4 F MPA1导管经右肘静脉完成双侧肾上腺静脉同步采血可行性和安全性研究——附51例报道

【摘要】 目的 探讨2根4F MPA1导管经右肘静脉行双侧肾上腺静脉同步采血术（AVS）的可行性和安全性。方法 连续纳入2021年10月至2022年10月在襄阳市中心医院需行AVS的51例原发性醛固酮增多症患者,采用2根4F MPA1导管（其中1根塑形成猪尾形）经右肘静脉行双侧同步AVS。统计选用导管、双侧肾上腺静脉同步采血成功率、并发症发生率。结果 对右肾上腺静脉均使用4 F MPA1导管,左肾上腺总干静脉、左肾上腺中央静脉均使用经特殊塑形的4 F MPA1导管。双侧同步AVS成功率为92.2%（47/51）。发生１例（1.96%）肾上腺血肿。结论 经右肘静脉使用2根4 F MPA1导管行双侧同步AVS,导管选择及操作简单、创伤小、安全可行,但因样本量小,仍需进一步研究验证。     

肾上腺静脉采血

肾上腺静脉采血是通过导管选择性插至肾上腺静脉内采取血样的一种介入检查方法,主要用于原发性醛固酮增多症(PA)的鉴别诊断.熟悉肾上腺静脉解剖及变异、术前充分准备、熟练的操作技术,可快速获得足量有效的样本,减少并发症.肾上腺静脉采血诊断准确、技术可行,应成为明确PA病因的常规检查手段.     

股静脉及胫前静脉入路导管接触溶栓治疗急性下肢深静脉血栓形成患者近期效果和安全性观察

【摘要】 目的 评价股静脉入路及胫前静脉入路导管接触溶栓（CDT）治疗急性下肢深静脉血栓形成（LEDVT）患者近期效果和安全性。方法 回顾性对照分析2019年1月至2021年12月在南京医科大学第二附属医院接受健侧股静脉入路及患侧胫前静脉入路CDT治疗的LEDVT患者临床资料。其中股静脉入路组40例, 胫前静脉入路组46例。主要观察终点为手术技术成功率和血栓清除率,次要观察终点为手术时间和并发症。结果 股静脉入路组、胫前静脉入路组手术技术成功率分别为92.5%、100%（P=0.097）,血栓清除率分别为（68.9±25.9）%、（78.3±21.0）%（P=0.067）,差异均无统计学意义;手术时间分别为（64.1±14.8） min、（72.0±19.9） min（P=0.037）,差异有统计学意义;并发症发生率分别为22.5%、10.9%（P=0.145）,差异无统计学意义。结论 股静脉入路和胫前静脉入路CDT均可有效治疗LEDVT,近期疗效和安全性相当。     

经导管主动脉瓣置换术治疗主动脉瓣狭窄应用进展

【摘要】 主动脉瓣狭窄（AS）是在解剖层面导致心脏射血受阻、心脏负荷增加以及冠状动脉、脑血管和全身脏器供血受限的疾病,对患者产生重要影响。随着我国老龄化进程加快,老年主动脉瓣钙化、退变导致AS患者越来越多,针对这类患者采取合适的治疗方案非常重要。AS根本治疗是瓣膜置换。外科主动脉瓣置换术（SAVR）对年轻AS患者耐受性良好,但仍存在创伤大等缺陷,对老年患者风险很高,并发症发生率也很高。微创经导管主动脉瓣置换术（TAVR）是老年AS患者的重要选择。该文就AS,TAVR手术患者、手术入路、人工瓣膜类型选择,术后抗栓策略,术后并发症及其处理及术后康复治疗等应用进展作一综述。     

