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目的 开展血管腔内带膜支架植入治疗主髂动脉多撕裂口夹层动脉瘤的临床研究。方法 总结采用血管腔内多枚带膜支架植入治疗2例主髂动脉多撕裂口夹层动脉瘤的临床经验。结果 2例均从股动脉入路植入多枚带膜支架封闭主髂动脉多个撕裂口。其中1例同期植入3枚封闭3个撕裂口3另1例同期植入3枚封闭4个撕裂口，手术均获得成功。术后3个月及6个月复查示夹层动脉瘤均消失，假腔内血栓形成，无内瘘发生，病人均存活。结论 血管腔内多枚带膜支架同期植入治疗主髂动脉多撕裂口夹层动脉瘤是可行、安全和有效的。     

血管腔内治疗DeBakeyⅢ型动脉夹层动脉瘤（附15例报告）

目的 探讨带膜支架植入治疗降主动脉夹层动脉瘤的经验。方法 我科1999年5月至2005年12月为15例DeBakeyⅢ型的主动脉夹层动脉瘤患者作血管腔内带膜支架植入治疗，并分析其临床资料。结果 15例病人共用带膜支架22个，手术技术成功率100％。6例患者术中出现内漏，植入第二枚支架后漏口封闭。1例术后3月复查发现支架移位，再植入带膜支架后治愈。3例术后死亡，死因为心律失常，呼吸功能衰竭。治愈12例，平均随访20个月。所有患者内膜破裂口全部完全封闭，假腔内血栓形成无内漏，假腔均明显缩小。结论 带膜支架血管腔植入术治疗主动脉夹层动脉瘤具有良好的近期疗效，长期效果还有待进一步的研究。     

头臂动脉瘤和动静脉瘘的腔内治疗

目的探讨头臂血管假性动脉瘤(BCPA)或颈动脉静脉瘘(CVEF)患者的腔内治疗效果。方法 2003年9月—2011年3月笔者诊治10例假性动脉瘤和动静脉瘘患者并行腔内治疗,其中假性动脉瘤7例,先天性动静脉畸形2例,外伤性动静脉瘘1例。假性动脉瘤的病因为外伤或医源性损伤;临床表现为颈部或锁骨下搏动性肿块,病程2 h至40年不等。10例均经股动脉穿刺造影明确病变性质、部位、大小,然后采用放射介入方法,用带膜支架封堵病变处破口,重朔血管。结果 8例假性动脉或外伤性动脉静脉瘘及1例先天性动静脉瘘达到满意疗效,1例先天性动静脉瘘畸形明显好转,动静脉瘘流量明显减少。结论头臂部动脉瘤或动静脉瘘采用带膜支架腔内隔绝治疗方法微创、简便、迅速、安全、有效,有实用价值。     

血管腔内治疗DeBakeyⅢ型主动脉夹层动脉瘤(附15例报告)

目的探讨带膜支架植入治疗降主动脉夹层动脉瘤的经验.方法我科1999年5月至2005年12月为15例DeBakeyⅢ型的主动脉夹层动脉瘤患者作血管腔内带膜支架植入治疗,并分析其临床资料.结果15例病人共用带膜支架22个,手术技术成功率100%.6例患者术中出现内漏,植入第二枚支架后漏口封闭.1例术后3月复查发现支架移位,再植入带膜支架后治愈.3例术后死亡,死因为心律失常,呼吸功能衰竭.治愈12例,平均随访20个月,所有患者内膜破裂口全部完全封闭,假腔内血栓形成无内漏,假腔均明显缩小.结论带膜支架血管腔植入术治疗主动脉夹层动脉瘤具有良好的近期疗效,长期效果还有待进一步的研究.     

带膜血管腔内支架植入术治疗Stanford B型胸主动脉夹层 (附29例报告)

目的介绍应用带膜血管腔内支架植入术治疗Stanford B型胸主动脉夹层的方法和效果。方法对29例(男25例,女4例,年龄38~77岁)胸主动脉夹层动脉瘤腔内隔绝术患者的临床资料进行回顾性分析。术前采用CT血管成像(CTA)、磁共振血管成像(MRA)技术或CT对主动脉夹层动脉瘤进行评估,术前穿刺左肱动脉行升主动脉对比剂追踪了解破口的位置及撕裂的范围,所有的患者都在全麻下进行的,术中在数字减影血管造影机监视下经股动脉或髂动脉将带膜支架导入胸主动脉封闭夹层破口。结果29例均成功进行了胸主动脉夹层的血管腔内隔绝术,其中25例使用Talent支架,4例为国产支架。术后主动脉造影证实夹层裂口完全封闭或内漏明显减少,无中转开胸手术,围手术期无死亡及严重并发症发生。术后随访3~29个月(平均15个月),其中21例行CT复查,8例行DSA复查,3例病人在术后2~8个月行心脏瓣膜置换术。结论带膜支架腔内隔绝术是治疗胸主动脉夹层动脉瘤的简便安全而有效的方法,近期疗效好。手术死亡率和并发症发生率低,手术成功率和生存率高。     

