头面部复杂动静脉畸形的栓塞治疗

目的　研究经导管栓塞技术在头面部动静脉畸形治疗中的应用。方法　 3 0例头面部动静脉畸形患者共接受 40次栓塞治疗。其中使用国产TH胶栓塞者为 18例 2 0次 ,使用进口PVA微粒栓塞者为 12例 2 0次。结果　 3 0例患者均成功实行瘤灶供血动脉栓塞术。所有患者栓塞术后临床症状明显改善 ,如瘤体缩小甚至消失 ,皮温降低 ,搏动感和血管杂音减弱或消失等。术后随访3～ 6个月 ,12例复发。全部病例均无严重并发症。结论　对于头面部动静脉畸形的患者来说 ,经导管栓塞术是一种较好的非手术治疗方法 ,在栓塞剂的选择方面 ,则以PVA微粒栓塞更为理想。     

Amplatzer封堵器栓塞肺血管瘘道畸形

目的 评价Amplatzer封堵器作为新型栓塞材料在治疗肺血管瘘道畸形的临床价值。方法 肺血管瘘道畸形5例，包括肺动静脉瘘4例与肺动脉左房瘘1例，采用Amplatzer封堵器对供血动脉行经导管封堵治疗。结果 5例栓塞均获得技术成功，未见封堵器脱落移位，局部右向左分流消失，股动脉血氧饱和度由术前78.2％上升至术后94.5％。结论 Amplatzer封堵器用于肺血管瘘道畸形的经导管治疗安全可靠，近期疗效满意。     

肺动静脉瘘的栓塞治疗（附六例报告）

笔者报告了６例肺动静脉瘘的栓塞治疗。经造影证实：弥漫性肺小动静脉瘘３例，多发囊状肺动静脉瘘１例，单发囊状肺动静脉瘘２例。栓塞材料为弹簧钢圈，技术操作成功５例，１例发生逆栓塞，但未产生不良后果。术后动脉血氧饱和度从７８％上升到９０％。缺氧症状及紫绀有明显好转。栓塞术是治疗肺动静脉瘘的有效方法。     

经导管肾动脉节段性栓塞治疗肾动静脉畸形

目的：探讨经导管肾动脉节段性栓塞治疗肾动静脉畸形的栓塞材料及其效果。方法：9例因肾动静脉畸形（先天性者8例，获得性者1例）引起大量血尿患者，施行经导管肾动脉节段性栓塞治疗10次，栓塞材料为无水乙醇、聚乙烯醇颗粒、异丁基-2-氰基丙烯酸酯和弹簧圈。9例患者术后随访观察10-56个月。结果：9例患者栓塞术后肾动脉造影显示畸形血管完全闭塞，3d内血尿消失。随访期间，9例患者中，只有1例单纯应用弹簧圈栓塞患者术后6个月血尿复发，血管造影证实为侧支血管形成导致畸形血管再通，改行无水乙醇及弹簧圈栓塞，术后18个月血尿未再复发。9例患者均无严重并发症发生。结论：经导管肾动脉节段性栓塞是治疗肾动静脉畸形的安全有效的方法，栓塞材料以无水乙醇和弹簧 圈联合栓塞为最佳。     

先天性肾动静脉畸形的栓塞治疗

目的评价经导管动脉栓塞治疗先天性肾动静脉畸形的价值。方法回顾性分析7例以肉眼血尿为主要症状的先天性肾动静脉畸形,选择性肾动脉造影确诊为肾动静脉畸形后,超选择性病变动脉插管,用明胶海绵、无水乙醇、弹簧钢圈等对病变血管进行栓塞治疗。结果所有7例先天性肾动静脉畸形都成功栓塞,栓塞24h内7例肉眼血尿消失,术后1周内可有栓塞侧腰部酸痛、低热、腹胀、恶心、呕吐等症状,但无严重并发症。随访36～98个月无血尿复发,肾功能正常。结论经导管肾动脉造影能明确诊断,动脉栓塞安全有效,对先天性肾动静脉畸形的治疗有重要意义。     

