Percutaneous transluminal angioplasty of abdominal aortic stenoses

Percutaneous transluminal angioplasty (PTA) was performed on 25 patients with localized distal abdominal aortic stenoses. All patients were smokers and all complained of bilateral lower limb claudication. Eleven patients had small distal aortas and iliac vessels. Technically successful dilatation was achieved in all patients. Long-term follow-up was available on 17 of the patients. The mean follow-up period was 38 months. Cumulative patency at 5 years was 70%. Thirteen patients remain asymptomatic 15–83 months following PTA. Late failure occurred in 4 patients, 1–38 months following PTA. No complications related to PTA were experienced. PTA of localized aortic stenoses is a safe alternative to surgery and should be the treatment of choice in this condition.     

裸支架在腹主动脉瘤腔内隔绝术后近端内漏治疗中的应用

目的：探讨应用裸支架治疗主动脉瘤腔内隔绝术后近端内漏的价值和安全性。方法：使用裸支架地治疗原发性内漏3例，继发性内漏1例。1例裸支架在肾动脉下固定。3例跨双侧肾动脉开口固定。结果：裸支架均成功置入，近端内漏完全消除，术后未观察到肾功能受损、裸支架移位和近端内漏复发等并发症。结论：使用裸支架法治疗近端内漏，是一种安全、有效、可行的选择。     

球囊扩张椎体成形术治疗老年胸腰椎多发性压缩骨折

目的探讨一次多椎体球囊扩张椎体成形术治疗老年胸腰椎多发性压缩骨折的临床疗效。方法应用一次多椎体球囊扩张椎体成形术,先扩张症状最严重椎体,再同时用球囊扩张其余椎体,恢复椎体部分或全部高度,每个椎体注入骨水泥3～8ml,术后行X线检查以评价椎体高度恢复、骨水泥填充情况及有无渗漏。疗效判断采用测类比评分法(VAS)计算患者的疼痛缓解率。结果 48例均经3～24个月的随访(平均13个月),疼痛缓解率平均为86.2%。术后X线片显示骨水泥在椎管内充填满意,椎体高度平均恢复达到60%～80%,前屈后伸未见椎体前缘高度改变。结论一次多椎体球囊扩张椎体成形术微创、止痛效果好,疗效明显,是治疗老年胸腰椎多发性压缩骨折的有效方法。     

肾下型腹主动脉瘤腔内隔绝术与传统手术对肾功能影响的比较研究

目的：对比肾下型腹主动脉瘤（AAA）腔内隔绝术（EVE）与传统手术（CS）对肾功能的影响。方法：回顾1997年3月至2002年3月间实施的157例肾下型AAA手术，其中EVE组115例，CS组42例，分析比较两组手术前后血肌酐、血尿素氮的变化情况。结果：CS组术后血肌酐、血尿素氮较术前明显升高，并发生急性肾衰1例，而EVE组手术前后两指标无显著差异。结论：EVE对肾下型AAA患者肾功能的影响明显小于CS。     

Retrograde embolization of the left vertebral artery in a type II endoleak after endovascular treatment of aortic thoracic rupture: technical note

Endoleak is a frequent complication after endovascular repair of aortic rupture. We describe the case of a female patient with traumatic aortic injury, treated with endograft, who developed a type II endoleak through the left subclavian and vertebral arteries. Both arteries originated independently from the aortic arch, and were managed with coil embolization of each vessel. We also report our experience with treating the left vertebral artery by placing a microcatheter through the right vertebral one.     

Multidetector row CT diagnosis of aortocaval fistula complicating aortic aneurysm: a case report

Aortocaval fistula is a rare complication of abdominal aortic aneurysm involving less than 1% of all abdominal aortic aneurysms and causing severe hemodynamic derangements from a large left-to-right shunt; early diagnosis and repair results in improved morbidity and lower mortality but the diagnosis is difficult. We report a case of prompt diagnosis obtained with thoracoabdominal aortic multidetector row angio-CT as the first imaging procedure and allowing immediate surgical repair. Our report emphasizes the crucial role played by multidetector row CT as the first procedure in thoracoabdominal vascular emergencies.     

