应用血管内栓塞形态学治愈脑动静脉畸形的临床研究

研究经血管内栓塞将脑动脉静脉畸形完全治愈的临床资料分析,总结此类病例的特点和表现,为临床工作提供帮助。方法通过５０例形态学治愈患者的临床资料及影象学资料,对其大小,部位,供血动脉及临床随的考察,总结脑动脉畸形态学治愈的规律。     

血管内介入诊疗技术在脑动静脉畸形中的应用

目的 探讨血管内介入诊疗技术在脑动静脉畸形诊疗中的价值。方法 回顾性分析98例脑动静脉畸形的血管内介入诊疗资料。结果 DSA能明确诊断，显示供血动脉、畸形血管团及引流静脉的情况。52例栓塞治疗的技术成功率为100％，单纯真丝线段栓塞36例．真丝线段和α-氰基丙烯酸正丁酯(NBCA)联合栓塞16例。栓塞程度：畸形血管团完全消失者12例，畸形血管团减少75％以上者21例，畸形血管团减少在50％．75％者11例，畸形血管团缩小不足50％者8例。结论 DSA检查是脑动静脉畸形合理而可靠的诊断方法，有利于估计其预后并制订治疗方案，血管内栓塞治疗是其安全有效的治疗手段。     

应用控制性降压降低脑动静脉畸形术后脑过度灌注

目的：应用手术切除脑动静脉畸形（ＡＶＭ）病灶后给予控制性低血压的方法,观察病灶周围脑组织的灌流情况,探讨术后脑肿胀发生的可能防治措施。方法：选择病灶最大径≥６ｃｍ的ＡＶＭ病人８例,在术中ＡＶＭ切除后,激光多普勒血流测定仪显示病灶周围脑组织高灌注时给予静脉推注２．５％硫喷妥钠－５￣１０ｍｇ／ｋｇ促使血压在原基因上下降２５％左右,观察病灶周围脑组织的灌注情况。结果：８例ＡＶＭ的基础平均血压为７７．６３     

血管内栓塞治疗脑动静脉畸形

目的探讨血管内治疗脑动静脉畸形的方法。方法采用血管内栓塞过程中注胶（NBCA）及单纯真丝线段作栓塞剂,经股动脉插管通过超选微导管栓塞畸形血管团13例。结果病灶被完全栓塞者1例,栓塞70%以上者3例,栓塞50%～70%者8例,栓塞50%以下者1例。栓塞后有3例表现一过性神经功能障碍。结论血管内栓塞治疗技术为脑动脉脉畸形的治疗展现了较为理想的前景。     

基底节区中小型动静脉畸形的血管内治疗

目的 分析基底节区中小型动静脉畸形血管内治疗的安全性及疗效.方法 回顾性分析经血管内治疗的基底节区中小型动静脉畸形16例患者的临床资料,其中畸形直径为中型4例,小型12例;16例患者共栓塞20次,采用Onyx或NBCA进行栓塞治疗;通过随访,分析疗效及预后.结果 16例患者完全栓塞7例（43.8％）,次全栓塞5例（31.2％）,4例部分栓塞（25％）,6例畸形残余者行伽玛刀治疗;随访3个月～5年,无再出血病例,3例轻度残疾,1例中度残疾.结论 血管内治疗基底节区中小型动静脉畸形能收到满意的效果,但栓塞率和畸形血管构筑、供血动脉多少以及血管条件相关.     

脑动静脉畸形团血管影像学特点

目的探讨脑动静脉畸形团的形态学特点。方法回顾性分析69例脑动静脉畸形脑血管造影影像资料。结果脑动静脉畸形团多表现为幕上、致密、类椭圆或不规则形，呈多支动脉的区域性供血，可伴有动脉瘤或动静脉瘘。结论脑动静脉畸形团形态存在多样性，结构复杂，其内部形态与临床症状与预后密切相关。     

脑动静脉畸形血管生成素表达与血管超微结构的观察

目的 探讨脑动静脉畸形(cAVM)血管生成素-1(Ang-1)和血管生成素-2(Ang-2)表达及其与血管超微结构变化的关系。方法 采用免疫组织化学方法检测正常脑组织和cAVM血管内皮细胞中Ang-1和Ang-2的表达情况;透射电镜观察畸形血管壁超微结构变化。结果 正常对照组血管内皮细胞仅表达较低水平的Ang-1和Ang-2,而cAVM及其周围小血管内皮细胞Ang-2表达显著增高(P<0.05)。畸形血管的内皮细胞间隙变宽,胞浆内线粒体丰富,核糖体及粗面内质网增多;平滑肌细胞和弹力纤维减少或消失,代之以大量的胶原组织沉积。结论 血管生成素表达可能参与cAVM的发生发展过程,并与畸形血管的超微结构改变有重要关系。     

