患肢)患者因毒品滥用死亡,余65例(66条患肢)存活,其中18例(18条肢体)出现间歇性跛行。彩超检查显示术前患肢血流量比健侧降低,术后患肢股动脉以远下肢动脉均通畅,血流量较术前没有明显减少;平均动脉压也证实术前血流动力学状态患侧较健侧有显著减弱[(18.08±2.76)mmHgvs(65.03±3.15)mmHg,P0.001],术后平均动脉压可维持在18.08mmHg左右。结论彩色多普勒超声对毒品注射所致感染性假性股动脉瘤诊断和术后随访是具有价值的手段。     

血管重建治疗注射毒品所致股动脉假性动脉瘤

目的探讨注射毒品所致股动脉假性动脉瘤的外科治疗方法。方法对14例注射毒品所致股动脉假性动脉瘤患者的临床资料进行回顾分析。9例直接采用ePTFE人工血管行原位移植间置术;4例采用自体大隐静脉原位间置移植术;1例行单纯股深动脉结扎术。结果全部病例术后患肢供血良好,无肢体缺血表现,其中11例患者成功随访1～45个月,1例患者出院后出现伤口感染,余患者伤口均在1个月内愈合,现患肢均无缺血症状,活动自如。结论吸毒所致股动脉假性动脉瘤切除后血管重建有利于保证下肢血供,在患者不能提供合适的自体大隐静脉移植时,人工血管原位移植仍是治疗假性股动脉瘤的有效方法。术中彻底清创及术后伤口引流、加强抗炎是预防术后人工血管并发感染的最主要措施。     

吸毒者假性动脉瘤治疗分析

目的 总结吸毒致股动脉假性动脉瘤的治疗经验,评价股动脉结扎或重建的可行性和有效性.方法 回顾性分析18例吸毒者血管损伤患者的临床特点,治疗方式及疗效.结果 14例急诊手术、4例择期手术.1例一期截肢,2例因出血再次手术,股动脉结扎术后6例出现间歇性跛行,未出现因缺血而截肢者,5例动脉重建患者术后无并发症,远期无间歇性跛行发生.结论 对于吸毒致假性动脉瘤者,股动脉结扎,清创术是安全、可行的方法,而动脉重建仍是最佳的治疗方式.     

经闭孔旁路术治疗股动脉感染性动脉瘤

目的：探讨采用经闭孔旁路术治疗股动脉感染性动脉瘤的方法和疗效。 方法：回顾性分析2004年8月—2014年7月间采用经闭孔旁路术治疗的4例股动脉感染性假性动脉瘤患者的临床资料。 结果：患者男3例，女1例，平均年龄26.5（22~31）岁，病因为注射吸毒损伤股动脉3例，下肢动脉栓塞介入治疗穿刺点并发症1例。3例接受单纯股动脉结扎及感染性动脉瘤清创术治疗，术后出现下肢缺血，二期行经闭孔髂动脉到股动脉旁路术，1例行同期股动脉结扎、动脉瘤清创加经闭孔髂外动脉到股浅动脉旁路术治疗。平均随访27（8~60）个月，4例患者术后患肢踝肱指数（ABI）为1.0~1.1，无间歇性跛行及其他不适。 结论：同期或分期经闭孔旁路是治疗股动脉感染性假性动脉瘤可避免术后的下肢缺血症状。     

注射毒品所致的股动脉假性动脉瘤的治疗：附45例报告

目的：探讨注射毒品所致的股动脉假性动脉瘤的外科治疗方法及效果。方法：对45例注射毒品所致的股动脉假性动脉瘤患者临床资料进行回顾性分析。其中27例进行血管重建,包括20例直接采用ePTFE人工血管移植,4例自体大隐静脉移植,3例覆膜支架腔内隔绝;18例直接采用单纯股动脉三头结扎。分析患者的近期治疗效果及随访资料。结果：所有患者均保肢成功。血管结扎术后3例分别于6个月、2年、3年出现间歇性跛行3例,2例分别于术后1年和2年出现肌肉萎缩乏力;血管重建术后近期2例出现人造血管感染和术后再出血4例。结论：患者一般情况允许时,应尽可能行假性动脉瘤切除+人工血管解剖旁路移植,但需预防近期术后再出血及感染发生;若患者一般情况差,不耐受大手术,或局部感染严重,单纯股动脉三头结扎是可行的方法,但需预防远期肌肉萎缩等并发症;覆膜支架腔内隔绝适合无明显感染且动脉瘤未破裂的患者。

     

人工血管旁路移植治疗感染性股动脉假性动脉瘤

目的探讨人工血管旁路移植术治疗感染性股动脉假性动脉瘤的效果。方法回顾性分析2005年1月—2010年12月40例感染性股动脉假性动脉瘤的临床资料,40例患者均为吸毒者,均接受了假性动脉瘤切除、彻底清创及人工血管旁路移植术。结果围手术期内无死亡患者,且均保肢成功,创口均二期愈合。34例(85.0%)术后获得随访3～12个月,平均7.4个月。随访期内发生移植物感染3例(8.8%),取出感染的移植物后2例保肢成功,1例最终因肢体缺血坏死而接受截肢术;彩超检查发现人工血管腔内部分血栓形成4例(11.8%),给予抗血小板治疗,远端肢体均无缺血坏死。结论人工血管旁路移植术是治疗注射吸毒所致感染性股动脉假性动脉瘤的安全、有效的方法。     