弹簧圈栓塞治疗弥漫性肺动静脉瘘2例疗效观察

目的总结使用弹簧圈血管内栓塞治疗弥漫性肺动静脉瘘的临床疗效及初步经验。方法 2例弥漫性肺动静脉瘘患者,父女关系,增强CT显示2例患者均为弥漫性肺动静脉瘘,经选择性肺动脉造影证实,并予以弹簧圈多枚对动静脉瘘进行分次选择性栓塞,成年患者先后行3次栓塞,儿童患者行2次栓塞,术中对分流量大的病灶优先进行栓塞治疗,术后1月复查血氧饱和度及血常规、术后1年行增强CT进行随访。结果手术顺利,术中再次肺动脉造影显示病灶栓塞完全,均未出现任何并发症,1个月后血氧饱和度分别由78%、75%升高至91%、86%,红细胞分别由8.17×1012/L、7.27×1012/L下降至6.63×1012/L、6.28×1012/L,血红蛋白分别由254g/L、199g/L下降至186g/L、161g/L,术后1年复查栓塞后动静脉瘘未再通,患儿发现合并脑动静脉畸形并发脑出血。结论弹簧圈血管内栓塞是治疗弥漫性肺动静脉瘘的有效方法,创伤小,近期疗效显著。     

螺旋弹簧圈堵塞术治疗先天性肺动静脉瘘

目的总结螺旋弹簧圈(Coil)堵塞术治疗先天性肺动静脉瘘的经验及疗效。方法回顾性分析用Coil弹簧栓堵塞治疗的肺动静脉瘘7例患者，其中单发囊状型4例，多发囊状型2例，多发弥漫型1例。结果7例患者均栓塞成功。6例囊性肺动静脉瘘平均股动脉血氧饱和度由术前87％上升为术后96％。1例弥漫型肺动静脉瘘在栓塞术中出现一过性胸前区隐痛，经分期堵塞血氧饱和度由术前79％上升为87％。随访6个月至5年，仅弥漫型肺动静脉瘘1例血氧饱和度较术后轻度下降，并超声心动图提示出现轻中度右房室瓣关闭不全，余病例均无复发。结论Coil堵塞术治疗先天性囊状型肺动静脉瘘是安全有效的治疗方法，但对弥漫型者仅为一姑息治疗，疗效有待经验总结。     

儿童周围血管畸形的血管内治疗

目的 研究儿童外周血管畸形的血管内治疗方法及疗效。方法 对83例周围血管畸形患儿实施血管内治疗。本组病例术前或术中分别诊断为：动静脉瘘23例,蔓状血管瘤32例,海绵状血管瘤28例。治疗方法：①经导管栓塞术,经导管释放弹簧圈或明胶海绵栓塞治疗;②导管栓塞术结合局部注射硬化剂治疗。结果 栓塞治疗后造影证实,动静脉瘘和血管瘤均得到有效闭塞,临床症状、体征迅速改善,术后1～3年观察随访,治疗有效率100％,治愈率68．7％。无并发症。结论 采用血管内治疗方法治疗儿童外周血管畸形,是一种微创而安全、疗效特别显著的方法。     

肺动静脉畸形经导管封堵术的疗效评价

目的对肺动静脉畸形(AVM)经导管封堵术进行疗效评估。方法16例肺AVM患者接受经导管弹簧圈栓塞术治疗,其中5例同时辅以经导管可脱式球囊栓塞术或国产自制双伞形血管封堵器置入术治疗。对所有患者的家族史,术前和术后的临床表现,动脉血气分析以及其影像学表现等作了回顾性分析。16例患者术后平均随访(21±1)个月,根据其胸部CTA检查结果及动脉血气分析结果评估疗效,并对其术前和术后血氧饱和度(SaO2)、动脉血氧分压(PaO2)进行统计学分析。结果16例首次经导管封堵治疗技术成功率75%(12/16),再次经导管封堵治疗技术成功率100%。16例患者术前SaO2平均值为(76±5)%,PaO2平均值为(46±3)mmHg;术后SaO2平均值上升为(94±5)%,PaO2平均值上升为(62±3)mmHg,与术前相比差异均有统计学意义(P<0.01和P<0.05)。术后随访,所有患者无症状复发,胸部CTA检查未发现明显血管再通。结论采用经导管弹簧圈栓塞术,或同时辅以经导管可脱式球囊栓塞术或国产自制双伞形血管封堵器置入术等治疗肺AVM,可获得满意的临床疗效。     

