超声引导下瘤腔内注射凝血酶治疗股动脉假性动脉瘤的临床研究

目的：评价超声引导下瘤内注射凝血酶治疗股动脉假性动脉瘤的应用价值。方法：入选33例经皮冠脉介入治疗术后形成的股动脉假性动脉瘤患者。采用超声引导下,于超声探头压迫瘤颈同时,瘤腔内注射凝血酶（浓度为100 U/mL）。分析假性动脉瘤的类型、大小、瘤径长度及宽度、凝血酶用量及其疗效,观察其并发症。结果：33例患者中,单纯型25例,复杂型8例。动脉瘤平均体积为（9.0±5.0）cm3,瘤颈部宽度（2.7±0.7）mm,颈部长度（5.9±0.9）mm,平均凝血酶用量（299±110）U。30例一次成功,3例第一次注射后复发,经第二次注射后成功,其中单纯型1例,复杂型2例。未发生动脉或静脉栓塞等并发症。术后随访3个月无复发。与单纯型相比,复杂型动脉瘤患者年龄更大,女性更多,体重指数及瘤腔体积更大,所需凝血酶剂量更多（P〈0.05）;两者在瘤径长度及宽度方面差异无统计学意义（P〉0.05）。结论：超声引导下瘤腔内注射凝血酶治疗股动脉假性动脉瘤操作简便,疗效好,安全性高,可作为介入术后股动脉假性动脉瘤的首选治疗方法。     

Surgical treatment of traumatic lower limb pseudoaneurysm

Objective：To summarize our experience in surgical treatment of traumatic lower limb pseudoaneurysm.Methods：Twenty patients with traumatic lower limb pseudoaneurysm were surgically treated in our department from January 2007 to January 2012.The treatment protocols included interventional covered-stent placement （10 cases）,spring coil embolization （2 cases）,and surgical operation （8 cases）.Surgical operations included pseudoaneurysm repair （2 cases）,autologousvein transplantation （1 case）,and artificial-vessel bypass graft （5 cases）.Results：All the patients were successfully treated without aggravating lower limb ischemia.Pseudoaneurysm disappeared after treatment.A surgical operation is suitable to most pseudoaneurysms,but its damage is relatively obvious and usually leads to more bleeding.It also requires a longer operating time.Compared to a surgical operation,interventional therapy is less traumatic and patients usually have a quicker recovery （P＜0.05）.All patients were followed up once per month for 12-36 months by color Doppler ultrasound examination.There were no cases of pseudoaneurysm recurrence.Conclusion：Both surgical operation and interventional therapy are safe and effective in the treatment of pseudoaneurysm.     

A rare cause of upper gastrointestinal haemorrhage: Ruptured cystic artery pseudoaneurysm with concurrent cholecystojejunal fistula

INTRODUCTION Cystic artery pseudoaneurysms and cholecystoenteric fistulae represent two rare complications of gallstone disease.PRESENTATION OF CASE An 86 year old male presented to the emergency department with obstructive jaundice, RUQ pain and subsequent upper gastrointestinal bleeding. Upper GI endoscopy revealed bleeding from the medial wall of the second part of the duodenum and a contrast-enhanced computed tomography scan revealed a cystic artery pseudoaneurysm, concurrent cholecystojejunal fistula and gallstone ileus. This patient was successfully managed surgically with open subtotal cholecystectomy, pseudoaneurysm resection and fistula repair.DISCUSSION To date there are very few cases describing haemobilia resulting from a bleeding cystic artery pseudoaneurysm. This report is the first to describe upper gastrointestinal bleeding as a consequence of two synchronous rare pathologies: a ruptured cystic artery pseudoaneurysm causing haemobilia and bleeding through a concurrent cholecystojejunal fistula.CONCLUSION Through this case, we stress the importance of accurate and early diagnosis through ultra- sonography, endoscopy, and contrast-enhanced CT imaging and emphasise that haemobilia should be included in the differential diagnosis of anyone presenting with upper gastrointestinal bleeding. We have demonstrated the success of surgical management alone in the treatment of such a case, but accept that consideration of combined therapeutic approach with angiography be given in the first instance, when available and clinically indicated.     