覆膜支架治疗降、腹主动脉假性动脉瘤13例分析

目的探讨覆膜支架治疗主动脉假性动脉瘤的疗效.方法回顾性分析应用覆膜支架治疗的13例降、腹主动脉假性动脉瘤患者的病例资料,并随访观察其疗效.结果8例覆膜支架植入后假性动脉瘤即刻被完全隔绝.5例覆膜支架植入后有内漏,其中1例吻合口漏致降主动脉假性动脉瘤患者补充植入一短段cuff覆膜支架后内漏消失;4例行球囊扩张,2例扩张后内漏消失,2例仍有少许内漏,但3个月后复查证实内漏完全消失.2例失访,其余11例随访4～30个月,平均18.6个月,1例死于上消化道大出血,其余病例覆膜支架均通畅,无移位,瘤腔无扩大.结论应用覆膜支架治疗降、腹主动脉假性动脉瘤是行之有效的治疗方法,且创伤小,恢复快,尤其适用于不能耐受传统手术治疗者,近期疗效满意,远期疗效尚待进一步观察.     

胸主动脉真性、假性和夹层动脉瘤行主动脉腔内修复术的临床和影像学研究

目的 总结胸主动脉真性、假性和夹层动脉瘤的术前诊断和腔内修复的要点,对术前、术后的主动脉CT血管造影(CTA)影像进行评估和比较,以探讨用统一的影像学指标在术前、术中、术后和随访中对病变演变和疗效进行系统评价和动态观察. 方法 48例胸主动脉瘤和夹层动脉瘤患者在术前CTA图象指导下行主动脉腔内修复术(EVR),植入覆膜支架,植入前、后做数字减影血管造影(DSA),术后定期多次做CTA随访评价疗效.所有CTA和DSA图象输入e-FilmTM软件中建立影像数据库,筛选关键层面,测量分析对比. 结果 48例共行EVR 49次,准确植入长、短支架54枚,夹层内膜破口封闭42例,胸主动脉真性动脉瘤完全隔绝2例,假性动脉瘤颈口封闭4例.术后发生不同程度的内漏9例,经相应的处理消除;因导入动脉出血抢救成功,但发生弥漫性血管内凝血、多器官功能衰竭死亡1例.随访47例,随访时间6～51个月.所有患者恢复良好,临床效果满意. 结论 EVR治疗胸降主动脉真、假性和夹层动脉瘤效果良好;夹层动脉瘤的早期诊断要点为胸痛和CTA扫描;CTA特定层面和左前斜位图象是术前评估和术后疗效评定的重要参考.     

创伤性假性动脉瘤的腔内介入治疗

目的探讨创伤性假性动脉瘤(TPA)血管腔内治疗方法及疗效。方法回顾性分析2009年6月至2016年7月解放军第148医院收治的28例TPA患者临床资料,其中TPA位于四肢动脉13例,颈内动脉2例,肾动脉5例,胆囊动脉2例,臀上动脉2例,髂总动脉1例,肠系膜上动脉1例,脾动脉1例,阴茎动脉1例。17例主干型假性动脉瘤采用覆膜支架腔内隔绝术或多层裸支架植入术,11例终末型假性动脉瘤采用弹簧圈栓塞术。结果 28例患者腔内介入治疗均取得成功,假性动脉瘤均消失。17例植入支架者术后远端动脉搏动正常,无重要分支动脉闭塞,11例弹簧圈栓塞者术后出血停止,未出现脏器缺血坏死。术后随访6~39个月,平均(18.9±10.7)个月,失访1例,所有随访患者假性动脉瘤未复发,支架植入患者血管通畅,未发现支架移位、断裂,弹簧圈异位等并发症。结论根据假性动脉瘤位置、类型和侧支循环等选择不同的介入方法治疗TPA,具有微创操作简单、手术成功率高、并发症少、疗效确切的优点,可作为TPA的一线治疗方法。     

主动脉减速伤的治疗(附12例报告)

