假性动脉瘤破裂出血的实验与救治研究

目的：探讨假性动脉瘤破裂出血的原因与临床救治的效果。方法：对20例兔假性动脉瘤动物模型进行血流动力学研究，分析23例瘤壁破裂出血患者的诱因与临床治疗方法。结果：动物实验人血流为涡流，瘤壁顺应性较低，血流阻力大，可导致瘤体逐渐增大，临床23例患者治疗均获得成功。结论：假性动脉瘤血流动力学改变，可导致瘤壁增大，破裂，感染可减弱瘤壁强度，是导致破裂的重要因素。     

手术治疗困难的上消化道出血病人处理

总结９例外伤临床上处理困难的上消化道出务从的治疗经验，４例十二指肠溃疡出血，１例毕Ⅱ式胃切除术十二指肠残端瘘侵蚀胃十二指肠动脉出血，１例胃十二指肠动脉残端假性动脉瘤破裂，３例假性肝动脉瘤破裂，采用介入放射技术和手术结合方法，９例病人均获得治愈。     

经导管动脉栓塞术治疗重症急性胰腺炎并发假性动脉瘤破裂出血

目的探讨经导管动脉栓塞术(TAE)在重症急性胰腺炎(SAP)并发假性动脉瘤破裂出血中的应用价值。方法对13例SAP并发假性动脉瘤破裂出血患者行TAE,分析假性动脉瘤DSA表现及栓塞情况。结果 13例SAP患者共并发15个假性动脉瘤,包括感染性假性动脉瘤13个、腐蚀性假性动脉瘤2个。6个(6/15,40.00%)假性动脉瘤的责任动脉为脾动脉,5个(5/15,33.33%)为肠系膜上动脉,2个(2/15,13.33%)为胃十二指肠动脉,1个(1/15,6.67%)为肠系膜下动脉,1个(1/15,6.67%)为胃网膜右动脉(1/15,6.67%)。TAE治疗技术成功率为93.33%(14/15)。1例(1个假性动脉瘤)TAE术后出现脾脓肿,经穿刺引流及抗感染好转。感染性假性动脉瘤患者死亡率为45.45%(5/11),腐蚀性假性动脉瘤无死亡患者。TAE术后复发出血率为15.38%(2/13)。结论 TAE是治疗SAP并发假性动脉瘤破裂出血的有效方法。     

手掌部创伤性假性动脉瘤的诊断与防治及形成机制

目的 研究手掌部创伤性假性动脉瘤的诊断、治疗、预防方法及其形成机理。方法 报告３例因锐器戳伤手掌部掌浅动脉弓及指掌侧总动脉而形成创伤性假性动脉瘤的临床表现、诊断和治疗。并通过动物实验研究小动脉创伤性假性动脉瘤的形成机理,从而提出预防方法。结果 ３例明确诊断后均行手术治疗,术后１年随访,假性动脉瘤未复发,手部血循环正常。实验证实,小动脉外伤致破裂后５～１１ｄ或形成创伤性假性动脉瘤。结论 手掌部创伤性假性动脉瘤的诊断依据是：（１）手掌部有锐器戳伤史;（２）伤后１周左右,局部隆起博动性小包块;（３）超声多普勒检查该包块具有收缩期血管杂音,彩色多普勒超声显像仪显示该包块呈囊状结构形态,囊腔内有血液涡流信号。治疗方法是切除瘤本并结扎其近、远两端载瘤动脉。伤后及时结扎手掌部破损动脉能预防创伤性假性动脉瘤的形成。     

注射毒品所致假性股动脉瘤18例的外科治疗

目的 探讨注射毒品所致假性股动脉瘤的外科疗法。方法 对18例注射毒品所致辞假性动脉瘤患者的临床资料进行回顾分析。13例直接采用ePTFE人工血管行旁路髂外动脉和股浅动脉端侧吻合术；3例采用自体大隐静脉间置移植术，其中１例吻合口破裂出血改用ePTFE人工血管行旁路髂外动脉和股浅端侧吻合术；2例股动脉结扎术。结果 全部病例保肢成功。血管移植术后复查彩色多普勒超声显示移植血管通畅。结论 在患者不能提供合适的自体大隐静脉移植时，人工血管移植仍是治疗假性股动脉瘤的有效方法。术中彻底清创及避免污染是预防术后人工血管并发感染的最主要措施     