导管开窗技术在右膈下动脉供血的肝癌TACE中的应用

【摘要】目的探讨导管开窗技术在右膈下动脉（right inferior phrenic artery,RIPA）供血的肝癌TACE超选择插管中应用的可行性和安全性。方法2023年3月至2023年5月烟台毓璜顶医院对5例合并RIPA供血的肝癌患者进行TACE中采用常规插管技术微导管RIPA超选择插管失败后,应用导管开窗技术完成RIPA的超选插管。结果5例患者均成功完成RIPA超选择插管及TACE治疗,手术成功率100%,超选择插管时间（3.2±2.39） min。术后肝肿瘤指标较前下降,肝功能指标无明显下降,按照mRECIST标准进行评估疗效,其中3例达到部分缓解（PR）,2例达到完全缓解（CR）。5例患者均无严重不良反应发生。结论导管开窗技术可提高RIPA供血的肝癌患者TACE时RIPA超选择插管的成功率,安全有效。     

经左侧腋静脉近侧段植入输液港穿刺方式临床研究

【摘要】 目的 探讨经左侧腋静脉近侧段完全植入式静脉输液港（TIVAP）穿刺方式的可行性、安全性及影响因素。方法 回顾性分析2015年8月至2020年4月在上海市公共卫生临床中心经左侧腋静脉近侧段植入TIVAP的252例患者临床资料。根据不同穿刺方式,将患者分为超声实时导引穿刺组（n=38）、超声定位标记盲穿刺组（n=84）、骨性标志盲穿刺组（n=49）、X线透视定位盲穿刺组（n=41）、静脉造影导引穿刺组（n=40）等5组。分析各组穿刺成功率、穿刺相关并发症发生率及影响穿刺成功率的因素。结果 超声实时导引穿刺组、超声定位标记盲穿刺组、骨性标志盲穿刺组、X线透视定位盲穿刺组、静脉造影导引穿刺组首次1针穿刺成功率,分别为94.7%、82.1%、65.3%、70.7%、75.0%,2～3针成功率分别为100%、96.4%、83.7%、87.8%、92.5%。252例中11例（4.37%）误穿刺动脉,3例（1.19%）发生气胸,无伤口渗血、血胸、腋神经损伤等严重穿刺相关并发症。超声定位标记盲穿刺患者体质量指数（BMI）越小、腋静脉横径越宽、腋静脉距体表距离越短,穿刺成功率越高。腋静脉横径为8.45 mm时曲线下面积为0.782,则Youden指数最大,灵敏度为76.8%,特异度为66.7%,提示腋静脉横径＜8.45 mm时不推荐盲穿刺。 结论 超声实时导引下穿刺腋静脉近侧段成功率高、穿刺相关并发症少。超声定位标记盲穿刺法、静脉造影导引穿刺法是可行的替代方式。临床实践中需根据患者实际情况、术者经验习惯、科室器械配置等灵活选择穿刺导引方式。     

经导管主动脉瓣置换术后患者早期运动康复及效果评价

【摘要】 目的 探讨经导管主动脉瓣置换术（TAVR）患者实施早期运动康复及效果评价。方法 选取 2019年12月至 2021年11月30 例TAVR患者,经过专家函询构建运动康复干预方案,分为术前预康复、心脏病监护治疗病房康复、普通病房康复及居家/院前康复等4个阶段,匹配相应运动锻炼内涵。干预4周后观察运动康复干预前后患者抑郁量表评分、营养量表评分、运动锻炼依从性评分、药物依从性评分、压力性损伤风险（Braden）评分、日常生活自理能力（Barthel）评分、Morse跌倒风险评分以及患者满意度评分。结果 与运动康复干预前比较,干预后患者抑郁量表评分降低,营养量表评分、运动锻炼依从性评分、药物依从性评分、Braden评分、Barthel评分增高,Morse评分降低,患者满意度评分增高,差异有统计学意义（均P＜0.01）。结论 TAVR术后早期运动康复安全有效,可促进患者长期健康行为依从性,提高患者生活质量,减少疾病相关危险因素。     