目的　随着交通的现代化 ,由车祸所致的主动脉减速伤 (Decelerationinjuryofaorta)将大为增加 ,很有必要对本病的诊治加以介绍。方法　回顾性分析本病 1 2例的临床和影像学表现、手术与血管腔内移植物治疗。结果　 1 1例获影像学诊断 ,1例术中获诊断。手术 4例及血管腔内移植物 6例治疗均获成功 ,术后恢复良好。未手术的 2例中 ,1例死亡 ,另 1例失访。结论　要提高对主动脉减速伤的警惕 ,病史十分重要 ,CTA、MRA或DSA检查可确诊本病。一旦诊断成立 ,应及时手术。手术疗效确切 ,但为大手术。血管腔内移植物植入法以其微创、并发症少、近期疗效好而值得提倡 ,尽管其远期疗效尚待观察     

钝性外伤后胸主动脉扩张性病变的临床分析

目的 总结钝性外伤后胸主动脉扩张性病变诊疗经验.方法 回顾性分析12例钝性外伤后胸主动脉扩张性病变的临床资料,其中主动脉夹层(Stanford B型)8例以及降主动脉假性动脉瘤4例.术前螺旋CT血管造影及术中数字血管减影造影对病变进行评估,待严重合并症稳定后行腔内支架型人工血管植入术.术后3、6、12个月以及其后每年随访CTA明确治疗效果.结果 11例行腔内支架型人工血管植入术,另1例未及手术死亡.所有手术患者均获技术成功,完全或部分遮蔽左锁骨下动脉6例,支架释放后即刻造影发现内漏3例,2例球囊扩张后内漏消失,1例仅给予随访.共9例获随访(B型主动脉夹层6例、降主动脉假性动脉瘤3例),均正常生存,未出现左上肢缺血症状及神经系统阳性体征,CTA检查示近远端主动脉无新发夹层或动脉瘤,无内漏、截瘫以及支架移位等并发症.结论 钝性外伤后胸主动脉损伤多位于主动脉峡部,待重要脏器合并症稳定后行腔内支架型人工血管治疗有效可行,安全性高.     

Translumbar thrombin embolization of an aortic pseudoaneurysm complicating lumbar disk surgery

We report a case of translumbar embolization of an aortic pseudoaneurysm complicating lumbar disk surgery. The iatrogenic pseudoaneurysm was initially treated by open repair, but due to failure of this treatment, we opted for direct translumbar thrombin injection under computed tomography (CT) guidance. The patient recovered completely, and follow-up CT scans showed progressive shrinkage of the residual retroperitoneal hematoma. This minimally invasive treatment should be considered in selected cases as a valuable treatment option for pseudoaneurysms that arise from the aorta.     

主动脉疾患误诊为下肢动脉血栓栓塞九例分析

目的 分析主动脉疾患误诊为下肢动脉血栓栓塞的原因,总结经验教训.方法 回顾性分析9例主动脉疾患误诊病例的临床表现、误诊误治情况及确诊方法.结果 9例均初诊为下肢动脉血栓栓塞.其中3例急诊行Fogarty导管取栓术,术后通过三维CT血管造影(3-dimensional CT angiography,3DCTA)检查明确诊断;另6例于术前行3DCTA而确诊为主动脉疾患.本组中5例为主动脉夹层累及髂股动脉,其中1例主动脉夹层患者放弃治疗后1 d死亡;另1例主动脉夹层患者拒绝治疗,离院后失访;3例成功施行腔内修复术.1例为腹主动脉瘤腔内附壁血栓脱落,施行动脉瘤切除术.其余3例为Leriehe综合征合并急性主动脉末端血栓形成,施行主髂动脉旁路术.本组无围手术期死亡,治疗后患肢缺血均改善.结论 主动脉疾患也可引起急性下肢缺血,易被误诊为肢体动脉血栓栓塞,影像学检查能够确立正确诊断.     

