颅内动脉瘤动物模型建立的研究进展

自从1957年Mccune等首次经动脉壁内注射芥子氮诱导出动脉瘤以后，学者们经过不断的研究和创新，动物模型颅内动脉瘤的建立越来越接近人体的动脉瘤。但目前还没有一种动脉瘤模型能真正完全模拟人颅内动脉瘤形成的生物学特性。我们对动脉瘤模型的各种建立方法、各自的特点以及在基础和临床方面的应用综述如下。     

动脉瘤动物模型的建立

颅内动脉瘤是引起蛛网膜下腔出血的主要原因。建立颅内动脉瘤模型，探索其发病机制和治疗方法具有重要意义。文章回顾了动脉瘤动物模型的建立方法和动物选择。     

通过三维数字减影血管造影影像学数据构建颅内动脉瘤的三维有限元模型

目的建立颅内动脉瘤三维有限元模型,为动脉瘤内的三维流场模拟和血流动力学研究提供可靠依据。方法选择10例颅内动脉瘤患者的三维数字减影血管造影(3D-DSA)容积成像数据,以DICOM格式输出并转换成三维灰度光栅图像,通过MIMICS 10.0数字化医学影像软件对三维灰度光栅图像编辑处理,运用三维重建技术完成初步重建,将其结果导入ANSYS 11.0有限元软件进行网格划分,建立三维有限元模型。结果 10例患者建立的三维有限元模型均符合颅内动脉瘤的形态,符合率100%,模型可用于颅内动脉瘤血流动力学计算分析。结论随着影像技术的发展,建立准确而有效的颅内动脉瘤三维有限元模型是颅内动脉瘤血流动力学研究前提和基础,对颅内动脉瘤的病理生理学研究以及治疗具有重要意义。     

特发性肺动脉瘤3D打印模型的构建与评估

目的 构建特发性肺动脉瘤3D打印模型，并对构建模型的准确性进行评估。方法 收集1例特发性肺动脉瘤患者的CT影像资料，用医学影像控制系统Mimics Research、3-Matic Research软件建立3D肺动脉瘤模型（3D模型），并对其进行优化（优化模型），将优化模型输入3D打印机构建肺动脉瘤3D打印模型（3D打印模型）。采用线性拟合回归分析、Bland-Altman分析法评价3D打印模型的准确性。结果 构建并打印出肺动脉瘤3D打印模型（肺动脉瘤直径为55.38 mm）。测量CT模型与优化模型、优化模型与3D打印模型所得到两组测量值相关性强（r=0.99），且一致性强。结论 成功构建特发性肺动脉瘤3D打印模型，且构建模型的准确性高。     

肾性高血压脑动脉瘤大鼠脑血管NO、NPY神经支配的变化

目的：研究高血压致脑动脉瘤形成对脑血管神经支配的影响，并进一步阐明脑动脉瘤形成机制。方法：利用改良Hashimoto方法建立实验怀大鼠高血压脑动脉瘤模型，应用NADPH－d组化和NPY免疫组化染色，观察肾性高血压脑动脉瘤大鼠脑血管壁NO，NPY神经支配变化，结果：在肾性高血压状态下，脑血管NADPH－d阳性神经纤维染色密度明显降低，NPY免疫反应阳性神经纤维密度明显增高，结论：脑血管舒缩神经递质的NO、NPY产生分布紊乱是持续高血压状态的结果，由此带来的脑血流动力学的改变可能参与了脑微动脉瘤的形成。     

兔颈囊状动脉瘤动物模型的研究进展

颅内动脉瘤是神经外科常见疾病之一,其破裂出血后的病死率和致残率较高.建立良好的动脉瘤动物模型是研究颅内动脉瘤病因学和病理生理学机制的基础.兔已被国内外学者广泛用作动脉瘤模型动物.文章主要介绍兔颈部动脉瘤模型的制作方法及应用前景.     

兔动脉瘤模型模拟动脉瘤不全夹闭前后血流动力学的改变

目的 利用计算机模拟不全夹闭并分析不全夹闭前后动脉瘤内血流动力学改变及手术中动脉瘤夹闭方向的选择.方法 利用静脉移植法制作兔颈总动脉侧壁动脉瘤模型.利用计算机模拟软件对动脉瘤进行不全夹闭的模拟并对不全夹闭前后瘤内血流动力学改变进行比较.研究不全夹闭对动脉瘤内血流动力学改变的影响并探讨不同方向不全夹闭对动脉瘤内血流动力学的影响.结果 动物模型制作成功11例.经过CFD软件运算分析及统计学检验,动脉瘤不全夹闭前后最大剪切力的改变具有统计学意义,瘤内湍流明显改变.结论 ①采用静脉移植法制做动脉瘤模型是一种操控性及重复性强的实验方法,可以建立形态、大小稳定的兔动脉瘤模型.动物存活率高,周期短.②动脉瘤不全夹闭减小了湍流对动脉瘤发展的不利影响,减小了动脉瘤颈所受的最大剪切力.在动脉瘤夹闭手术中应尽可能逆血流方向平行夹闭动脉瘤颈,加强动脉瘤颈受力最大方向,防止动脉瘤颈继续生长.     