DSA引导的经减压孔快速交换法置入经鼻型肠梗阻导管

【摘要】 目的 研究快速交换法置入经鼻型肠梗阻导管的可行性和优势。方法 29例小肠梗阻患者接受快速交换法置入肠梗阻导管。泥鳅交换导丝到位后,其尾端经肠梗阻导管端孔进入,并经减压侧孔引出,透视下快速交换法置管。临床转归为分为:痊愈、手术、好转、无效。其中,痊愈、好转、手术视为临床有效。以技术成功率和临床有效率评价效果。结果 技术成功率100%。临床转归计有痊愈9例、手术5例、好转13例、无效2例。临床有效率93.1%（27/29）。 结论 DSA引导的经侧孔快速交换法可简捷地置入经鼻型肠梗阻导管,是治疗小肠梗阻的有效方法。     

药物-机械导管溶栓联合Venovo静脉支架植入治疗髂静脉压迫伴急性下肢深静脉血栓形成

【摘要】 目的 评价药物-机械导管溶栓（pharmacomechanical catheter-directed thrombolysis,PCDT）联合Venovo（Bard）静脉支架植入治疗髂静脉压迫综合征（iliac vein compression syndrome,IVCS）伴急性下肢深静脉血栓形成（deep venous thrombosis,DVT）的短期疗效及安全性。方法 回顾性分析2022年7月至2022年12月于郑州大学第五附属医院采用PCDT联合Venovo静脉支架植入治疗IVCS伴急性下肢DVT的23例患者临床资料,评价患者手术前后下肢周径差及术后血栓清除率。于术后第1、3、6个月进行门诊随访,记录患者静脉临床严重程度评分（venous clinical severity score,VCSS）并检查支架通畅情况。结果 所有手术均获成功,靶病变血栓均达到完全清除（清除率＞95%）,同期植入Venovo髂静脉支架23枚。术后6个月随访期间未见支架发生移位、断裂或脱落等情况,无死亡病例。23例患者下肢患-健侧周径差（大腿、小腿）分别由术前（5.59±0.93） cm、（3.52±0.85） cm下降为术后（1.43±0.68） cm、（1.41±0.72） cm,差异具有统计学意义（均P＜0.05）。术后第6个月时VCSS较术前显著降低（5.4±1.1 vs 8.0±1.9,P＜0.05）,差异具有统计学意义。术后第6个月时一期通畅率为95.7%（22/23）,手术再干预率为4.3%。结论 应用PCDT联合Venovo静脉支架植入治疗IVCS伴急性下肢DVT安全有效,具有较好的临床应用前景。     

经导管动脉栓塞术治疗腹部外科术后迟发性出血

【摘要】 目的 评价经导管动脉栓塞术（TAE）治疗腹部外科术后迟发性出血的临床应用价值。方法 回顾性分析2010年5月至2019年6月采用TAE诊断治疗的腹部外科术后迟发性出血患者23例。术中动脉造影明确出血责任动脉,对动脉主干出血予以弹簧圈栓塞动脉远段和近段,对动脉末梢出血予以明胶海绵颗粒或明胶海绵颗粒联合弹簧圈栓塞。术后随访至患者治愈出院或院内死亡。结果 23例患者中造影表现阳性22例,阴性1例,阳性率为95.7%。阳性患者中动脉假性动脉瘤形成8例,动脉破裂伴对比剂外溢14例。所有阳性患者均接受进一步TAE治疗,术后治愈17例,死亡3例,复发2例,临床有效率为86.4%。术后1例死于肝衰竭,2例死于多脏器衰竭,2例复发患者再次TAE治疗后治愈出院,所有患者均未发生胃肠坏死和胃肠穿孔等栓塞并发症。结论 动脉造影结合TAE诊断腹部外科术后迟发性出血阳性率高,治疗效果确切,可作为首选方法。     

Dynamic multidetector CT and non-contrast-enhanced MR for right adrenal vein imaging: comparison with catheter venography in adrenal venous sampling

Objectives

To evaluate visualization of the right adrenal vein (RAV) with multidetector CT and non-contrast-enhanced MR imaging in patients with primary aldosteronism.

