上肢无脉症多层螺旋CT血管成像分析

目的 探讨多层螺旋CT血管成像（MSCTA）对上肢无脉症的诊断及应用价值.方法 对71例无脉症患者的影像资料进行回顾性分析,MSCTA图像传输至AW4.2工作站,重建方法 包括最大强度投影（MIP）、曲面重建（CPR）、容积显示（VR）及高级血管分析（AVA）等.结果 71例的血管重建图像对无脉症均有特征显示,病变累及血管共201个节段（占血管节段总数的17.7%）,狭窄163个节段（占病变血管的81.1%）,闭塞38个节段（占病变血管的18.9%）,其中锁骨下动脉狭窄62个节段,闭塞21个节段,共83节段（占病变血管的41.3%）,上肢无脉症累及锁骨下动脉最多,以狭窄居多.结论 MSCTA对上肢无脉症的显示有独特的优势,可以清楚而准确的显示上肢无脉症的病变情况,是上肢无脉症理想的影像学检查方法 ,并将逐渐成为诊断血管病变及评估手术疗效的首选影像学检查方法 .     

多发性大动脉炎累及脑血管六例临床分析

摘要　目的　观察多发性大动脉炎累及脑血管病例的临床特点、血管造影影像特点、治疗和随访情况,探讨介入治疗的价值。回顾性分析我院2007~2009年住院的大动脉炎患者,因临床上怀疑有脑血管受累,经血管造影证实颈动脉、椎动脉、锁骨下动脉病变狭窄大于50%的病例,并进行跟踪随访。结果　大动脉炎累及脑血管经造影证实共6例,男性1例,女性5例,年龄19~54(36.5±13.5)岁,均有头晕、黑蒙等症状和外周动脉病变的证据,血管造影表现为双侧多支血管狭窄或闭塞。其中3例4处脑血管病变行支架治疗,术后症状缓解。随访12.7±5.7个月,1例患者出现支架内再狭窄,但无明显症状。结论　大动脉炎累及脑血管多为多支狭窄或闭塞,介入治疗可有效缓解脑缺血症状。     

平板旋转血管造影及三维重建在先天性心脏病的应用

目的评价平板旋转血管造影及三维重建在先天性心脏病临床应用的价值。方法回顾了34例先天性心脏病患者的CT或MR、二维血管造影、旋转血管造影及三维重建影像学资料,并对其结果进行对比分析。结果行胸主动脉造影33例。其中肺动脉瓣闭锁主动脉侧支14例,法乐氏四联症主动脉侧支9例,动脉导管未闭8例,主动脉缩窄1例,主动脉弓畸形1例。行无注射对比剂房间隔堵闭器扫描重建1例。2例肺动脉瓣闭锁主动脉侧支,6例动脉导管未闭进行了介入治疗,侧支及动脉导管堵闭效果良好。旋转血管造影及三维重建和常规二维血管造影、CT及MR对比结果基本相符。旋转血管造影及三维重建相对常规二维血管造影更加快捷、方便,提供更多影像学信息。和CT或MR相比更能够清楚、直观、精确的显示检查区域的解剖结构,并且能够为介入治疗直接提供更多影像学资料。结论旋转血管造影及三维重建对先天性心脏病主动脉病变有较高的临床应用价值,提高诊断的准确性和介入治疗的安全性及疗效。     