注射吸毒所致感染性假性股动脉瘤的股动脉结扎治疗

目的总结股动脉结扎治疗注射吸毒所致感染性假性股动脉瘤的体会。方法对45例注射吸毒所致感染性假性股动脉瘤患者资料进行回顾性分析。采用股动脉或髂外动脉结扎+瘤体切除术治疗感染性假性股动脉瘤,术后预防血栓形成及抗感染治疗,并随访患肢功能。结果44例患者保肢成功,近期患肢行走功能良好。1例术后因深静脉血栓形成,出现肢体坏死而截肢。结论34例(75.6%)获3～12个随访,疗效满意。股动脉结扎是治疗感染性假性股动脉瘤的有效方法。     

大隐静脉移植治疗髂股动脉假性动脉瘤

目的 探讨因注射吸毒致髂股动脉假性动脉瘤一期动脉重建术的治疗效果.方法 本研究系按照时间序列的单中心研究,回顾性分析2004年3月至2007年10月澳门仁伯爵综合医院收治的由于注射吸毒导致的髂股动脉假性动脉瘤21例的临床资料,其中男15例,女6例,平均年龄31.3岁,瘤体最大直径3.0～7.5 cm.有14例以动脉瘤破裂出血为首发症状就诊.应用对此类病例设计的髂股部单一弧形切口,取同侧大隐静脉倒置搭桥对本组21例假性动脉瘤患者进行治疗.结果 21例手术均获成功,随访19例,随访时间2～36个月,失访2例.无围手术期死亡病例,无术后心、脑等器官并发症,手术后腹股沟出血、波动性肿物均消失.术后股部血肿1例,术后切口感染不愈合、股部窦道形成1例,同侧大腿前内侧感觉异常1例,术后间歇性跛行1例. 结论 获取适宜的自体大隐静脉用于血管重建是对该病治疗的前提.应用单一弧形切口取同侧大隐静脉倒置搭桥是可行的.对吸毒致髂股动脉假性动脉瘤行动脉重建术有利于减少间歇性跛行的发生.     

Coronary artery spasm following coronary artery revascularization

Coronary artery spasm is a well-documented phenomenon in patients undergoing medial treatment. We describe coronary artery spasm occurring in the immediate postoperative period following coronary artery bypass operation. The spasm occurred in a vessel that was not operated on and that had no apparent lesion. The diagnosis of spasm was made by coronary angiography immediately after operation. Complications associated with this spasm are discussed. Emphasis is placed on early postoperative angiography for patients whose condition is inexplicably unstable after operation.     

Coronary artery spasm following coronary artery surgery

Coronary artery spasm during the early postoperative period following cardiopulmonary bypass for coronary artery surgery can be an unrecognized cause of sudden, severe cardiopulmonary collapse. The literature regarding perioperative coronary artery spasm is reviewed, and methods of prevention, diagnosis, and treatment are suggested. Preoperative angina at rest appears to be an important identifying factor in patients who experience postoperative coronary spasm. Anatomically, the presence of a relatively normal, dominant right coronary may also indicate increased risk for early post-coronary bypass spasm. Acute hypotension is often the first sign of coronary artery spasm, and conventional treatment methods may only worsen the vasospastic reaction. Peripheral intravenous nitroglycerin infusion has often been unsuccessful treatment while intragraft or intracoronary nitroglycerin injection or administration of calcium channel-blocking drugs, or both, has proven to be effective in reversing the coronary artery spasm and ventricular dysfunction. Reluctance to use vasodilating agents must be overcome, even in the face of hypotension, when evidence of spasm is present.     

Internal mammary artery to pulmonary artery fistula

A rare case of arteriovenous fistula between an internal mammary artery and a pulmonary artery is presented. The clinical history of recurrent bronchitis and dyspnoea during exercise, the presence of right parasternal murmur with normal heart size and normal blood gases justified the execution of an arteriovenous thoracic angiography which revealed the presence of a cirsoid aneurysm supplied by the internal and external mammary arteries. Diagnostic investigation and surgical indication in patients with the rare fistulous communication between the internal mammary artery and the systemic or pulmonary circulation are analysed.     

Iliac artery pseudoaneurysm following umbilical artery catheterization

We report a case of a large iliac artery pseudoaneurysm in a newborn infant following umbilical artery catheterization. The aneurysm was excised and a primary repair was performed with limb salvage and reestablishment of normal blood flow to the foot. While these aneurysms are rare, prompt surgical repair should be performed as soon as the diagnosis is made because the associated mortality is high.     

Superficial temporal artery to superior cerebellar artery anastomosis for distal basilar artery stenosis

The conceptualization, rationale and surgical technique involved with a superficial temporal artery to superior cerebellar artery anastomosis for midbrain ischemia in a patient with symptomatic mid-basilar artery stenosis is described and discussed.     

Mycotic pulmonary artery aneurysm following pulmonary artery banding

A neonate with situs inversus, transposition of the great arteries, ventricular septal defect, cross-crossventricles and hypoplastic right ventricle underwent pulmonary artery banding at the age of 7 days. The course was complicated by septicaemia and subsequently the development of an aneurysm of the pulmonary artery. Serratia marcessans was grown from the band site. The pulmonary artery aneurysm was resected and the pulmonary artery was repaired. The literature is reviewed with the emphasis on diagnosis, natural history and surgical management.