肢体创伤性动脉病变的介入诊断与治疗

目的 评价介入放射方法诊断治疗肢体创伤性动脉病变的效果。方法 8例肢体动脉创伤伴有远端肢体缺血改变，其中2例伴大出血，伤者接受了选择性患肢动脉造影检查；7例随后进行了动脉病变的血管腔内介入治疗。治疗方法包括动脉分支或主干栓塞、动脉内溶栓和血管内支架置放。结果 血管造影精确显示了动脉破裂、假性动脉瘤、血栓形成或动脉内膜损伤等病变性质。3例假性动脉瘤、3例动脉血栓病变综合应用介入治疗方法取代外科手术获得满意疗效。1例溶栓后证实动脉破裂和1例造影证实动静脉瘘后转手术治疗。结论 介入放射与外科方法相结合能明显提高肢体动脉创伤的诊断治疗水平，有效挽救伤者肢体和生命。     

毒品注射所致股动脉假性动脉瘤的治疗

摘要：目的 探讨毒品注射所致股动脉假性动脉瘤的治疗方法。方法 共治疗11例股动脉假性动脉瘤。4例患者因动脉瘤破裂急诊经股部切口直接行瘤体动脉结扎术，7例择期手术，先经下腹部切口（腹膜外）暴露骼动脉控制出血再经股部切口行瘤体动脉结扎术。结果 所有手术均获得成功，无1例发生肢体坏死。结论 动脉结扎术治疗毒品注射所致股动脉假性动脉瘤是简单而有效的方法。术中观察远端动脉血回流情况、动脉测压、术中造影能提高其安全性。     

大动脉病变的外科手术治疗

目的　探讨大动脉病变的手术治疗方法。方法　回顾性分析 86例大动脉病变外科手术治疗的临床资料。其中胸腹主动脉瘤 3例 ;降主动脉夹层破裂并巨大假性动脉瘤形成椎骨破损 2例 ;腹主动脉局限性夹层破裂并假性动脉瘤形成 2例 ;腹主动脉瘤十二指肠空肠曲瘘并消化道大出血 1例 ;腹主动脉瘤破裂并休克 5例 ,腹主动脉外伤后破裂 3例 ;腹主动脉瘤和 /或并单或双侧髂动脉瘤2 1例 ;髂动脉瘤 6例 ;股动脉瘤 9例 ;髂或股动脉假性动脉瘤 2 1例 ;右锁骨下动脉和椎动脉起始部破裂并巨大假性动脉瘤形成 1例 ;左或右锁骨下动脉破裂并假性动脉瘤形成 3例 ;颈动脉瘤 2例 ,颈动脉假性动脉瘤 7例。行人工血管置换治疗 71例 ,自体静脉修补 3例 ,动脉破口修补术 12例。结果　术中及术后 3 0d死亡率为 3 .5 % ( 3 /86)。随访 73例 ,随访时间 1个月至 5年 ,除 1例腹主动脉瘤十二指肠瘘患者已死亡外 ,余均生存良好。结论　大动脉病变的外科手术治疗仍然是一种十分有效和经济实用的方法 ,在技巧等方面的改进有利于提高手术的成功率     

覆膜支架置入术救治肝动脉假性动脉瘤破裂大出血一例

肝动脉假性动脉瘤多继发于胰腺癌术后、急性胰腺炎、肝脏移植术后及腹腔感染性病变等,由于肝动脉假性动脉瘤破裂发生率高,可导致致命性大出血,因此需要给予积极治疗 [1].近年介入微创技术已逐步成为治疗这类病变的首选方法.我院采用被覆膜支架置人术成功救治1例肝总动脉假性动脉瘤破裂大出血患者,疗效良好.     