脑动静脉畸形血管结构发生学研究进展

脑动静脉畸形（cerebral arteriovenous malformation，CAVM）是一种先天性疾病．它是血管重塑过程中，毛细血管生物学结构发育不良的结果。原始血管树的保留、修复、矫正和更新是由机体自身代谢所决定的．主要涉及到代偿机制，同时也受基因的介导和控制。血管畸形的发生与血管壁长期遭受高血流量撞击有关。正是血管壁所感受压力和血流量的变化，构成了CAVM形成的所谓“压力扳机”。扳机点出现的早晚与畸形血管团的大小有直接关系。     

颅外动静脉畸形血管生成的研究进展

颅外动静脉畸形(Extracranial arteriovenous malformation,AVM)是一种动静脉异常沟通的血管畸形,AVM的发生发展机制尚未明确,目前认为血流动力学改变和体内激素水平升高可能在其中起着重要作用。众多研究发现,包括血管新生(Angiogenesis)和血管发生(Vasculogenesis)在内的血管生成也参与了AVM的发生和发展过程,并可能具有重要作用。本文对AVM发生发展过程中血管生成的研究进展进行综述。     

真丝线段血管内栓塞治疗脑动静脉畸形

目的：探讨应用国产医用真丝线段行血管内栓塞治疗脑动脉畸形的疗效。方法：３３例行选择性全脑血管造影,取得主要供血动脉后,采用Ｍａｇｉｃ１．８Ｆ微导管超选择进入大脑前、中动脉直至病灶内。栓塞剂为５／０真丝线段,栓塞至畸形血管闭消失或减少。结果：血管团完全消失６例,消失达９５％７例,９０％６例,７０％５例,５０￣７０％７例。无死亡及严重并发症发生。结论：真丝线段血人栓塞后临床症状改善显著,显示了介入放射     

The Influence of Vascular Pressure and Angiographic Characteristics on Haemorrhage from Arteriovenous Malformations

Summary ? Background. The present study was designed to determine whether there is a physiological explanation for the predisposition of patients with certain angiographic characteristics to haemorrhage from cerebral arteriovenous malformations (AVMs).  Methods. Intra-operative measurement of feeding artery pressure (FAP) and intravascular pressures in the draining venous system [draining vein pressure (DVP) and cranial sinus pressure (SP)] were performed for 30 AVM cases using direct puncture of the vessels. The correlation between pressures and previously described angiographic characteristics predisposing to haemorrhage were evaluated.  Findings. Small nidus size and only one draining vein increased the risk of haemorrhage. FAP and DVP are both inversely related to the number of draining veins and the size of the AVMs. DVP was significantly higher in AVMs with haemorrhage (23.1±8.7 mmHg) than in those without (13.5±4.4), as was FAP (58.6±12.8 as opposed to 38.7±4.7) (p<0.05). Moreover, the difference between systemic blood pressure and the FAP with haemorrhagic AVMs (17.0±9.5 mmHg) was significantly lower than that in nonhaemorrhagic cases (33.7±5.5) (p<0.05). The pressure difference between the feeding artery and draining vein was not significant between the haemorrhagic and nonhaemorrhagic groups. There was no significant difference of SP between haemorrhagic and nonhaemorrhagic patients.  Interpretation. The present study suggests that a high DVP probably induced by high resistance in the venous drainage system, as well as a high FAP, may contribute to the development of haemorrhage from AVMs, and physiologically supports previous reports that small AVMs and AVMs with only one draining vein are susceptible to haemorrhage.     

选择性介入栓塞治疗耳廓动静脉畸形

目的：探讨选择性介入栓塞治疗（STAE）耳廓动静脉畸形（AVM）的疗效。方法回顾7年来我院治疗的耳廓血管畸形病例14例,比较采用单纯手术治疗、STAE结合手术治疗,以及单纯STAE治疗后的病变改善情况及复发率。结果单纯手术治疗,手术创伤大,失血量多,复发率较低;STAE后手术,手术时间缩短,出血大幅减少,手术野清晰,并发症减少,安全性提高;单独STEA治疗,短期内易复发,但通过选择更好的栓塞剂或技术,其效果将会大幅提高。结论选择性介入栓塞治疗在耳廓动静脉畸形的治疗中起着重要的作用,是一种重要的治疗手段。     

Vascular anomalies of the male genitalia

Purpose

Vascular tumors and malformations of the male genitalia can affect urinary, sexual, reproductive, and emotional function.

Methods

Male patients with a genital lesion evaluated or treated at our center from 1995 to 2010 were reviewed to analyze presentation, diagnosis, treatment modalities, and outcome.