Methods

A total of 125 patients (67 men) scheduled for adrenal venous sampling (AVS) were included. Dynamic 64-detector-row CT and balanced steady-state free precession-based non-contrast-enhanced 3-T MR imaging were performed. RAV visualization based on a four-point score was documented. Both anatomical location and variation on cross-sectional imaging were evaluated, and the findings were compared with catheter venography as the gold standard.

Results

The RAV was visualized in 93.2 % by CT and 84.8 % by MR imaging (p?=?0.02). Positive predictive values of RAV visualization were 100 % for CT and 95.2 % for MR imaging. Imaging score was significantly higher in CT than MR imaging (p?<?0.01). The RAV formed a common trunk with an accessory hepatic vein in 16 % of patients. The RAV orifice level on cross-sectional imaging was concordant with catheter venography within the range of 1/3 vertebral height in >70 % of subjects. Success rate of AVS was 99.2 %.

Conclusions

Dynamic CT is a reliable way to map the RAV prior to AVS. Non-contrast-enhanced MR imaging is an alternative when there is a risk of complication from contrast media or radiation exposure.

Key Points

? Dynamic CT and non-contrast-enhanced MR imaging detect the right adrenal vein (RAV). ? Dynamic CT can visualize the RAV more than non-contrast-enhanced MR imaging. ? Mapping the RAV helps to achieve successful adrenal venous sampling. ? Sixteen per cent of RAVs share the common trunk with accessory hepatic veins.

     

Cerebrovascular disease: evaluation with transbrachial intraarterial digital subtraction angiography using a 4-F catheter

Three hundred sixty-one patients underwent intraarterial digital subtraction angiography for definite or probable occlusive vascular disease of the carotid arteries. Examinations were performed with 65-cm-long, 4-F aortic catheters. A transbrachial approach was used. Images were good or excellent in nearly all cases. No postprocedural neurologic deficits or hematomas occurred. Permanent pulse deficit occurred in two patients, and temporary deficit occurred in three patients, an improvement over the frequency found in previous transbrachial series using 6-8-F catheters. While these results establish the efficacy of this technique, they also indicate a possible greater relative safety in men than in women.     

Uterine artery embolisation for uterine fibroids using a 4F Rosch inferior mesenteric catheter

Purpose: To evaluate in a prospective study the use of a 4F Rosch inferior mesenteric (RIM) catheter for uterine artery embolisation (UAE). Materials and methods: UAE was performed in 72 women over a 37-month period. A 4F RIM braided J-curve 65-cm catheter was used in combination with an angled hydrophilic 150 cm, 0.035 flexible tip guide-wire to catheterise the horizontal portion of both uterine arteries (UA) from a right common femoral artery (CFA) approach. Technical success was defined as successful catheterisation and embolisation of both uterine arteries. Fluorosocpic and procedure times were recorded. Results: Mean subject age=43.7 years (range=25–57 years). Technical success was 98.6% (n=71/72). A single approach via the right CFA was used in 88.9% (n=64/72) and a bilateral CFA approach in 11.1% (n=8/72). Bilateral uterine artery catheterisation using a single 4F RIM catheter via the right CFA approach was successful in 79.2% (n=57/72). Microcatheters were used in 2.8% of patients (n=2/72). Mean fluoroscopic time=13.6±5.3 min (mean±SD). Mean procedure time=44.2±16.5 min. Conclusion: High technical success rate for UAE is possible using a single 4F RIM catheter via a unilateral right CFA approach, which obviates the need for Waltman loop formation, reversed curve catheters and complex suture-catheter arrangements.     