侧支代偿在缺血性脑血管病诊治中的类型及意义

目的探讨脑血管侧支循环代偿类型及其在缺血性脑血管病诊治中的意义。方法通过对32例缺血性脑血管病患者脑部数字减影血管成像（DSA）影像分析,判定责任血管,分析侧支代偿是否存在及其代偿类型,并结合临床资料,探讨侧支代偿在缺血性脑血管病诊治中的意义。结果所有患者病变累及血管共47支,其中锁骨下动脉14支（29.8%）,颈内动脉13支（27.7%）,大脑中动脉7支（14.9%）,颈总动脉2支（4.3%）,颈外动脉1支（2.1%）,大脑前动脉2支（4.3%）,大脑后动脉1支（2.1%）,基底动脉4支（8.5%）,椎动脉3支（6.4%）。经W illis环开放代偿14例,软脑膜动脉吻合代偿14例,颈内-颈外动脉代偿4例,颈外-椎动脉和锁骨下动脉肌间支吻合代偿1例,颅底异常血管网2例,锁骨下动脉窃血综合征11例,未见明确侧支代偿1例。结论缺血性脑血管病发生时,颅内可形成多种类型的侧支循环,部分病例由两种或两种以上侧支代偿共同向缺血区供血;临床症状与侧支循环建立速度、类型、完善程度密切相关;侧支循环的存在对缺血性脑血管病诊治及预后意义深远,存在双面性,应有效利用。     

成人出血型烟雾病54例DSA诊断与分析

目的分析成人出血型烟雾病的数字减影血管造影的影像学特点。方法 54例成人出血型烟雾病患者经股动脉穿刺插管行DSA血管造影。结果 54例患者中累及大脑前动脉31例,累及大脑中动脉19例,同时累及大脑前动脉、大脑中动脉18例,其中82.76%闭塞,7例累及大脑后动脉,6例出现基底动脉异常,7例合并动脉瘤。结论出血型烟雾病血管病变不仅累及大脑前、中动脉,大脑后动脉及基底动脉亦可累及,动脉闭塞多于狭窄,可出现于单侧型烟雾病,可合并动脉瘤,DSA检查是诊断烟雾病的最主要的手段。     

合并2型糖尿病的冠心病病人临床和冠状动脉病变特点

为探讨合并2型糖尿病(DM)的冠心病病人临床及冠状动脉病变的特点，对经冠状动脉造影诊断的伴DM(354例)和不伴DM(1222例)的冠心病病人临床表现和造影结果进行对比分析。结果表明，与不伴DM的冠心病者相比，伴DM的冠心病病人存在有更多的心血管危险因素：高血压、血清甘油三酯异常、女性吸烟，且无症状心肌缺血者比例高。在冠状动脉病变特点方面，伴DM者合并冠脉血管3支、C型病变发生率高(35．9％比27．6％；60．6％比48．7％，均P&;lt;0．01)，小血管病变及弥漫性血管病变较多见(26．3％比l8．0％；32．0％比25．1％，均P&;lt;0．01)，而单支、A型病变少(34．5％比41．8％；7．3％比19．0％，均P&;lt;0．01)。结论：伴DM与不伴DM的冠心病病人临床及冠脉病变有显著差异，前者多支冠状动脉病变、C型病变发生率高，冠脉病变分布于小血管多且病变复杂。     

彩色多普勒超声与经颅多普勒联合应用对sssa9诊断意义

目的探讨经颅多普勒（TCD）与彩色多普勒血流显像联合检查锁骨下动脉盗血综合征的诊断价值。方法锁骨下动脉盗血综合征患者24例,均经临床检查及相关影像学检查确诊,其中14例经血管造影（DSA）检查,10例经磁共振血管造影检查（MRA）,采用TCD方法观察椎动脉颅内段血流方向及频谱变化,二维超声显示椎动脉颅外段、颈动脉、锁骨下动脉及无名动脉的内膜和内径,彩色频谱多普勒检测血流方向及速度。结果TCD检查时,24例患者中18例均表现为椎动脉血流反向,肢体束臂试验反向血流增加,6例血流方向正常,束臂试验患侧椎动脉反向峰值血流速度增快,或由正向变为反向。二维超声示引起锁骨下动脉盗血综合征的病因动脉硬化占90％,大动脉炎占20％。结论TCD诊断锁骨下动脉盗血综合征具有直观、快捷、准确的优点,结合二维及彩色多普勒超声可以明确锁骨下动脉盗血综合征的病因、病变部位及程度。     