Traumatic pseudoaneurysms of external carotid artery branch: Case series and treatment considerations

PurposeTo explore the diagnosis and treatment of traumatic external carotid branch pseudoaneurysms.MethodsEleven cases of traumatic external carotid artery branch pseudoaneurysms were admitted in our hospital. Digital subtraction angiography was performed in all patients. It revealed that the pseudoaneurysms originated from the internal maxillary artery in 5 cases, superficial temporal artery in 5 cases and occipital artery in 1 case. Five cases of internal maxillary artery pseudoaneurysms and 2 cases of superficial temporal artery pseudoaneurysms were treated by embolization; the other 3 cases were surgically resected.ResultsComplete cessation of nasal bleeding was achieved in all the 5 pseudoaneurysms of internal maxillary artery after the endovascular therapies. Scalp bleeding stopped and scalp defect healed up in 2 patients with superficial temporal artery pseudoaneurysms treated by interventional therapy. All patients were followed up for 0.5–2.0 years without recurrence of nosebleed and scalp lump.ConclusionFor patients with repeated severe epistaxis after craniocerebral injury, digital subtraction angiography should be performed as soon as possible to confirm traumatic pseudoaneurysm. Endovascular therapy is an effective method for traumatic internal maxillary artery pseudoaneurysms. For patients with scalp injuries and pulsatile lumps, further examinations including digital subtraction angiography should be performed to confirm the diagnosis. Surgical treatment or endovascular therapy for scalp traumatic pseudoaneurysm is effective.     

Vascular complications in orthopaedic surgery

Vascular complications during orthopaedic surgery, although rare, do occur. Most vascular complications occur intraoperatively, immediately postoperatively or in the late postoperative period; they most commonly include lacerations, pseudoaneurysms, thrombosis, and arteriovenous fistulas. The operations most commonly associated with vascular injuries are knee arthroplasty, followed by hip arthroplasty, spinal surgery, and knee arthroscopy. Most commonly the popliteal artery is involved, followed by the tibial, superficial femoral, iliac, common and profunda femoral arteries. Color Doppler ultrasound is the initial imaging method used to evaluate a vascular injury. Computed tomography and magnetic resonance angiography are usually not applicable in joint replacement surgery because of the artifacts caused by the prostheses. When noninvasive imaging fails to reveal the injury, angiography is required. Traditional management of vascular surgical complications have included vascular surgical intervention. However, the availability of a vascular surgical team is required, and re-exploration of the operative site to treat acute ischemic complications of joint replacement may be difficult and may fail because the source of bleeding is not always apparent. In this setting, endovascular treatments such as balloon arterial thrombectomy, balloon angioplasty with and without stenting, and transcatheteral selective arterial embolization have been effective, successful, and safe interventional techniques in the acute or late postoperative period after elective orthopedic surgery. These techniques should be considered as the first option in the treatment of these lesions.     

Midterm results of endoluminal stent grafting of the thoracic aorta

The purpose of this study was to evaluate the overall outcome of repair of thoracic aortic lesions with endoluminal grafts. Patients were studied prospectively following the implantation of a thoracic endovascular device. Preoperative imaging was performed by helical computed tomography (CT), angiography, transesophageal ultrasonography, or magnetic resonance imaging. Procedures were performed in an endovascular surgical suite under general anesthesia. All patients were evaluated with CT and chest radiography at discharge and at 1, 6, and 12 months. From December 1999 to November 2001, thirty-two patients were enrolled in the study (mean age 62 years; 20 male and 12 female patients). Seventeen patients had dissections, five patients had ruptured aortic ulcer, five patients had traumatic ruptures, three patients had atherosclerotic aneurysms, and two patients had pseudoaneurysms. An American Society of Anesthesiology score of III or IV was evaluated in 22 (69%) patients. The procedure was performed under emergency conditions in 11 cases. All prostheses were implanted successfully. There were no conversions. Three patients (9%) presented with a neurologic event following the implantation procedure, which was lethal in one case (hemorrhagic stroke). Two other patients died during early follow-up of myocardial infarction and multiorgan failure. The early death rate was 9%. The mean follow-up was 13.5 months. During follow-up, the maximal diameter of the aorta shrunk (> or = 5 mm) in 9 (28%) patients, remained stable in 17 (53%) patients, and increased (> or = 5 mm) in 6 (19%) patients. All patients presenting with an increased diameter were initially treated for dissections. A type 1 endoleak was diagnosed on the discharge CT scan in one patient. It sealed spontaneously thereafter. A type 3 endoleak was diagnosed 3 months after the procedure in one patient. A complementary stent graft was implanted in two patients presenting with a dissection with persistent patent false lumen and aortic enlargement. Three patients died during follow-up (two aneurysm-related and one aneurysm-unrelated death). The morbidity and mortality rates reported in our series related to the preoperative morbid conditions of the patients treated. Thoracic aorta endografting is an alternative to open surgery in this subset of patients.     

