超选择性肾动脉栓塞治疗肾脏出血性假性动脉瘤的护理

目的探讨超选择性肾动脉栓塞治疗肾脏出血性假性动脉瘤的护理对策。方法回顾性总结我院成功进行的超选择性肾动脉栓塞治疗肾脏出血性假性动脉瘤的术前术后护理经验。结果 8例患者均康复出院,结果满意。结论对超选择性肾动脉栓塞治疗肾脏出血性假性动脉瘤的患者采取纠正休克、加强心理护理、处理膀胱痉挛、积极术前准备;术后加强穿刺处的观察和护理、造瘘管的护理及造瘘管拔除后的护理等,能促进患者术后恢复。     

Subclavian artery pseudoaneurysm in Behcet’s disease

Behcet’s disease (BD) is an autoimmune, multisystemic, and chronic inflammatory disease. Although it affects all systems, involvement of the vascular system is of vital importance. Pseudoaneurysm ruptures in the arteries are the major causes of sudden deaths in BD. Although pseudoaneurysms in aorta and pulmonary arteries are rare, it is even more rare in the subclavian arteries. In our case, a pulsatile mass in the right clavicular area was determined to be associated with BD and this case is presented because subclavian artery pseudoaneurysm is seen rarely in BD.     

Bare Stent Implantation in Iatrogenic Dissecting Pseudoaneurysm of the Superior Mesenteric Artery

Iatrogenic arterial dissection leading to the development of dissecting pseudoaneurysms of the superior mesenteric artery (SMA) is a rare complication of angiography. Surgical and endovascular treatment options exist for this important condition. We report a case of bare stent implantation in dissecting pseudoaneurysm of the SMA that developed after angiography in a patient with acute mesenteric ischemia. Although it is rarely published, iatrogenic arterial dissection causing pseudoaneurysm can occur after diagnostic and interventional angiography. Bare stent implantation in dissecting pseudoaneurysm of the SMA could be an advantageous endovascular treatment option in selected cases due its to potential preservation of important side branches of the SMA.     

Uninfected Para-Anastomotic Aneurysms after Infrarenal Aortic Grafting

Purpose

This single-institution retrospective review examines the management of uninfected para-anastomotic aneurysms of the abdominal aorta (PAAA), developed after infrarenal grafting.

Materials and Methods

From October 1979 to November 2005, 31 PAAA were observed in our Department. Twenty-six uninfected PAAA of degenerative etiology, including 24 false and 2 true aneurysms, were candidates for intervention and retrospectively included in our database for management and outcome evaluation. Six (23%) patients were treated as emergencies. Surgery included tube graft interposition (n = 12), new reconstruction (n = 8), and graft removal with extra-anatomic bypass (n = 3). Endovascular management (n = 3) consisted of free-flow tube endografts.

Results

The mortality rate among the elective and emergency cases was 5% and 66.6%, respectively (p = 0.005). The morbidity rate in elective cases was 57.8%, whereas 75% in emergency cases (p = 0.99). The survival rate during the follow-up was significantly higher for elective cases than for emergency cases.

Conclusion

Uninfected PAAA is a late complication of aortic grafting, tends to evolve silently and is difficult to diagnose. The prevalence is underestimated and increases with time since surgery. The mortality rate is higher among patients treated as an emergency than among patients who undergo elective surgery, therefore, elective treatment and aggressive management in the case of pseudoaneurysm are the keys to obtain a good outcome. Endovascular treatment could reduce mortality. Patients who undergo infrarenal aortic grafting require life-long surveillance after surgery.     

Giant renal angiomyolipoma with fatal hemorrhage due to a large pseudoaneurysm

We report a case of giant renal angiomyolipoma (AML) with a large pseudoaneurysm causing fatal hemorrhage. A 60-year-old woman presented with right-sided abdominal pain. Sonographic examination revealed a large hyperechoic renal mass. CT examination of the abdomen revealed a 15-cm AML of the right kidney with a large hemorrhagic area within it. Subsequent color Doppler examination revealed a 2.9-cm pseudoaneurysm arising from the upper segmental branch of the right renal artery. The patient, who was about to undergo transcatheter embolization of the pseudoaneurysm, died from cardio-respiratory arrest. The autopsy findings confirmed a large right renal AML containing a thrombosed pseudoaneurysm and a large perinephric hematoma.     