医源性假性动脉瘤的诊治

目的提高医源性假性动脉瘤的诊治水平。方法报告２２例医源性假性动脉瘤诊治经验。男性１９例，女性３例。年龄２０～７８岁，平均４３．６岁。病程７小时～１３个月，平均４．７个月。１６例行择期手术，３例急诊手术，压迫治疗４例。结果手术治疗１９例均痊愈，压迫治疗者１例失败改行手术治疗。结论医源性损伤是假性动脉瘤的主要原因，并且是可以预防的。假性动脉瘤治疗应根据患者的具体情况而定。对于动脉穿刺所致的假性动脉瘤患者病程不超过１个月。压迫治疗可作为首选的治疗方式。     

外伤性肾动脉假性动脉瘤的诊断和治疗(附2例报告及文献复习)

目的:探讨外伤性肾动脉假性动脉瘤(Renal artery pseudoaneurysm,RAP)的诊断与治疗方法。方法:回顾性分析2例RAP患者的临床资料:均为男性,年龄分别为17岁和42岁,临床主要表现为持续性出血或迟发性肉眼血尿。血管造影示损伤动脉活动性出血,肾内见充盈造影剂的囊腔状结构。2例患者均行超选择性血管栓塞治疗。结果:2例患者术后血尿或出血均消失,无并发症发生。术后3个月以上行CT检查,肾功能均未见异常。结论:RAP临床表现为持续性出血或迟发性肉眼血尿;血管造影在诊断RAP中具有重要价值;超选择性动脉栓塞是治疗RAP的安全、有效方法。     

移植肾假性动脉瘤的诊断和治疗四例报告

目的 总结移植肾假性动脉瘤的诊治体会.方法 首次接受肾移植者4例,其供肾动脉均为单支,肾动脉无损伤,也未行动脉修补成形术.供肾动脉均与受者的髂外动脉行端侧吻合.术中发现受者髂外动脉有粥样斑块或动脉分层者2例.术后4例均未出现移植肾周感染,亦未行移植肾穿刺活检或其他有创检查.依据临床表现、彩色多普勒超声检查、多层螺旋CT血管成像和数字减影血管造影诊断移植肾假性动脉瘤.结果 分别在术后1.5个月、2个月、5个月和7个月诊断移植肾假性动脉瘤,其临床表现缺乏特异性,3例经数字减影血管造影、1例经多层螺旋CT血管成像确诊.1例移植肾假性动脉瘤突发破裂,急诊切除假性动脉瘤和移植肾;1例因瘤体短期迅速增大,行带膜支架置入及栓塞术;2例行移植肾动脉瘤切除及动脉裂口修补术.结论 移植肾假性动脉瘤是肾移植术后的少见并发症,其临床表现缺乏特异性,多层螺旋CT血管成像和数字减影血管造影有助于本病的诊断.对于移植肾假性动脉瘤的治疗,可选择手术切除或介入栓塞术,关键在于是否保留移植肾,并需考虑移植肾血管重建方式.     

腹部手术后腹腔干分支假性动脉瘤消化道瘘的临床分析：附5例分析

目的:总结分析腹部手术后腹腔干分支假性动脉瘤消化道瘘导致的迟发性消化道大出血的诊断和治疗。方法:回顾性分析自2013年1月—2014年9月腹部肿瘤术后上消化道大出血经造影证实腹腔干分支假性动脉瘤消化道瘘的5例患者的临床资料。结果:5例患者消化道出血时间平均为术后53.6 d;假性动脉瘤位于脾动脉2例,位于肝总动脉2例,位于左肝动脉1例;造影后行栓塞治疗4例,行覆膜支架置入1例。无术后严重并发症及围手术死亡病例。随访时间6~16个月,无再次假性动脉瘤破裂出血,肝总动脉覆膜支架置入患者于8个月猝死,原因未明。结论:腹腔干分支假性动脉瘤消化道瘘是腹部手术后罕见而又致命的并发症,应提高该病的认识,其诊断及治疗首选动脉造影及血管腔内治疗,避免医源性损伤可能是减少该病发生的关键。     