Results

Of the 3889 male patients, 117 had a vascular anomaly of the genitalia: 12 tumors and 105 malformations. The referring diagnosis was accurate in 72.7% of patients with a tumor, whereas 46.3% of malformations were misdiagnosed. Tumors included infantile hemangioma (n = 10) and kaposiform lymphatic anomaly (n = 2). Common vascular malformations were lymphatic (n = 46), venous (n = 33), and capillary-lymphatic-venous (n = 16). Presenting signs for tumors included ulceration (33.0%) and ambiguous genitalia (25.0%). Malformations manifested with swelling (40.0%), fluid leakage (16.2%), and pain (16.2%). Treatment was necessary for 69.9% (79/113) of patients. The remaining lesions (34/113) were observed. Tumor management included observation, pharmacotherapy, and excision. Malformations were largely treated with sclerotherapy and/or surgical procedures.

Conclusions

Vascular anomalies of the male genitalia are uncommon and frequently misdiagnosed. Accurate diagnosis can be made and appropriate treatment can be instituted based on presentation, natural history, and radiographic imaging. Observation and pharmacotherapy are the mainstays of tumor management. Malformations require sclerotherapy and/or resection. Interdisciplinary care optimizes outcomes for males with these often-disfiguring vascular lesions.     

Intralesional Interstitial Injection of Bleomycin for Management of Extracranial Arteriovenous Malformations in Children

BackgroundDespite many advances in the treatment for extracranial arteriovenous malformations (AVMs), they still result in tedious dissection and potential unacceptable complications, particularly in children. Therefore, this study aimed to investigate the efficacy and safety of intralesional interstitial injection of bleomycin for the treatment of children with AVMs.MethodsA total of 10 children (6 boys and 4 girls) with AVMs were treated with serial interstitial bleomycin injections between May 2014 and January 2017. Maximum single doses of 15 U and 1 U/kg per session were administered for six sessions at a 1-month interval. Therapeutic effectiveness was evaluated and classified into four categories: complete response (CR), partial response (PR), no response, and worsening at 3 months after the last session. Further clinical follow-up outcomes were classified as improved, stable, or aggravated. Adverse events were recorded according to the Society of Interventional Radiology classification.ResultsAll 10 children completed the sessions and follow-ups. CR occurred in 3 (30%) patients, PR in 6 (60%), and no response in 1 (20%). Minor complications (class A) included maculopapular rash, bulla, vomiting, and hyperpigmentation, whereas no major complications occurred.ConclusionIntralesional interstitial injection of bleomycin is a feasible approach for the treatment of AVMs in children and provides safe and effective outcomes. This method may be an earlier treatment alternative in children to prevent potential destructive progression, considering the serious complications of currently available therapeutic methods.     

The Factors Influencing Haematoma Volume due to Arteriovenous Malformations

Summary  Haemorrhage due to cerebral arteriovenous malformations (AVMs) varies from massive, requiring urgent operations, to clinically silent. The present study was designated to identify factors influencing haematoma size, and the pathophysiological mechanisms of massive haemorrhage were studied. 55 patients with intracerebral haematomas due to supratentorial AVMs were included in this study. Angiographic and clinical findings were retrospectively evaluated in relation to haematoma size.  Statistical analysis demonstrated that small size and the presence of only one draining vein were high risk factors for massive haemorrhage. The haematoma volume in small AVMs (30±4 cm³) was significantly larger than in other AVMs (7±3 cm³) (p=0.0005). AVMs with only one draining vein were associated with massive haematoma volume as compared to AVMs with two or more draining veins (30±4 versus 11±3 cm³, p=0.0023).  Our previous study demonstrated that feeding artery pressure (FAP) was significantly higher in AVMs with haemorrhage than in those without, as was draining vein pressure (DVP), and FAP and DVP were inversely related to the number of draining veins and the size of the AVMs. Thus, in small AVMs and AVMs with only one draining vein, local increase in DVP may thus contribute to massive haemorrhage.     

DNA Fragmentation in Central Nervous System Vascular Malformations

Recent studies have shown that apoptosis plays an important role in vascular remodeling. We examined central nervous system vascular malformations for the presence of DNA fragmentation which is the evidence of apoptosis. We hypothesize that vascular remodeling through apoptosis may be responsible for recurrence or hemorrhage in these lesions. We examined the specimens of central nervous system vascular malformations by in situ end labeling (ISEL) of fragmented DNA. Moreover, we examined the expression of Caspase-3 which is apoptosis-related proteins in these lesions by immunohistochemistry. DNA fragmentation was observed in all 15 arteriovenous malformation (AVM) specimens. ISEL-positive cells were mainly distributed in the endothelium, media and perivascular tissue. In cavernous hemangioma (CH), DNA fragmentation was also observed in all 5 specimens. ISEL-positive cells were distributed in the endothelium, subendothelium and intercavernous matrix. Thirteen out of 15 AVM lesions stained positive for Caspase-3. Caspase-3 immunoreactivity was mainly distributed in the endothelium, media and perivascular tissue. This distribution was similar to that of ISEL positive cells. As for CHs, all 5 lesions stained positive for Caspase-3. Caspase-3 immunoreactivity was distributed in the endothelium, subendothelium and intercavernous matrix. Our findings indicate that apoptotic cell death and vascular remodeling play a role in the development and maintenance of vascular malformations.