Traumatic anterior cerebral artery aneurysms and management options in the endovascular era

Traumatic anterior cerebral artery (ACA) pseudoaneurysms are a challenge to manage. Difficult diagnosis, delayed presentation and catastrophic outcomes contribute to the overall prognosis of traumatic intracranial aneurysms. Clipping or coiling of the aneurysm and/or parent vessel occlusion are the treatment options. However, surgery and coiling both may be difficult due to limited access and the need for parent vessel preservation. Rarely, these aneurysms must be managed conservatively. We present four patients with traumatic ACA aneurysms admitted to our center in the last 10 months. Three patients had pseudoaneurysms of the distal ACA and one had an aneurysm arising from a cortical branch of the ACA. Their clinical presentations and management, along with outcomes, are discussed as well as the dilemmas associated with them. Three patients were managed by clipping and coiling while one was managed conservatively. The diagnosis was made relatively early in three patients while delayed subarachnoid hemorrhage led to diagnosis in the fourth. Although the overall prognosis remains grim, with high mortality and morbidity rates, both microsurgical and interventional management of these traumatic aneurysms may be useful, if detected early before rupture. Expectant management and surveillance may be required in a select group of patients.     

A cost effective endovascular approach for management of post-catheterization profunda femoris artery pseudoaneurysm using thrombin

Post-catheterization PSA is one of the most commonly encountered vascular complications of cardiac and peripheral angiographic procedures. We report the case of patient who developed deep-seated profunda femoris artery pseudoaneurysm (PSA) following cardiac catheterization. Despite, repeated ultrasound guided compressions the PSA failed to close and instead produced local site pressure ulcers. The secondary infection followed which precluded use of percutaneous thrombin injection. The PSA was finally closed via a total endovascular technique combining intravascular thrombin injection and coil embolization, thus obviating the need for expensive measures like cover stents or invasive surgical repairs.     

Pseudoaneurysm of the abdominal aorta caused by acupuncture therapy

Acupuncture is a major treatment modality used in Oriental medicine to control chronic pain. However, several complications have been reported, including spinal cord injury, pneumothorax, and subcutaneous pseudoaneurysm, according to the puncture sites. We report the case of a pseudoaneurysm of the abdominal aorta caused by acupuncture. Received: September 25, 2001 / Accepted: March 5, 2002     

注射毒品引起假性股动脉瘤的外科治疗(附11例报告)

目的　探讨对注射毒品引起的假性股动脉瘤行血管移植的疗效 ,提高治疗效果。方法　行血管移植手术治疗 11例 ,其中人工血管移植 9例 ,自体血管移植 2例 ,均行股动脉及股静脉移植。结果　 11例患者术后平均随访 2年 ,均获得良好效果 ,移植血管通畅 ,未出现血管阻塞 ,伤口愈合欠佳 1例。结论　血管移植是注射吸毒引起假性股动脉瘤外科治疗取得成功的关键。     

Pseudoaneurysm formation secondary to spontaneous thrombosis of a massive cerebral arteriovenous malformation

Summary A case of a large cerebral arteriovenous malformation (AVM) with spontaneous partial thrombosis and intracerebral hematoma is reported. The unusual and unique features of the radionuclide brain scan and cerebral angiogram are described. The characteristic angiographic features of residual tortuosity and dilatation or pseudoaneurysm formation at the bifurcations of the feeding arteries in a partially thrombosed cerebral AVM have not been described previously in the literature.     

Pseudoaneurysm after total pharyngolaryngectomy with jejunal graft insertion: two different presentations

Pharyngeal reconstruction after total pharyngolaryngectomy using a jejunal graft is now a common procedure in head and neck oncological surgery. The vascular supply of this graft comes from the anastomosis between a branch of the mesentric artery and a branch of the external carotid artery. We report two cases of pseudoaneurysm, one at the site of ligation of the lingual artery and the other at the site of arterial anastomosis. One presented with dramatic hematemesis and was managed by the interventional radiologist, and the second presented with a pulsating neck mass and required a surgical revision. In both cases, the jejunal graft survived.     

Symptomatic Internal Carotid Artery Dissecting Pseudoaneurysm: Endovascular Treatment by Stent-Graft

Dissecting pseudoaneurysm of the extracranial portion of the internal carotid artery (ICA) is a usually benign complication of spontaneous ICA dissection. We report a case in which pseudoaneurysm volume enlarged progressively and new clinical symptoms developed 9 months following disease onset. Placement of a coronary stent-graft resulted in immediate complete resolution of clinical symptoms and radiologic restoration of normal flow.