Inadvertent embolic obstruction of abdominal aorta from left atrial thrombus after percutaneous mitral valvuloplasty

Inadvertent embolic obstruction of the distal abdominal aorta and left renal artery during a percutaneous mitral valvuloplasty procedure in a patient with mitral stenosis is reported. The embolism was from a left atrial thrombus which was detected by magnetic resonance imaging (MRI) but not by transesophageal echocardiography.     

Congenital subclavian steal associated with an unusual type of right aortic arch

A case of congenital subclavian steal caused by a previously unreported aortic arch anomaly was demonstrated by angiography. The patient was shown to have a right aortic arch with a retroesophageal segment, a stenotic proximal portion of the left subclavian artery, and a left descending aorta.     

椎弓根螺钉内固定治疗不稳定中上胸椎骨折

目的探讨应用椎弓根螺钉内固定治疗不稳定中上胸椎骨折的临床效果。方法对自2001年3月起收治的17例经椎弓根螺钉内固定治疗的不稳定中上胸椎骨折患者进行回顾性分析，骨折部位：T31例，T42例，T52例，T64例，T76例，T82例。其中压缩性骨折9例，骨折脱位5例，爆裂型骨折3例。本组均行后路椎弓根螺钉内固定及后外侧植骨融合，其中江苏武进通用型脊柱内固定系统（GSS）固定11例，AO通用脊柱内固定系统（USS）固定6例。结果本组17例均获随访，随访时间为10～38个月，平均21．1个月，伤椎前缘高度由术前平均40％恢复至术后91％，螺钉位置不良4枚，术后无神经系统症状加重，随访时无内固定松动及断裂，伤椎高度及脊柱生理弧度无丢失。结论胸椎椎弓根螺钉内固定是治疗不稳定中上胸椎骨折的一种有效方法，中上胸椎椎弓根螺钉固定有一定风险，但只要熟悉其解剖特点，正确选择螺钉直径及进针点、角度和深度，胸椎椎弓根螺钉可安全地置入椎弓根。     

Paradoxical emboli: demonstration using helical computed tomography of the pulmonary artery associated with abdominal computed tomography

We report the case of a 60-year-old woman with a recent history of a cerebrovascular accident. Because of clinical suspicion of pulmonary embolism and negative Doppler ultrasound findings of the lower limbs, spiral computed tomography of the pulmonary artery was performed and demonstrated pulmonary emboli. We emphasize the role of computed tomography of the abdomen, performed 3 min after the thoracic acquisition, which showed an unsuspected thrombus within the abdominal aorta and the left renal artery with infarction of the left kidney. Paradoxical embolism was highly suspected on computed tomography data and confirmed by echocardiography which demonstrated a patent foramen ovale. Received: 23 April 1999; Revised: 17 August 1999; Accepted: 18 August 1999     

脊柱骨盆矢状面平衡参数对老年单节段骨质疏松压缩性骨折行PKP术后继发椎体骨折的影响

目的探讨脊柱骨盆矢状面平衡参数对老年单节段骨质疏松压缩性骨折(OVCF)行经皮球囊扩张椎体后凸成形术(PKP)术后继发椎体骨折的影响。方法回顾性分析2016年12月-2018年12月在四川省第二中医医院骨伤科确诊并行PKP治疗的128例单节段OVCF患者的临床资料,根据PKP术后是否继发椎体骨折将其分为继发组(n=60)和未继发组(n=68),在站立位全脊柱侧位X线片上测量脊柱骨盆矢状面平衡参数,比较两组手术相关资料、VAS评分、ODI评分、脊柱骨盆矢状面平衡参数。结果两组骨水泥用量差异无统计学意义(t=1.446,P=0.151);两组手术节段、手术入路差异无统计学意义(χ^2=0.187、0.008,P=0.911、0.929)。继发组VAS评分、ODI评分明显高于未继发组(t=5.717、9.935,P=0.000、0.000)。两组胸腰椎后凸角(TLK)、骨盆倾斜角(PT)差异无统计学意义(t=0.953、1.086,P=0.342、0.279)。继发组矢状面偏移(SVA)明显高于未继发组(Z=-9.142,P=0.000),胸椎后凸角(TK)明显高于未继发组(t=3.827,P=0.000),腰椎前凸角(LL)、骶骨倾斜角(SS)、骨盆入射角(PI)明显低于未继发组(t=4.002、4.794、4.078,P=0.000、0.000、0.000)。结论较小SVA、TK及较大LL、SS、PI可减小老年单节段骨质疏松压缩性骨折患者PKP术后继发椎体骨折的概率。     