创伤性肾动静脉瘘的介入治疗

目的 评价用介入技术治疗创伤性肾动静脉瘘(RAVFs)的安全性和疗效。方法 对8例不适宜做外科治疗的RAVFs患者进行了介入治疗，其中外伤性损伤4例，医源性损伤4例。6例行经导管超选择性肾动脉内钢丝圈栓塞术，2例行被覆膜支架置入患侧肾动脉内封闭瘘口。结果 血管造影显示肾内型动静脉瘘4例，累及肾动脉段-亚段级分支；主干(肾外)型动静脉瘘4例。治疗均获成功，治疗结束时复查血管造影显示瘘口被封闭。轻微并发症1例。医源性RAVFs患者术后失血症状迅速改善，肉眼血尿消失；4例术前存在心脏负荷过度症状患者，闭塞动静脉瘘后症状迅速改善，血管杂音消失。术后肾功能测定均属正常范围，其中2例肾动脉被覆膜支架置入患者，同位素肾扫描显示患侧肾脏形态、功能正常。术后随访10～42个月，2例分别于术后10，18个月死于与RAVFs无关的疾病。6例仍然生存，一般情况良好，未再针对RAVFs进行外科或介入治疗。结论 介入技术，包括经导管超选择性肾动脉内栓塞术和被覆膜支架置入术，是治疗创伤性、复杂型RAVFs的安全、有效的方法。     

Clinical and Radiological Long-Term Follow-up After Embolization of Pulmonary Arteriovenous Malformations

The purpose was to evaluate the clinical and radiological long-term results of embolization of pulmonary arteriovenous malformations (PAVMs) and to assess the quality of life after treatment. A clinical follow-up was undertaken after 67 months (mean) in 35 consecutive patients with 106 PAVMs. Outcome parameters at follow-up were PaO₂ and patients’ satisfaction. During follow-up, the patients had a clinical examination, measurement of arterial blood gases, chest X-ray, and contrast echocardiography performed and were asked to fill in a questionnaire exploring experience of the treatment and subjective effect of treatment on physical and social functioning. A significant rise in oxygenation of the blood after embolization was measured. In 77% of the patients symptoms improved, and 71% felt better performance. In eight patients, one of the PAVMs was found insufficiently embolized or recanalized at follow-up angiography and therefore were re-embolized. Endovascular embolization for PAVMs is effective. Clinical parameters and quality of life improved significantly. Regular clinical controls after therapy are necessary to discover insufficiently embolized, recanalized or new PAVMs.     

Coil embolization of pulmonary arteriovenous malformations

Pulmonary arteriovenous malformations (PAVMs) are uncommon lesions that can be treated by surgery or interventional radiology. Forty-four PAVMs in 11 patients were occluded by transcatheter coil embolization with only one symptomatic complication, deep venous thrombosis, attributable to the procedure. There was a significant improvement in symptoms and a reduction in pulmonary AV shunting in the 9 patients in whom embolization of all visible discrete lesions was successfully completed. Coil embolization is an effective alternative to other methods of treating PAVMs.     

Feasibility of Single-Shot Whole Thoracic Time-Resolved MR Angiography to Evaluate Patients with Multiple Pulmonary Arteriovenous Malformations

ObjectiveTo evaluate the feasibility of single-shot whole thoracic time-resolved MR angiography (TR-MRA) to identify the feeding arteries of pulmonary arteriovenous malformations (PAVMs) and reperfusion of the lesion after embolization in patients with multiple PAVMs.Materials and MethodsNine patients (8 females and 1 male; age range, 23–65 years) with a total of 62 PAVMs who underwent percutaneous embolization for multiple PAVMs and were subsequently followed up using TR-MRA and CT obtained within 6 months from each other were retrospectively reviewed. All imaging analyses were performed by two independent readers blinded to clinical information. The visibility of the feeding arteries on maximum intensity projection (MIP) reconstruction and multiplanar reconstruction (MPR) TR-MRA images was evaluated by comparing them to CT as a reference. The accuracy of TR-MRA for diagnosing reperfusion of the PAVM after embolization was assessed in a subgroup with angiographic confirmation. The reliability between the readers in interpreting the TR-MRA results was analyzed using kappa (κ) statistics.ResultsFeeding arteries were visible on the original MIP images of TR-MRA in 82.3% (51/62) and 85.5% (53/62) of readers 1 and 2, respectively. Using the MPR, the rates increased to 93.5% (58/62) and 95.2% (59/62), respectively (κ = 0.760 and 0.792, respectively). Factors for invisibility were the course of feeding arteries in the anteroposterior plane, proximity to large enhancing vessels, adjacency to the chest wall, pulsation of the heart, and small feeding arteries. Thirty-seven PAVMs in five patients had angiographic confirmation of reperfusion status after embolization (32 occlusions and 5 reperfusions). TR-MRA showed 100% (5/5) sensitivity and 100% (32/32, including three cases in which the feeding arteries were not visible on TR-MRA) specificity for both readers.ConclusionSingle-shot whole thoracic TR-MRA with MPR showed good visibility of the feeding arteries of PAVMs and high accuracy in diagnosing reperfusion after embolization. Single-shot whole thoracic TR-MRA may be a feasible method for the follow-up of patients with multiple PAVMs.     