后循环缺血患者126例的血管因素分析

目的进一步评价血管结构变化在后循环缺血中的重要性。方法对126例临床诊断为后循环缺血的患者行CT血管造影(CTA)和数字减影血管造影(DSA)检查资料进行回顾性分析。结果 126例后循环缺血患者中,后循环合并前循环病变34例,单纯前循环病变12例;基底动脉狭窄2例,单侧椎动脉血管狭窄26例,单侧椎动脉发育不良61例;大脑后动脉狭窄39例,发育不良26例;小脑下后动脉狭窄21例,发育不良6例;三叉永存动脉1例;(单纯锁骨下动脉狭窄)椎动脉盗血1例;全部病例检出正常的18例,其中MRI检查已发现有小脑梗塞,CTA及DSA检查正常2例。结论后循环血管结构变化是后循环缺血的根本因素,CTA及DSA检查,对于评价颅内近端或是远端血管病变,决定治疗方案具有重要临床指导意义。     

锁骨下动脉损伤的显微外科救治临床研究

目的：探讨锁骨下动脉损伤的显微外科救治的方法及疗效。方法回顾分析该院及解放军第153中心医院27例锁骨下动脉损伤的致伤原因及血管损伤情况,分别采用直接端端吻合、静脉移植及旁路血管移植等方法进行修复。合并筋膜间隙综合征患者同时给予切开减压,合并神经损伤患者同时一期行神经修复。结果成功26例,1例因肢体缺血时间过长行截肢术,经3个月～2年的随访,救治成功患者肢体供血良好,动脉造影显示血管通畅,无神经损伤患者功能恢复理想。结论锁骨下动脉损伤应及时得到快速诊断。有效控制出血、积极抗休克治疗、尽快进行显微外科修复等是挽救肢体最有效的途径。     

脑梗死患者脑血管病变及侧支循环的研究

目的:分析脑梗死患者的责任病变血管及侧支循环主要方式.方法:对70例脑梗死患者行牛津郡社区卒中项目(OCSP)分型,进行全脑数字减影血管造影(DSA)检查,判定梗死的责任血管、侧支循环是否存在及方式.结果:各型患者,病变血管共92条,其中颈内动脉(ICA)39条(42.31%),病变血管有锁骨下一椎动脉(SUB-VA)22条(23.9%),大脑中动脉(MCA)16条(23.5%)、颈总动脉(CCA)2条(2.17%)、大脑前动脉(ACA)3条(4.41%);基底动脉(BA)6条(6.5%)和大脑后动脉(PCA)2条(2.2%),脑前动脉(ACA)和大脑后动脉(PCA)各1条(各1.1%):责任血管ICA 41条(44.57%),MCA 22条(23.9%),SUB-VA24条(26.1%).经软脑膜支吻合代偿47例,Willis环代偿27例,来自各种颅外代偿计20例,两种及以上方式联合代偿20例,罕见代偿2例,未发现代偿8例.结论脑动脉病变最多位于ICA、SUB-VA主干,其次位于MCA;前循环病变较后循环病变具有更高的梗死发生率.侧支循环代偿以Willis环最充分,软脑膜支吻合最常见,因此,脑梗死的类型和预后受血管病变和侧支循环状态的整体影响.     

Variations of the hepatic and cystic arteries among Ethiopians

The anatomy of the hepatic and cystic arteries were investigated in 110 postmortem and cadaveric subjects. The right hepatic artery took origin from the proper hepatic artery (66.3%), the common hepatic artery (18.2%), the superior mesenteric artery (8.2%) or the celiac trunk (7.3%). Ten cases of accessory right hepatic artery originating from the superior mesenteric artery (7 cases), gastroduodenal artery (2 cases) or the left hepatic artery (1 case) were observed. The origin of the left hepatic artery included the proper hepatic artery (71.8%), the common hepatic artery (16.4%), the celiac trunk (10.9%) and the splenic artery (0.9%). The 14 cases of accessory left hepatic arteries originated from the common hepatic artery (5 cases), right hepatic artery (3 cases), gastroduodenal artery (2 cases) or the celiac trunk (4 cases). An extrahepatic branch to the quadrate lobe of the liver, also known as the middle hepatic artery, was observed in 47.3% arising mainly from the right or left hepatic arteries (20% each), the superior mesenteric artery (2.7%) and from the gastroduodenal artery (4.6%). The cystic artery mainly arose from the right hepatic artery (75.5%) but also took origin from the middle hepatic artery (12.7%), gastroduodenal artery (7.3%) or the left hepatic artery (4.5%). When the cystic artery is to the left of the common hepatic artery at its origin (39.1%), it crossed from left to right anterior to the common hepatic duct (28.2%) or posterior to the duct (10.9%). Irrespective of its relationship with the common hepatic duct, the cystic artery passed in the triangle of Calot in 89 cases. There were 11 accessory cystic arteries arising from the right hepatic (6 cases), the middle hepatic (3 cases) or the left hepatic arteries (2 cases). Arterial variations seen in the present study were significantly higher (p < 0.05) than that reported in the literature. This was mainly due to the variations seen in origin of the right hepatic artery in the female subjects which was significantly higher (p < 0.05) than in the male subjects. The significance of this finding needs further investigation.     