动脉瘤几何形状改变与破裂关系:动脉瘤破裂前后的高分辨率磁共振三维成像

<正>荷兰学者Schneiders等比较了动脉瘤破裂前后的几何形状,认为几何形状的改变可能是导致动脉瘤破裂的危险因素。以往由于患者在动脉瘤破裂前行颅内血管影像学检查的比例很少,因此很难获取与破裂相关的形状变化数据。该研究通过高质量的3D影像技术,获得了动脉瘤破裂前后的3D几何模型,而且比较了动脉瘤体积和位置变化。神经放射专家对动脉瘤形状改变、动脉瘤周围血肿以及作用在动脉瘤和载瘤动脉上的扩张效应进行了评估。     

MRA和CTA应用于颅内动脉瘤诊断中的比较

目的 通过与CTA的对比研究，初步探讨MRA对颅内动脉瘤的显示能力和诊断价值。方法 对14例临床怀疑颅内动脉瘤患者进行MRA和CTA检查，后处理使用最大密度投影（MIP）和容积重建（VR）。以DSA和动脉瘤夹闭术作为参考标准，比较MRA和CTA对颅内动脉瘤的显示情况。结果 在14例中，经选择性DSA和动脉瘤夹闭术证实21个动脉瘤，其中17个动脉瘤CTA和MRA均显示良好，两种检查方法所得瘤颈宽度、瘤体最长径数值比较无显著性差异（P〉0．05）。MRA发现的颅内动脉瘤敏感性为90.5％。CTA为95．2％。结论 MRA具有无创、费用低、无并发症、无放射性损害、空间分辨率高、不用造影剂即可明确诊断的优点，在评估动脉瘤及帮助确定治疗方案等方面能满足临床的需求，可以成为临床筛查大部分颅内动脉瘤的首选方法。     

颈内动脉壁动脉瘤的诊断与治疗

目的探讨颈内动脉壁动脉瘤的诊断与治疗。方法回顾分析自2002年1月～2009年1月我科共完成的421例动脉瘤夹闭手术患者的临床资料，其中颈内动脉壁动脉瘤16例（占3．8％）共17个动脉瘤，分析其诊断与治疗经过。结果动脉瘤均发生在眼动脉和颈内动脉分叉之间的血管壁上。17枚动脉瘤均成功夹闭，共用20枚动脉瘤夹，术中动脉瘤破裂6例，均夹闭成功，14例痊愈，2例瘫痪。结论CT血管造影对颈内动脉壁动脉瘤的诊断敏感性高于数字减影血管造影。术中反复多次应用临时阻断夹及跨血管动脉瘤夹对动脉瘤的夹闭起到关键的作用。     

Detection of left ventricular aneurysm on two dimensional echocardiography

The differentiation of left ventricular aneurysm from diffuse left ventricular dilation and hypokinesia may have important therapeutic consequences. Thus the diagnostic accuracy of wide angle two dimensional echocardiography for the detection of left ventricular aneurysm was evaluated in a prospective study of 26 consecutive patients with the clinical suspicion of left ventricular aneurysm referred over a 10 month period. Every patient was examined with two dimensional echocardiography and left ventricular cineangiography, and findings were interpreted by two independent observers. A dilated hypokinetic left ventricle without aneurysm formation on cineangiography in nine patients was identified in all with two dimensional echocardiography. A left ventricular aneurysm on cineangiography in 17 patients was correctly identified in 14 with the two dimensional study, as were the site and extent of the lesion (apical in 12, anterior in 1 and inferior in 1). One apical aneurysm was interpreted on the two dimensional study as apical dyskinesia; one anterior and one posterobasal aneurysm were missed with this technique. Mural thrombi were correctly identified with two dimensional echocardiography in seven of seven patients.It is concluded that two dimensional echocardiography is an accurate noninvasive method that allows differentiation of left ventricular aneurysm from diffuse left ventricular dilation in the majority of patients. It provides information regarding the resectability of the aneurysm and may obviate cineangiography in many cases.     

Surgical treatment of a giant external-iliac-vein aneurysm in a patient with a post-traumatic femoral arteriovenous fistula

Iliac vein aneurysm is a rare vascular abnormality. It has been reported as a primary aneurysm of unknown cause, or, when a cause could be identified, as a secondary iliac vein aneurysm. Occasionally, iliac vein aneurysm develops in association with distal arteriovenous fistula. Although venous aneurysms occur most commonly in the neck and central thoracic veins, they also have been reported in the visceral veins and the extremities.Herein, we present the case of a 34-year-old man in whom a giant external-iliac-vein aneurysm was incidentally found during the investigation of a post-traumatic femoral arteriovenous fistula. The aneurysm was surgically resected, the iliac vein was reconstructed by means of lateral venorrhaphy, and the patient had an uneventful, complete recovery. We discuss the origin of the aneurysm and our choice of surgical techniques.     

