A new balloon catheter for coaxial embolization

Summary A new design for double lumen catheters which increases the size of the injection lumen by 30% is described.     

Endovascular treatment of a large fusiform splenic artery aneurysm with a coaxial technique using a 5-f balloon catheter and a microcatheter

A coaxial technique was introduced for successful embolization of a large fusiform splenic artery aneurysm in a vessel with a large caliber and a great degree of tortuosity. A standard 5-F angioplasty catheter was placed at the immediate afferent artery for occlusion of arterial inflow into the aneurysm, thereby preventing intraaneurysmal hypertension during embolization of the efferent segment. This was followed by coaxial microcatheterization of the immediate efferent segment for coil embolization, and then embolization of the afferent segment. It is postulated that this approach may improve the safety of embolization of large aneurysms with unfavorable morphology by decreasing the pressure on the aneurysm just after closure of the efferent segment.     

Partial splenic artery embolization in cirrhotic patients

Splenomegaly is a common sequela of cirrhosis, and is frequently associated with decreased hematologic indices including thrombocytopenia and leukopenia. Partial splenic artery embolization (PSE) has been demonstrated to effectively increase hematologic indices in cirrhotic patients with splenomegaly. This is particularly valuable amongst those cirrhotic patients who are not viable candidates for splenectomy. Although PSE was originally developed decades ago, it has recently received increased attention. Presently, PSE is being utilized to address a number of clinical concerns in the setting of cirrhosis, including: decreased hematologic indices, portal hypertension and its associated sequela, and splenic artery steal syndrome. Following PSE patients demonstrate significant increases in platelets and leukocytes. Though progressive decline of hematologic indices occur following PSE, they remain improved as compared to pre-procedural values over long-term follow-up. PSE, however, is not without risk and complications of the procedure may occur. The most common complication of PSE is post-embolization syndrome, which involves a constellation of symptoms including fever, pain, and nausea/vomiting. The rate of complications has been shown to increase as the percent of total splenic volume embolized increases. The purpose of this review is to explore the current literature in regards to PSE in cirrhotic patients and to highlight their techniques, and statistically summarize their results and associated complications.     

脾动脉栓塞与脾切除的对比分析

目的探讨脾动脉栓塞和脾切除治疗脾功能亢进的疗效及并发症,为临床治疗脾功能亢进方式提供选择依据。方法回顾分析我院近年部分性脾动脉栓塞46例和脾切除33例,比较两种方法治疗后血象改善及并发症发生情况。结果两种方法均能有效改善肝硬化继发脾肿大脾功能亢进患者血小板和白细胞计数(P<0.001),但两组患者中脾切除组术后血小板计数改善明显优于脾动脉栓塞组,而白细胞计数的改善两组无明显差异。脾动脉栓塞组术后并发症发生率明显高于脾切除组(P<0.001)。结论对于腹水较多、门脉高压明显、脾脏巨大的患者不宜行脾动脉栓塞治疗,行脾切除术较好;对于肝脏功能较差、凝血功能严重障碍、高龄和伴肝癌的脾功能亢进患者宜行脾动脉栓塞治疗。     

Distal arterial splenic embolization via collaterals: report of two cases

Two patients were treated for bleeding gastric varices, developed due to splenic vein occlusion. In one patient with occlusion of the main splenic artery, splenic embolization performed via collaterals facilitated open splenectomy with minimal blood loss. In another patient, bleeding from the gastric varices stopped after partial arterial splenic embolization performed via the accessory left gastric and inferior phrenic arteries. No complications were encountered.     

Supraclinoid intracarotid chemotherapy using a flow-directed soft- tipped catheter

In an attempt to avoid toxic reactions of the eye as a complication of internal carotid arterial infusion of cisplatin, carmustine, or a combination of both for the treatment of brain tumors, a new Gore-Tex/Teflon coaxial catheter system has been used for supraclinoid placement. Catheter placement was successful in 14 of 16 attempts in eight patients. Two patients experienced eye pain and conjunctivitis--a result of the chemotherapeutic agent leaking through the Gore-Tex portion of the catheter at the infusion rate of 170 ml/h. No complications were noted as long as the infusion rate was maintained at 125 ml/h or lower.     