动态心电图结合CT血管造影对无痛性心肌缺血的诊断价值

目的 探讨动态心电图结合CT血管造影(CTA)检查对无痛性心肌缺血的诊断价值.方法 回顾性分析144例有心肌缺血表现患者的24h动态心电图及发生无痛性心肌缺血(SMI)的患者的CT血管造影(CTA)结果.结果 动态心电图检测出ST段压低者120例,ST段抬高者24例;SMI 93例(64.6％),心绞痛48例(33.3％),急性心肌梗死(AMI)3例(2.1％).93例SMI的CTA检查显示71例(76.3％)阳性,其中冠状动脉狭窄＞70％者42例(59.0％).冠状动脉狭窄50％～70％者29例(40.8％).CTA显示病变血管共172支(狭窄＞70％的病变血管69支),单支病变20例,2支病变33例,3支病变18例.累及左主干4支,左回旋支42支,左前降支65支,右冠状动脉61支.22例(23.7％)CTA结果阴性.结论 动态心电图并选择性地结合CTA可提高无痛性心肌缺血的诊断率价值.     

MSCT冠状动脉造影术对显示冠脉病变价值应用初探

目的评价MSCT冠脉造影技术对判断冠状动脉病变的价值。方法对临床疑冠心病40例和2例联合瓣膜病变以及2例冠脉搭桥术后复查患者行冠状动脉MSCT检查,行增强扫描并进行3D图像后处理,包括曲面重组(CPR)及仿真内镜(VE)、最大密度投影(MIP)等方法,观察其对冠状动脉病变的显示。结果对于血管直径≥2mm无伪影能清晰显示,满足管腔评价情况502支血管进行分析。不能满足管腔评价的血管支数为30支。心率<60次/min的管腔评价情况明显好于心率>60次/min。冠状动脉斑块情况:共57支血管发现钙化斑块。6支血管出现纤维斑块。4支血管发现软斑块。狭窄情况分析,63支钙化和纤维斑块中,轻度狭窄14支,中度狭窄20支,重度狭窄1支。4支软斑块均为重度狭窄。2例冠状动脉搭桥术后复查桥血管通畅。发现一例右侧冠状动脉发自左侧冠状动脉窦的变异。结论MSCT曲面重建结合其他方法,对诊断冠状动脉病变有重要的价值。     

Acute myocardial infarction and left subclavian artery occlusion in Behçet's disease: a case report

A 42-year-old woman with Behcet's disease and pericardial effusion for 14 years presented with acute myocardial infarction and received thrombolytic therapy. Coronary angiography showed total occlusion of the left anterior descending artery. Subsequently, the left internal mammary artery was grafted to the left anterior descending artery. Approximately one year after bypass surgery, digital subtraction angiography of the left subclavian artery, performed because of chest and left arm pain, showed total occlusion of the left subclavian artery. Retrograde flow from the left vertebral artery filled the distal portion of the left subclavian artery. In conclusion, patients with Behcet's disease should be investigated closely for involvement of other arteries when one vessel's involvement has been detected. We also recommend that free arterial grafts be used for any coronary surgical intervention, because of the risk of occlusion associated with the vasculitis of Behcet's disease.     