Spontaneous rupture of a left gastroepiploic artery pseudoaneurysm

We report a previously healthy young adult man presenting with generalized peritonitis secondary to a ruptured pseudoaneurysm of the left gastroepiploic artery. This extremely rare cause of haemoperitoneum was not considered in the differential diagnosis prior to operation, and might have had an infective aetiology.     

Hepatic artery pseudoaneurysm and hemobilia following laser laparoscopic cholecystectomy

This report describes injury to the hepatic artery with pseudoaneurysm formation and hemobilia following the use of laser-assisted dissection to perform laparoscopic cholecystectomy.A 57-year-old woman was referred emergently 2 weeks after laser laparoscopic cholecystectomy with upper abdominal pain, upper gastrointestinal bleeding, and jaundice. A selective hepatic arteriogram showed a right hepatic artery pseudoaneurysm which was embolized. Two weeks later the patient had recurrent hemobilia as the result of blood flow restoration in the pseudoaneurysm and a fistula to the cystic duct remnant. She was treated with two additional embolizations and direct injection of the aneurysm with thrombogenic material. Follow-up at 2 years showed no further recurrence.Since the laser has never been shown to have advantages over electrocautery, its use during laparoscopic cholecystectomy is difficult to justify.Presented at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), San Francisco, California, USA, October 1993     

Perforation of the Right Ventricle After Endomyocardial Biopsy Detected by Color Flow Doppler Echocardiography

Right ventricular perforation after endomyocardial biopsy of a heart transplant patient was established by color flow Doppler echocardiography. Systolic filling and diastolic drainage of the pericardium were seen. Healing of the perforation occurred spontaneously with no Doppler signs of perforation 8 days later.     

颈动脉损伤的外科治疗(附16例报告)

目的 探讨颈动脉损伤的早期诊断和外科治疗方法。方法 回顾性分析2003年10月至2006年12月哈尔滨医科大学附属第二医院血管外科收治的16例颈动脉损伤的临床资料。颈外动脉损伤4例，颈总动脉损伤3例，颈内动脉损伤1例，颈动脉假性动脉瘤3例，颈动脉血栓形成1例，医源性颈动脉损伤4例。结果行颈外动脉结扎4例，颈总动脉修补2例，自体大隐静脉移植7例，覆膜支架植入2例，抗凝溶栓1例。死亡1例，偏瘫、失语1例．Homer综合征5例，声音嘶哑、饮水呛咳5例，7例痊愈。结论 早期诊断，及时有效的止血，修复血管．尽快恢寅颈动脉血流和必要的脑保护措施是降低病死率，减少神经系统并发症的关键。     

颈外静脉修复重建股动脉的临床应用

目的 介绍应用颈外静脉移植修复重建股动脉的临床效果。方法 2002年6月～2006年4月。对22例因注射毒品所致的假性股动脉瘤手术切除后致股动脉缺损患者。应用颈外静脉移植修复晕建。其中男20例。女2例；年龄25～46岁，平均31．2岁。股动脉缺损5～9cm。平均6．8cm。左侧14例。右侧8例。结果 术后伤口Ⅰ期愈合10例，Ⅱ期愈合4例。余8例伤口裂开并溃疡形成。二次手术行局部皮瓣移位修复，创面愈合。除1例因吻合口破裂出血而最终结扎股动脉外。其余均成功重建股动脉缺损。足背动脉均可扪及搏动。18例获1～30个月随访。动脉瘤无复发。12例复查彩色多普勒显示移植的颈外静脉已动脉化，并替代原缺损股动脉。结论 颈外静脉解剖恒定且表浅。切取容易。口径接近于股动脉，可作为自体静脉移植材料修复重建股动脉。手术操作简便。疗效确切。有一定的临床府用价值。