Endovascular exclusion of a splenic artery aneurysm using a pipeline embolization device

The Pipeline Embolization Device (ev3 Endovascular Inc, Plymouth, Minnesota) is a new endovascular device designed to exclude suitable intracranial aneurysms. A 56-year-old woman presented with a symptomatic 4.1-cm splenic artery aneurysm (SAA) that was successfully managed with a two-staged treatment plan involving selective segmental splenic artery embolization and subsequent deployment of a Pipeline Embolization Device across the aneurysm neck to exclude the aneurysm and maintain splenic perfusion.     

Coil embolization of splenic artery aneurysm with preservation of the parent artery using a neck remodeling technique

We describe a case of a large and wide neck splenic artery aneurysm, treated by coil embolization using a balloon neck remodeling technique. The patency of the splenic artery was preserved without technical complications. This method should be considered as an alternative method for transcatheter management of splenic artery aneurysms.     

Spontaneous splenic rupture due to extensive venous malformation with consumptive coagulopathy: treatment with splenic artery embolization

Extensive venous malformation (VM) is often associated with chronic consumptive coagulopathy, which may result in bleeding complications. We report herein the case of a 25-year-old man with extensive VM involving the left lower extremity who presented with hypovolemic shock and abdominal distension without abdominal trauma. Abdomen computed tomography revealed splenic rupture with massive hemoperitoneum. He was managed successfully by repeated splenic artery embolization.     

脾动脉栓塞在急诊外伤性脾破裂治疗中的应用价值

目的 评价脾动脉栓塞在急诊外伤性脾破裂治疗中的应用价值.方法 采用Seldinger技术经皮穿刺股动脉,经脾动脉造影,根据脾脏受损程度行脾动脉栓塞治疗急诊外伤性脾破裂101例.结果 术后患者均有左上腹轻度胀痛,左侧胸腔积液56例,腹膜后血肿5例,脾脓肿1例,胰腺炎1例,左下肺膨胀不全1例.96例急诊外伤性脾破裂止血效果...     

经导管组织黏合剂结合弹簧圈栓塞脾动脉瘤

目的 探讨采用组织黏合剂NBCA结合弹簧圈经导管栓塞脾动脉瘤的可行性及安全性.方法 3例脾动脉瘤患者,2例位于脾动脉主干,1例位于脾动脉分支.均先经导管置入弹簧圈栓塞载瘤动脉的远端,再以NBCA与碘化油混合物栓塞载瘤动脉的近端包括瘤体.术后采用CT增强扫描随访4~20个月.结果 3例脾动脉瘤均成功栓塞,未出现严重并发症...     

经脾动脉行明胶海绵与碘化油栓塞治疗脾功能亢进的对照研究

目的探讨经脾动脉行明胶海绵和碘化油栓塞治疗肝硬化脾功能亢进(脾亢)的疗效与并发症,为临床治疗肝硬化脾亢栓塞剂的选择提供依据。方法回顾性分析40例肝硬化脾功能亢进患者行经脾动脉明胶海绵栓塞和39例行经脾动脉碘化油栓塞治疗的临床资料,观察两组患者外周血三系细胞改善和并发症以及复发情况。结果两组患者的脾脏体积回缩、血红蛋白、白细胞和血小板计数差异无显著性(P>0.05),但碘化油栓塞组患者6个月后有部分病例出现血小板再次减少,明胶海绵栓塞组术后并发症发生率高于碘化油栓塞组(P<0.05),碘化油栓塞组肝、胃肠道毒性分级均较明胶海绵栓塞组低。结论对高龄、肝功能差、腹水较多、凝血功能严重障碍、肝硬化门脉高压明显的患者可行经脾动脉碘化油栓塞治疗脾亢。     

Therapeutic embolization with a microballoon catheter system

Clinical experience with a new embolization and perfusion microballoon catheter system is presented in 34 patients with angiomas, arteriovenous fistulas, and cerebral hemorrhages. The system uses two separate balloon tips, one for detachment as an embolus and one for perfusion of elastomer. The criteria for catheter and perfusate selection are described. One permanent complication, two temporary complications, and one death occurred in this series. The technique represents a primary mode of therapy for treatment of certain vascular lesions, especially in nonsurgical candidates by virtue of their lesion or clinical state. Abdominal and extremity applications in 15 additional patients are also described. No complications occurred in these patients.     