室壁瘤39例冠状动脉造影分析

目的：分析冠心病室壁瘤的造影表现、好发部位及其与冠状动脉病变的关系。方法：分析连续393例冠状动脉造影中39例室壁瘤的造影表现,统计左室各部位室壁瘤的例数（百分比）、冠状动脉病变支数与狭窄程度。结果：39例均为真性室壁瘤,其中37例为解剖性室壁瘤,2例为功能性室壁瘤。左心室造影表现为心室局部呈囊袋样凸隆,室壁运动消失或矛盾运动,造影剂排空延迟。解剖性室壁瘤肌小梁消失,瘤壁光滑,功能性室壁瘤仍可见肌小梁。解剖性室壁瘤中,30例（81.1%）累及左室前侧壁心尖部,其中3例同时累及隔面,7例下壁,其中1例合并肌部室间隔穿孔。27例（69.2%）为双支或三支病变,8例（20.5%)为单支病变,2例（5.1%）冠状动脉未见狭窄,左前降支病变31例（79.5%)。结论：室壁瘤的发生部位与其供血冠状动脉病相对应,好发于左室前侧壁心尖部。左室及冠状动脉造影可明确室壁瘤的发生部位与性质、冠状动脉病变情况,指导介入及手术治疗。     

Correlation of leukocyte adhesiveness, adhesion molecule expression and leukocyte-induced contraction following balloon angioplasty

1. The aim of this study was to examine the changes in leukocyte adhesion and leukocyte-induced contraction in balloon-injured rabbit subclavian artery and to correlate these changes with vessel morphology and expression of adhesion molecules on the injured arteries. 2. Rabbits were anaesthetized and their left subclavian arteries were injured by balloon inflation and withdrawal followed by sacrifice at 2, 24, 48 h or 8 days after injury. The left and right subclavian arteries were removed and leukocytes were isolated from autologous rabbit blood. Leukocyte-induced contraction was measured in 5-HT precontracted artery rings and leukocyte adhesion was measured using (51)Cr-labelled leukocytes. Immunocytochemistry using paraffin-embedded tissue was employed to detect changes in the expression of adhesion molecules on injured arteries. 3. Autologous leukocytes caused a contraction of rabbit subclavian artery rings, which was prevented by L-NAME (10(-3) M). Balloon-induced injury abolished the contractile response to leukocytes, which correlated with loss of carbachol-induced relaxation 4. Balloon injury markedly enhanced the adhesiveness of the subclavian artery for leukocytes, most notably at 24 and 48 h after injury (1.7 and 1.8 fold respectively). Increased leukocyte adhesion at these two time points correlated with an upregulation of E-selectin, P-selectin and VCAM-1 expression on the remaining endothelium of the injured artery. 5. Vessel morphology revealed that balloon inflation had induced an infiltration of inflammatory cells into the vessel wall, the greatest increase being seen at 24 h after injury. 6. It is concluded that an increase in the expression of E-selectin, P-selectin and VCAM-1 following balloon-induced injury leads to enhanced leukocyte adhesion and migration into the injured vessel.     

A case of symptomatic aberrant right subclavian artery

Aberrant right subclavian artery is one of the aortic arch anomalies which is almost always asymptomatic. A 27-year-old lady, from Asebe Teferi, presented with dysphagia of eight months duration. Physical examination revealed no abnormality. Barium swallow and post Intravenous-contrast computerized tomography (CT) scan showed aberrant right subclavian artery. She was operated via the approach of left thoracotomy. The aberrant right subclavian was legated, brought anterior to trachea and reimplanted to the left stubclavian artery. She had uneventful postoperative course and discharged symptom free.     