经皮球囊扩张椎体成形术治疗陈旧性椎体压缩性骨折并假关节形成的疗效观察

目的：探讨经皮球囊扩张椎体成形术（percutaneous balloon kyphoplasty,PKP））治疗陈旧性椎体压缩性骨折并假关节形成的临床疗效。方法回顾性分析我科2009年9月～2014年3月收治的15例患者,均确诊为陈旧性椎体压缩性骨折并假关节形成,行经皮球囊扩张椎体成形术（ PKP）治疗;术前、术后行视觉模拟评分（ visual analogue scales,VAS）及日常生活能力（ Macnab标准）比较,测量术前、术后伤椎节段矢状面指数,明确椎体后凸矫正情况。结果15例均顺利完成手术,无一例并发症。患者疼痛症状及日常生活能力明显改善,术后VAS评分：1d（2．53±0．51）、1个月（2．06±0．70）、3个月（2．13±0．51）,均比术前（7．47±0．64）有显著性差异（P＜0．05）。术后伤椎节段矢状面指数（25．8±5．12）°与术前（34．4±5．10）°有显著性差异（P＜0．05）。结论 PKP技术可以稳定陈旧性椎体压缩性骨折后形成的假关节,改善椎体后凸,明显减轻患者的腰痛症状,提高患者日常生活能力。     

后路内固定融合术联合术后伊班膦酸钠治疗创伤性胸腰椎椎体压缩性骨折临床疗效

目的探究后路内固定融合术联合术后伊班膦酸钠治疗创伤性胸腰椎椎体压缩性骨折患者的效果及对VAS评分、Barthel指数的影响。方法 2016年10月—2017年10月汉中市中心医院脊柱科收治胸腰椎椎体压缩性骨折患者90例,按照随机数字表法分为联合组和对照组,各45例。两组患者均接受后路手术内固定融合术治疗,联合组在术后1周联合伊班膦酸钠治疗。比较两组患者的术中指标,检测并比较两组患者治疗前后椎体前缘高度、Cobb角、VAS评分、Barthel指数及骨密度和血清抗酒石酸酸性膦酸酶(TRACP-5b)水平。结果两组的手术时间、术中出血量、切口长度以及住院天数差异无统计学意义(P>0.05)。治疗前两组椎体前缘高度和Cobb角差异无统计学意义(P>0.05),治疗后均显著改善(P<0.05),治疗后6个月联合组椎体前缘高度(24.64±2.53)mm显著高于对照组(19.37±1.56)mm,Cobb角(9.23±2.64)°显著低于对照组(16.31±3.06)°。术后两组VAS评分和Barthel评分均有改善,术后3个月联合组VAS评分(1.74±0.45)分显著低于对照组(2.36±0.54)分(P<0.05),术后6个月联合组Barthel评分(87.42±5.21)分显著高于对照组(81.53±4.75)分(P<0.05)。治疗后两组骨密度和血清TRACP-5b有不同程度改善,联合组的骨密度显著高于对照组,血清TRACP-5b显著低于对照组(P<0.05)。结论使用伊班膦酸钠可减轻接受后路手术内固定融合术患者的疼痛,并可以提高胸腰椎压缩性骨折患者的骨密度,提高疗效。     

Fatal thromboembolic complications following assault in a subject with an abdominal aortic aneurysm

A 62-year-old male with no significant medical history developed thromboembolic complications in the lower limbs shortly after an assault which involved punching and kicking to the trunk. Laparotomy revealed intra-abdominal injuries and an abdominal aortic aneurysm. Death from multi-organ failure and sepsis occurred 9 days post-injury. The discussion concentrates on blunt force trauma to the abdominal aorta, specifically on causation, mechanisms of injury and complications.     