Outpatient transbrachial arterial DSA using a 4F catheter for the clarification of extracranial vascular processes

Experience with intravenous digital subtraction angiography (DSA) has proven disappointing in the outpatient evaluation of cerebrovascular disease. Variations in cardiac output, vessel superimposition, patient motion and poor vascular opacification frequently combine to produce nondiagnostic examinations. To assess the safety of nonselective intra-arterial DSA performed from a brachial artery approach, the complications of 103 examinations, most of which (85%) were performed on outpatients, were prospectively studied. The injection of contrast material into the aorta was made through a 4F multiple side-hole pigtail catheter, inserted percutaneously from the brachial artery. Images were good or excellent in nearly all cases. No permanent neurovascular complications or local artery complications such as thrombosis requiring surgery were encountered and only a few minor complications occurred. We believe that transbrachial intraarterial DSA is a safe, simple and well-tolerated out-patient procedure that can yield reliable, definitive, and complete cerebrovascular studies in nearly all patients referred for the examination.     

Mechanical thrombectomy in hemodialysis access shunts using a 5F pigtail rotation catheter. In vitro and in vivo investigations.

RATIONALE AND OBJECTIVES: To evaluate the feasibility of mechanical thrombectomy in occluded hemodialysis access shunts by using a newly developed 5F pigtail rotation catheter. METHODS: Thrombosed hemodialysis access shunts were simulated by clotted bovine blood in silicone tubing (diameter 6 mm). After retrograde and antegrade sheath placement (6F), mechanical fragmentation was performed using a 5F rotatable pigtail device. Average tube length was 27 to 47 cm; average thrombus weight was 5 to 11.9 g (8.2 +/- 1.59). Clinical application involved six patients with fresh shunt occlusions (three Brescia-Cimino shunts, three Gore-Tex shunts). RESULTS: Using the in vitro setup, the device was able to restore a continuous lumen within 10 minutes with no remaining wall-adherent thrombi. The average amount of particles in the effluent was 3.0 g (2.0 to 3.9) for particles < or = 1.0 mm and 0.67 g (0.44 to 0.96) for particles > or = 0.2 mm wet weight; (compared with initial thrombus weight, 30.7% and 1.1%, respectively). Clinically, all six hemodialysis access shunts were successfully recanalized. Technical problems did not occur. There were no clinical symptoms indicating pulmonary embolism in any of the treated patients. CONCLUSIONS: In our experimental setup as well as under clinical conditions, effective treatment of occluded hemodialysis access sites was achieved. The pigtail rotation device is an easy-to-handle, inexpensive alternative to mechanical thrombus fragmentation in occluded hemodialysis access shunts. The rate of emboli in the effluent vein of approximately one third of the initial thrombus weight must be taken into consideration in frequent intraindividual use of this technique.     

Efficacy and complications in peripherally inserted central catheter insertion: a study using 4-Fr non-valved catheters and a single infusate

The purpose of this prospective study was to evaluate the efficacy and complications associated with the use of 4-Fr single-lumen non-valved peripherally inserted central venous catheters (PICC) for the infusion of long-term antibiotics. Forty-four non-valved PICC were inserted using micropuncture technique by interventional radiologists. Six patients were lost to unrelated death or follow up. The remaining 38 patients (24 men and 14 women; mean age 54.79 years) were analysed. Catheters were placed under ultrasound guidance using micropuncture technique and subsequently advanced over guidewire through peel-away sheath under fluoroscopic guidance. Doppler ultrasound was used before PICC removal in order to detect possible complications. All non-valved PICC were flushed with 5 ml of heparinized saline before and after each antibiotic infusion. Efficacy was evaluated and analysed on the average duration of catheter patency and whether any complication was present. Procedural success rate was 100% in our patient population. Seven patients had complications necessitating early PICC removal with the average patency duration of 44 days (95% confidence interval 7.79-80.21 days), whereas an average indwelling patency duration of the remaining 31 patients with no complication was 30.58 days (95% confidence interval 25.74-35.43 days). Total complication rate was calculated to be 5.58 incidences per 1000 catheter days. Complication rate associated with the placement and use of 4-Fr non-valved PICC for antibiotic therapy was observed to be low when compared with other studies using valved and non-valved PICC for various infusates.