下肢动脉CT造影解剖分析在血管介入术操作中的指导意义

目的：探讨下肢动脉从髂总动脉到股动脉段CT造影在冠状位及矢状位最大密度投影中的解剖特点分析,指导下肢动脉疾病介入治疗时患者正确的投照体位及超选择下肢血管的插管方法,以提高介入插管的准确率及成功率。方法：（1）分析56例正常成人髂总动脉至股动脉段CT造影资料,测量冠状位测量髂总动脉间成角。（2）在矢状位和冠状位测双侧髂内动脉开口位置高低,髂总动脉的长度。（3）在横断位观测两侧股深动脉开口位置。结果：（1）正常成年男性双侧髂总动脉间成角均值小于正常成年女性,男女均值间差异有统计学意义。（2）左侧髂总动脉长于右侧髂总动脉,右侧髂内动脉开口高于左侧髂内动脉开口。（3）股深动脉开口起始部位81%起自于股动脉后侧。结论：（1）在髂内动脉介入手术操作时,成年男性股动脉穿刺对侧髂内动脉插管应用成袢技术,成年女性应采用直接插管技术。（2）病变在右侧动脉的介入操作的难度明显高于左侧。对不同患者应根据其髂内动脉的解剖特点实行个体化介入手术操作。（3）在动脉造影时,若发现股浅、股深动脉显影有重叠,则将患者臀部抬高25~°30,°或将X线球管旋转25~°30°（即斜位）,这样可明显弥补前后位时的不足,使大部分肢体的股深动脉开口及其第1段清楚显示。     

冠状动脉旁路移植术前行左锁骨下动脉狭窄筛查及诊治的临床研究

摘要： 目的 探讨冠状动脉旁路移植术前进行左锁骨下动脉狭窄筛查及诊治的意义和方法。方法 对天津市胸科医院612例冠状动脉旁路移植术患者术前采用无创动脉硬化检测技术筛查合并左锁骨下动脉重度狭窄或闭塞患者， 用电子计算机断层扫描血管造影 （CTA） 明确诊断， 然后行左锁骨下动脉支架成形术， 术后1周行非体外循环冠状动脉旁路移植术， 术中均使用左乳内动脉与前降支吻合。结果 使用无创动脉硬化检测技术筛查出5例左锁骨下动脉狭窄病变患者， 且均得到了CTA确诊。左锁骨下动脉支架成形术成功率为100% （5/5）， 术后残余狭窄率均小于 10%， 症状性患者的症状均消失， 双侧上臂收缩压差均小于20 mmHg。使用左乳内动脉与冠状动脉前降支搭桥术中左乳内动脉血流量正常， 术后心绞痛症状均消失， 未发现冠状动脉-锁骨下动脉窃血综合征。围手术期无脑卒中、 心肌梗死及死亡并发症。随访6~12个月， 平均10个月， 无后循环缺血、 上肢缺血、 心肌缺血相关症状， 双侧上臂收缩压差均小于20 mmHg。结论 无创动脉硬化检测技术对锁骨下动脉狭窄的筛查有独到的价值。     

锁骨下动脉盗血综合征椎基底动脉供血不足与盗血程度及类型的相关性分析

目的 探讨锁骨下动脉盗血综合征椎基底动脉供血不足与盗血程度及类型的关系.方法 对80例行经颅多普勒超声诊断为锁骨下动脉盗血综合征患者回顾分析,其中24例进一步行数字减影动脉血管造影（DSA）.以同侧椎动脉血流方向判定盗血程度,以基底动脉是否参与盗血为类型,对椎基底动脉供血不足与盗血程度及盗血类型进行相关性分析.结果 24例进一步行DSA检查者锁骨下动脉起始部狭窄严重程度同TCD检查同侧椎动脉盗血程度成正比（t=15.59,P＜0.05）.椎基底动脉供血不足症状与盗血程度无关（P＞0.05）.基底动脉参与盗血的患者中有21例（77.8％）存在椎基底动脉供血不足,未参与盗血的患者中有18例（33.9％）,两者比较差异有统计学意义（P＜0.05）.结论 由锁骨下动脉盗血综合征引起的椎基底动脉供血不足与同侧椎动脉盗血程度无关,与基底动脉是否参与盗血密切相关,关注基底动脉是否参与盗血有利于分析患者病情并指导临床治疗.