Comparison of intravenous digital subtraction angiography to conventional aortography in patients with abdominal aortic aneurysm

Evaluation of intravenous digital subtraction angiography (IV DSA) in patients with abdominal aortic aneurysm was performed by obtaining catheter aortograms immediately before DSA studies in ten patients. Diagnostic images were obtained in nine of ten digital subtraction examinations. Although repeat injections were necessary in six DSA and three conventional aortography cases for adequate imaging of both cephalad and caudal extension of the aneurysm, average contrast dose was 53 cc (62 cc in standard catheter studies). Renal artery stenosis was diagnosed by DSA in two of three vessels, multiple renal arteries were demonstrated by both modalities in two cases. Digital subtraction and conventional aortographic findings were proved at surgery. Intravenous DSA was shown to be useful in the preoperative evaluation of patients with abdominal aortic aneurysm. This work was supported in part by U.S. Public Health Service Grant No. HL07334.     

The intravertebral vacuum phenomen as specific sign of osteonecrosis in vertebral compression fractures: results from a radiological and histological study

This study investigated the prevalence of the intravertebral vacuum phenomenon (IVP) and osteonecroses in vertebral compression fractures (VCFs). We therefore performed an histological analysis of biopsies obtained from VCFs prior to balloon kyphoplasty. Computed tomography (CT) scans were reviewed regarding the presence of an IVP (i.e. cleft sign, Kümmell disease). We reviewed the data of 266 consecutive patients treated by balloon kyphoplasty in 501 procedures from 2002 to 2004. From 180 patients (68%) we obtained adequate bone tissue for histological evaluation. Biopsy specimens were analysed regarding the presence of osteoporosis, infection, malignancy and osteonecrosis. CT scans of all 180 patients were reviewed for presence of an IVP. Histological examination revealed 135 (75%) osteoporoses, 20 (11%) neoplasms, 12 (7%) trauma cases and 13 (7%) osteonecroses. An IVP was present in 12 (7%) patients. There was a significant association of osteonecrosis and IVP (P < 0.0001). Eleven of 12 patients with a vacuum phenomenon showed an osteonecrosis on histology, wheras 11 of 13 patients with osteonecrosis showed an IVP on CT. The IVP is a specific sign of osteonecrosis in vertebral compression fractures (sensitivity 85%, specificity 99%, positive predictive value 91%). Our findings strongly support the thesis that an IVP indicates local bone ischemia associated with a non-healing vertebral collapse and pseudarthrosis. M. Libicher and A. Appelt contributed equally to this work This paper is dedicated to Professor G.W. Kauffmann, Heidelberg, Germany     

Detection of carotid artery calcification on the panoramic images of post-menopausal females is significantly associated with severe abdominal aortic calcification: a risk indicator of future adverse vascular events

Objectives:

Outcome studies among post-menopausal females with calcified carotid artery plaque (CCAP) on their panoramic images have not been previously undertaken. We sought to compare the extent of abdominal aortic calcification (AAC) on lateral lumbar spine radiographs (LLSRs), among groups of females with (CCAP+) and without (CCAP−) carotid lesions on their panoramic images. “Severe” levels of AAC have previously been validated as a risk indicator of future adverse cardiovascular events.

Methods:

This cross-sectional case–control study included a “CCAP+ group” consisting of females more than 50 years of age having the carotid lesion diagnosed by their dentists and an atherogenic risk factor (age, body mass index, hypertension, diabetes and dyslipidaemia)-matched “CCAP− group”. A physician radiologist, using the Framingham index, evaluated the LLSRs for the magnitude of AAC. Summary statistics for key variables were computed and conditional logistic regression techniques were considered.

Results:

Members of the CCAP+ group were significantly (p = 0.038) more likely to demonstrate “severe” levels of AAC on their LLSRs than members of the CCAP group.