Feasibility of Time-Resolved MR Angiography for Detecting Recanalization of Pulmonary Arteriovenous Malformations Treated with Embolization with Platinum Coils

PurposeTo assess the feasibility of time-resolved magnetic resonance (MR) angiography as a follow-up method after embolization for pulmonary arteriovenous malformations (PAVMs).Materials and MethodsEvaluation of 28 PAVMs in 10 patients previously treated with embolization with platinum coils was performed. The mean observation period after embolization was 49 months. All patients underwent unenhanced chest computed tomography (CT) and time-resolved MR angiography followed by transcatheter digital subtraction angiography within 5 weeks for a definite diagnosis. Two radiologists reviewed the CT and time-resolved MR angiography findings using a blinded method. On CT, the draining veins of the PAVMs were measured before and after embolization, and shrinkage rates were calculated. On time-resolved MR angiography, recanalization was diagnosed when the draining vein or aneurysmal sac or both were enhanced in the pulmonary arterial phase. Correlations between recanalization, the shrinkage rate of the draining vein, and the diagnostic accuracies of CT and time-resolved MR angiography were assessed and compared with digital subtraction angiography.ResultsFive lesions could not be measured on CT because of metallic artifacts. The mean shrinkage rates of the draining vein for recanalized and occluded PAVMs were 23% ± 19 (SD) for recanalized PAVMs and 47% ± 21 for occluded PAVMs (P = .001). The sensitivity and specificity were 93% and 53%, respectively, when the shrinkage rate threshold was set to 50%. On time-resolved MR angiography, the sensitivity and specificity were 93% and 100%, respectively, for Reader 1 and 100% and 93%, respectively, for Reader 2. The κ coefficient was 0.86.ConclusionsTime-resolved MR angiography appears to be a feasible method for PAVM follow-up examinations and to provide a more accurate diagnosis of recanalization compared with unenhanced CT.     

Amplatzer血管塞封堵先天性心脏病异常血管畸形的临床应用

目的 评价Amplatzer血管塞(AVP)封堵先天性心脏病异常血管畸形的临床疗效.方法 2006年6月至2008年6月共有12例患者接受AVP封堵治疗,其中单发及多发囊状肺动静脉瘘7例,冠状动脉右室瘘2例,法洛四联症大型体肺侧支3例.均经临床和经胸超声心动图(TTE)及胸部CT造影筛查,并经心血管造影证实.结果 本组均应用AVP有效封堵异常血管畸形,造影判断即刻成功率为100%,无移位、脱落等早期并发症.封堵血管16支,平均内径(5.2±1.9)mm,所用AVP直径为(9.2±2.4)mm.所有患者封堵术后平均3个月随访心超和(或)胸部CT造影,显示封堵血管闭塞良好,无异常、无残余分流.结论 经导管应用AVP封堵先天性心脏病血管畸形是一种安全、有效的治疗方法,能显著改善患者生活质量,值得临床进一步推广.     