脾修补术、部分切除术及动脉栓塞术治疗创伤性脾破裂的疗效以及对患者免疫功能的影响

目的探讨对比脾修补术、部分切除术及动脉栓塞术治疗创伤性脾破裂的疗效及对患者免疫功能的影响。方法回顾性分析2015年1月—2018年12月海南医学院第一附属医院普外科收治的160例创伤性脾破裂患者,男性84例,女性76例;年龄37~68岁,平均45.86岁。其中50例行脾修补术(修补组),55例行脾部分切除术(切除组),55例行脾动脉栓塞术(栓塞组)。对三组患者的手术情况、手术疗效及手术前后外周血T淋巴细胞变化进行对比、分析。结果栓塞组的手术时间为(116.42±34.37)min,显著低于另外两组的(224.36±42.58)min和(218.74±36.04)min;栓塞组的术后住院时间为(7.85±1.30)d,显著低于另外两组的(10.36±2.74)d和(11.09±3.14)d;栓塞组的术中输血量为(205.80±46.68)mL,显著少于另外两组的(576.32±51.74)mL和(560.68±49.92)mL(P<0.05)。三组的手术总有效率分别为94%、87%和95%,组间比较差异无统计学意义(P>0.05)。与术前相比,三组术后2周的CD3^+、CD4^+、CD4^+/CD8^+、IgG、IgA及IgM水平均明显降低,术后4周较术后2周有所提高。栓塞组术后4周的CD3^+、CD4^+、CD4^+/CD8^+、IgG、IgA及IgM水平分别为(60.95±3.77)%、(36.07±4.45)%、(1.21±0.14)%、(11.20±1.84)g/L、(1.59±0.36)g/L、(0.96±0.27)g/L,均与术前对应值接近,但均显著高于另外两组对应值(P<0.05);栓塞组术后2周CD3^+、CD4^+、CD4^+/CD8^+、IgG、IgA及IgM水平分别为(50.96±2.14)%、(32.20±3.17)%、(1.09±0.07)%、(9.05±1.66)g/L、(1.21±0.35)g/L、(0.82±0.23)g/L。栓塞组术后并发症总发生率为7%,显著低于修补组(24%)和切除组(20%),P<0.05。结论脾修补术、部分切除术和动脉栓塞术治疗创伤性脾破裂均有较好的效果,其中脾动脉栓塞术的操作更简单、创伤更小、并发症更少、免疫功能恢复更快,应用优势更显著。     

Autoperfusion balloon catheter for treatment of vertebral artery stenosis

Percutaneous transluminal angioplasty (PTA) of the vertebral artery was performed with an autoperfusion balloon catheter in five patients. There were no complications in the form of embolic episodes or neurological deficits due to brain ischaemia during inflation. In critical cases with insufficient collateral circulation during temporary occlusion, the use of an autoperfusion balloon catheter may expand the indications for PTA in patients with ischaemic cerebrovascular disease.     

Dilatation of experimental renal artery stenosis by balloon catheter

An experimental model has been developed in the pig in order to evaluate the effect of percutaneous transluminal angioplasty on fibrous renal artery stenosis. Stenoses were induced by bilateral subtotal ligation with chromic catgut. Six weeks following ligation unilateral transluminal dilatation was performed in 9 pigs using Grüntzig balloon catheters. In only one case a serious complication occurred with rupture of the renal artery. Seven pigs with dilated stenoses were re-examined by angiography 8 to 10 weeks after dilatation. In 6 cases the stenoses were practically completely eliminated while in one cases a re-stenosis developed. Microscopy of the dilated arteries revealed several small and large ruptures of th internal elastic membrane.