Conclusions:

This is the first published study demonstrating that CCAP on panoramic images of post-menopausal females is significantly associated with “severe” levels of AACs on LLSRs independent of traditional risk factors. Given that these levels of AAC are a validated risk indicator of future myocardial infarction and stroke, dentists must evaluate the panoramic images of post-menopausal females for the presence of CCAP. Patients with carotid atheromas should be referred to their physicians for further evaluation given the systemic implications.     

瘤体动脉分支与腹主动脉瘤腔内隔绝术后Ⅱ型内漏的关系

目的 明确瘤体动脉分支和腹主动脉瘤(AAA)腔内隔绝术(EVE)后Ⅱ型内漏之间的关系。方法 回顾性分析8例行EVE出现Ⅱ型内漏的AAA患者的临床资料。结果 所有患者瘤体上均有数目不等的通畅的动脉分支，术中并发即时性内漏。结论 瘤体上通畅的动脉分支是Ⅱ型内漏发生的主要原因，术后根据瘤径的变化采用相应的动脉栓塞治疗以防止动脉瘤继发性破裂。     

Aneurysmal sizing after endovascular repair in patients with abdominal aortic aneurysm: interobserver variability of various measurement protocols and its clinical relevance

The aim of this study was to determine the variability of various measurement protocols for measurement of abdominal aortic aneurysm (AAA) and the clinical relevance of variability. Three radiologists performed computed tomographic angiography measurements of both the aorta and the largest portion of the aneurysm on selected axial slices. Then measurements of the largest portion of the aneurysm were performed on unselected axial slices, sagittal and coronal reformatted. Finally, aortic volume was calculated. Measurements and volume calculation were performed before and after endovascular repair and assessed: Part 1: interobserver variability for maximum anteroposterior (MAP) and maximum transverse (MTR) diameters on selected slices; part 2: interobserver variability for unselected slices considering MAP and MTR; part 3: interobserver variability considering maximum diameter in any direction (MAD); part 4: interobserver variability for sagittal (SAG) and coronal (COR) free curved multiplanar reformation (MPR); and part 5: volume calculations. We then determined which technique of measurement was the most clinically relevant for detecting changes in aneurysm size or aortic volume. Parts 1 and 2: interobserver variability was 4.1 mm for both MAP and MTR; part 3: interobserver variability was 7 mm for MAD; part 4: interobserver variability was 5.5 mm (COR) and 4.9 mm (SAG); part 5: interobserver variability for volume was 5.5 ml. A combination of MAP and MTR was the most useful for detecting aortic modification. Volume calculation was needed in only a few cases. We recommend avoiding MAD and MPR measurements and suggest instead measuring both maximum anteroposterior and maximum transverse diameters. If aneurysm size remains stable after endovascular repair, aneurysm volume should be measured.     

MR imaging for the detection of endoleaks in recipients of abdominal aortic stent-grafts with low magnetic susceptibility

RATIONALE AND OBJECTIVES: This study was performed to assess the efficacy of magnetic resonance (MR) imaging for the detection of endoleaks in recipients of abdominal aortic stent-grafts with low magnetic susceptibility. MATERIALS AND METHODS: A retrospective search was conducted in radiology department records for cases of patients with low-susceptibility stent-grafts who had been evaluated with MR imaging and either computed tomography (CT) or conventional angiography within a 1-month time frame. Any endoleaks previously confirmed and classified with the use of CT and/or conventional angiography were compared with findings from MR imaging. RESULTS: Nine patients fit the selection criteria. Images of five of those patients depicted six different endoleaks. Two endoleaks had been confirmed with CT, another two had been confirmed with CT and angiography, and two had been confirmed with angiography alone. All endoleaks visualized at CT and/or angiography were accurately detected and classified also with MR imaging. In some cases, the endoleak was more clearly visualized with MR imaging than with CT. In four patients in whom no endoleaks were found at CT, MR imaging also indicated no endoleaks. CONCLUSION: MR imaging is a suitable modality for identifying endoleaks in patients with low-susceptibility stent-grafts. Moreover, MR imaging may be more sensitive than CT for the detection of small endoleaks.