Embolization of peripheral vascular malformations with ethylene vinyl alcohol copolymer (Onyx)

PURPOSE: To demonstrate the feasibility and preliminary efficacy of endovascular embolization of peripheral congenital vascular malformations (VMs) with use of a nonadhesive liquid embolic agent, Onyx. MATERIALS AND METHODS: Nine patients with a mean age of 20.8 years had local low-flow (n = 4), local high-flow (n = 3), or diffuse high-flow (n = 2) VMs located in the upper or lower extremities. In all patients, endovascular embolization was performed via the superselective catheterization of arterial feeders of VMs with use of microcatheters in a coaxial technique. A total of 15 embolization procedures were performed with Onyx, which was composed of 6%, 8%, or 20% ethylene vinyl alcohol copolymer dissolved in dimethyl sulfoxide. RESULTS: In two of four patients with local low-flow VMs, the lesions were embolized completely. In the other two patients with local low-flow VMs, embolizations were incomplete. The remaining five high-flow lesions of local (n = 3) or diffuse (n = 2) types were also embolized incompletely. In all patients with local low-flow VMs and in one patient with a local high-flow VM, clinical signs and symptoms were resolved significantly. Other patients did show clinical benefit from embolization to varying degrees. CONCLUSION: In our experience in a limited number of cases, Onyx promises and provides important advantages over conventional embolic agents in the endovascular transcatheter embolization of congenital peripheral VMs. However, as with other embolic agents, it is far from perfect.     

Resolution of secondary pulmonary arteriovenous malformations after embolization of a congenital superior-mesenteric-vein-to-left-renal-vein shunt

A 7-year-old boy who presented with cyanosis and exercise intolerance was diagnosed with pulmonary arteriovenous malformations (PAVMs) secondary to a congenital superior-mesenteric-vein-to-left-renal-vein (SMV-LRV) shunt. Resolution of the PAVMs (confirmed by chest computed tomography [CT]) occurred after embolization of this shunt. Although the pathogenesis of his PAVM is not well known, this case demonstrated a close relationship between a congenital SMV-LRV shunt and the development of PAVM.     

Hemoptysis after coil embolization for pulmonary arteriovenous malformation: Histopathological confirmation of bronchial epithelium extension

Coil embolization is widely performed for pulmonary arteriovenous malformations (PAVMs). We describe herein 2 cases of hemoptysis during long-term follow-up after coil embolization for PAVMs. For both cases, lobectomy was performed and histopathological examinations revealed chronic inflammation and bronchial epithelium extension into the sac of the PAVM. In addition, we performed a systematic review of previous reports of hemoptysis after embolization for PAVMs.     

Embolotherapy of pulmonary arteriovenous malformations: long-term results in 112 patients

PURPOSE: To evaluate the long-term results of embolotherapy of pulmonary arteriovenous malformations (PAVMs) in a large group of patients. MATERIALS AND METHODS: Between July 1988 and August 2001, 134 consecutive patients underwent embolotherapy of PAVMs with feeding arteries larger than 3 mm or that had previously caused bleeding or systemic complications. The mean follow-up was 62.2 months. The primary endpoints of the study were the efficacy of embolotherapy, decrease in right-to-left shunt, and increase in partial arterial oxygen pressure (PaO(2)); the secondary endpoint was the prevalence of complications. Standard follow-up consisted of yearly history, chest radiography, and arterial blood gas measurement. RESULTS: Follow-up was available in 112 patients. Initially, 296 PAVMs were embolized in these patients. Nineteen patients (17%) underwent a second procedure and four patients underwent a third procedure because of recanalization of originally occluded feeding arteries (25 PAVMs, 8%) or interval enlargement of untreated PAVMs (53 PAVMs). In total, 349 PAVMs were embolized in 157 sessions. The mean diameter of occluded vessels was 4.7 mm. The long-term outcomes of embolotherapy were successful in 83% of patients overall and in 96% of patients in whom all angiographically visible PAVMs were embolized. Recanalization occurred in 12 of 16 patients who underwent repeat treatment because of enlargement of nonembolized PAVMs. Postprocedural pleurisy occurred after 14 of 157 sessions (9%). Periprocedural complications occurred in 12 sessions (8%) and included migration of an embolic device, transient ischemic attack (TIA), angina pectoris, and early cerebral infarction after embolization. Three patients experienced TIA and two patients experienced a cerebral abscess during follow-up after embolotherapy. CONCLUSIONS: Embolotherapy of PAVMs is efficacious and durable in the majority of patients. Patients should remain under regular review because recanalization of PAVMs or enlargement of untreated PAVMs can occur years after treatment.