Decision-making aspects in the timing of surgical intervention in aortic rupture

Twenty-one consecutive patients with traumatic rupture of the thoracic aorta were treated at the University Hospital of Basel, Switzerland. The patients were divided into two groups according to their clinical status at the time of surgery. Six patients with unstable vital functions underwent immediate surgery (group 1), while 15 patients were operated upon semi-urgently because of delayed diagnosis or electively (group 2). Five of 6 patients undergoing immediate repair in group 1 died intraoperatively, 3 of 15 patients with deferred surgery expired postoperatively after a period of 6 weeks to 3 months. All 13 survivors underwent follow-up for 10 months to 20 years. NMR imaging of the aorta in 12 patients revealed neither pseudoaneurysms nor stenosis at the anastomoses. The results indicate that the timing of the surgical intervention in stable contained aortic rupture with serious associated injuries should preferably be deferred until after stabilization of the clinical status.     

血管腔内移植物治疗大动脉疾病的探讨

目的探讨以血管腔内移植物为主的血管腔内疗法治疗胸或胸腹主动脉疾病的疗效和存在问题。方法治疗包括夹层动脉瘤、真性和假性胸主动脉瘤、主动脉减速伤和缩窄患者共137例。主要病变的最低部位在腹腔动脉和肠系膜动脉之间。除血管腔内治疗法外,尚辅以腹主或髂动脉-肠系膜上动脉、或腋动脉-左颈总动脉等架桥术。结果发生急性内脏动脉缺血而急症开腹手术2例。早期漏7例。围手术期死亡6例(4．4％)。随访1～43(平均11)个月,发现后期内漏2例、血管腔内移植物部分断裂1例。DeBakeym型夹层治疗后发生Ⅰ型夹层病变1例。后期死亡5例(4例与腔内移植物无关,1例为多发性动脉瘤复发),失访11例,115例存活。结论以血管腔内移植物治疗高风险的大动脉病变相对安全有效,具有发展前景;但器材有待改进、远期疗效有待观察。     

Obliteration of femoral artery pseudoaneurysm by thrombin injection

BACKGROUND: Femoral artery pseudyoaneurysms are a common complication after femoral access for transcatheter procedures, frequently requiring operative repair. We review the safety and efficacy of a novel nonsurgical method of pseudoaneurysm treatment METHODS: From June 1998 to November 2001, a total of 47 femoral artery pseudoaneurysms in 46 patients were treated by bedside ultrasound-guided injection of dilute topical thrombin. All pseudoaneurysms occurred after femoral access for transcatheter procedures, and were diagnosed clinically and confirmed with ultrasound imaging. Clinical follow-up was performed and included ultrasound (2 hours to 1 month) in 64.4% of patients, including any patient with a symptomatic or clinical change. RESULTS: Pseudoaneurysms ranged in size from 1.5 to 4.5 cm. Of 47 pseudoaneurysms, 45 were successfully obliterated on the initial injection. After successful obliteration of pseudoaneurysm, 1 patient sustained thrombosis of the tibioperoneal trunk that required surgical embolectomy, yielding a complication rate of 2%. Four pseudoaneurysms recurred after initially successful obliteration. In 1 of these cases, the patient was taken directly to surgery, and 3 were successfully treated with repeat injection, for an overall success rate of 93.6%. CONCLUSIONS: Obliteration of femoral artery pseudoaneurysm by injection is safe and effective, and may be associated with decreased morbidity. Recurrent pseudoaneurysms may be safely reinjected, with a high success rate.     

Surgical treatment of post—traumatic pseudoaneurysms and arteriovenous fistulas

Objective:To report the experience in the diagnosis and treatment of post-traumatic pseudoaneurysms and arteriovenous fistulas.Methods:A series of 30 patients(11 women and 19 men) with posttraumatic pseudoaneurysms were reviewed retrospectively.Among them 7 patients (5 women and 2 men) were associated with arteriovenous fistula.Results:The causes included sharp penetration trauma(18 cases),blunt trauma (6 cases) and iatrogenic arterial injury (6 cases).The main clinical manifestations consisted of local pulsatile mass (26 cases),vascular bruits (19 cases),thrill (13 cases),ischemia of distal limb (9 cases),neuropathy (5 cases) and pseudoaneurysm rupture (2 cases).All patients underwent surgery.The operations included:ligation of the vessels (12 cases),surgical resection and primary suture repain of the vascular defect or anastomosis (11 cases),vascular reconstruction with autogenous saphenous vein (3 cases) and synthetic vascular graft (4 cases).Conclusions:Because of the imminent clinical course,early operation is usually indicated.The operative treatment is effective and safe for most of the patients with post-traumatic pseudoaneurysms and arteriovenous fistulas.