Pulmonary intralobar sequestration accompanied by aneurysm of an anomalous arterial supply.

A 47-year-old woman presented with hemoptysis and her chest X-ray films showed an opacity suggesting a mass in the left lower lung field. Based on radiographic investigations, the mass was diagnosed as an aneurysm develop in an anomalous vessel and was considered to be a Pryce type I pulmonary intralobar sequestration. Resection of the left lower lobes was performed and the aneurysm was found to be filled with thrombus. It is rare for an aneurysm to form in an aberrant vessel. This complication may have been the result of regional sclerosis affecting the anomalous artery as well as systemic atherosclerosis.     

Unruptured congenital aneurysm of the sinus of valsalva presenting with pulmonary stenosis

Congenital aneurysm of the sinus of Valsalva is a rare cardiovascular anomaly. It is usually silent until rupture occurs. The natural history of unruptured aneurysm of the sinus of Valsalva is still not clear, and the therapeutic strategy is uncertain. Here we reported a case of unruptured aneurysm of the sinus of Valsalva which was correctly diagnosed before invasive diagnostic procedures. A 30-year-old female noted mild palpitation and dyspnea for 1 month. Physically, a grade 3/6 systolic ejection murmur at upper left sternal border was detected. Echocardiography revealed dilatation and irregular protrusion of the right sinus of Valsalva encroaching on right ventricular outflow tract to cause obstruction. With these findings, unruptured aneurysm of the sinus of Valsalva with pulmonary stenosis was diagnosed. Cardiac catheterization and angiography confirmed the diagnosis. The aneurysm was repaired with a Dacron patch with good results. It is concluded that sinus of Valsalva aneurysm can be diagnosed by echocardiography before its rupture so as to render a proper management for this potentially life-threatening anomaly. Cathet. Cardiovasc. Intervent. 46:210–213, 1999. © 1999 Wiley-Liss, Inc.     

A case of bronchial artery aneurysm demonstrating a mass shadow on chest X-ray film]

A 66-year-old woman was admitted on May 13, 1989, because of an abnormal round shadow in the right hilum on chest X-ray film. Bronchoscopy revealed a stenosis of the right B8 caused by a bulging lesion. An aortogram showed a large meandering bronchial artery and a saccular aneurysm. The aneurysm was about 25 mm in diameter and associated with a bronchopulmonary anastomosis. It was surgically removed by right lower lobectomy. Pathological examination proved that the resected lesion was an arterial aneurysm. Patchy arteriosclerotic change was present in the intima of the aneurysm, but there was no evidence of inflammatory change in the arterial wall and the adjacent alveoli and bronchi. Twenty-six cases of bronchial artery aneurysm have been previously reported in the literature, but this is the first case that appeared as a solitary nodule on conventional chest X-ray.     

Mitral annular subvalvular left ventricular aneurysm

Annular subvalvular left ventricular aneurysm was first reported in 1962. This type of aneurysm usually arises from the annular subaortic or submitral region of the left ventricle. It should be differentiated from the left ventricular false aneurysm, which was caused by myocardial necrosis. The etiology of subvalvular aneurysm remains unclear. We have presented a case of annular submitral left ventricular aneurysm. The patient had no history of coronary artery disease. Two-dimensional echocardiography and magnetic resonance image (MRI) showed a huge left ventricular aneurysm existed. An annular submitral left ventricular aneurysm was confirmed by an open heart surgery and pathological examination.     

Unruptured sinus of Valsalva aneurysm

An unruptured congenital sinus of Valsalva aneurysm (behind the right aortic valve cusp) is described as an incidental necropsy finding in an 82 year old man. Review of previous reports on aneurysms involving only one of the three aortic sinuses discloses that few cases have been described, and that these lesions are rarely diagnosed during life. It is probable, however, that unruptured aortic sinus aneurysm (involving only one sinus) is more common than previous reports indicate, but that, among patients with congenital sinus aneurysm, rupture is likely to occur.     

Évolution dramatique d’un anévrisme bilatéral de l’artère fémorale chez une fille de 16 ans

Femoral artery aneurysm is a rare entity among the vascular complications of Takayasu's disease. It is sometimes characterized by the risk of serious local complications with hemorrhagic or ischemic event, as well as by a big therapeutic handling difficulty. We report a case of bilateral femoral artery aneurysm in a 16-year-old girl having a dramatic evolution turn after surgical treatment and irreversible limb ischemia.     

Enigma of primary aortoduodenal fistula

A diagnosis of primary aortoenteric fistula is difficult to make despite a high level of clinical suspicion. It should be considered in any elderly patient who presents with upper gastrointestinal bleeding in the context of a known abdominal aortic aneurysm. We present the case of young man with no history of abdominal aortic aneurysm who presented with massive upper gastrointestinal bleeding. Initial misdiagnosis led to a delay in treatment and the patient succumbing to the illness. This case is unique in that the fistula formed as a result of complex atherosclerotic disease of the abdominal aorta, and not from an aneurysm.