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目的 探讨注射毒品所致假性股动脉瘤外科治疗的疗效。方法 对15例注射毒品所致假性股动脉瘤病人的临床资料进行回顾性分析。结果 15例病人的接受手术治疗，瘤体切除并清创后均采用ePTFE人造血管行髂外动脉和股浅动脉端端吻合术，术后10天及3个月复查彩色多普勒超声显示人造血管血流通畅。结论 戒除毒彻底清创和血管重建是注射毒品所致假性股动脉瘤外科治疗取得成功的关键。     

Hemobilia complicating elective laparoscopic cholecystectomy: a case report

Iatrogenic injury to the hepatic or cystic arteries can occur during laparoscopic cholecystectomy and can be seen in isolation or in association with bile-duct injury. The most common manifestation of arterial injury is intraoperative hemorrhage; also, interruption of the right hepatic artery can occur without hemorrhage, and this can be clinically insignificant or associated with hepatic ischemia. A less common manifestation of arterial injury during laparoscopic cholecystectomy is presented. A 48-year-old woman had a pseudoaneurysm of the major anterior branch of the right hepatic artery in association with an injury to the common hepatic duct. This complication presented as massive hemobilia after she had been discharged from the hospital. Definitive repair of the pseudoaneurysm was carried out at the time of Roux-en-Y hepaticoje-junostomy for correction of the associated duct injury. This unusual vascular complication should be considered in patients after laparoscopic cholecystectomy who demonstrate evidence of late occult or obvious hemorrhage.     

Repeated embolization of intercostal arteries after blunt chest injury

To deal with an arterial bleeding from the chest wall after a blunt chest injury, embolization of the bleeding arteries can be a valuable therapeutic option, which is less invasive than a thoracotomy. However, its results are variable, being highly operator-dependent. In the present case, we performed successful emergency embolization of the 4th and 5th intercostal arteries for persistent hemorrhage following blunt trauma to the chest. Several days after the first embolization, secondary embolization was required for treating a pseudoaneurysm that was formed in the 5th intercostal artery. Although the mechanisms underlying pseudoaneurysm formation are not clearly understood, its rupture is potentially fatal. Therefore, it is essential to carefully follow-up patients who experience blunt chest injury to avoid this serious complication.     

Vertebral artery complications in anterior approaches to the cervical spine: report of two cases and review of literature

BACKGROUND: Cases of lesions to either the carotid artery or the vertebral artery in anterior approaches to the cervical spine are rarely found in medical literature. Two cases of vertebral artery injury in anterior approaches as well as a review of the pertinent literature are presented. In cases of arterial injury, appropriate management strategies are necessary to avoid or minimize harm to the patient. CASE REPORTS: In the first case, the vertebral artery was injured during decompression of a cervical spinal stenosis while drilling the neuroforamen. Local compression provided sufficient control of hemorrhage. Nevertheless, rebleeding from a pseudoaneurysm occurred 2 days later. After removal of the hematoma, the pseudoaneurysm was treated successfully with coils by an endovascular approach. In the second case, misplacement of one screw in screw-fixation of a type II odontoid fracture caused a pseudoaneurysm of the vertebral artery. This led to a fatal subarachnoid hemorrhage 4 days later. CONCLUSIONS: In ventral approaches to the cervical spine, precise preoperative planning and a detailed knowledge of the surgical anatomy are mandatory. In cases of injury to the vertebral arteries, direct surgical repair is most appropriate to prevent complications arising from fistulas, late-onset hemorrhages, pseudoaneurysms, thrombosis, and emboli. Alternatively, endovascular techniques or even clipping or ligation of the affected artery should be considered.     

急诊经导管动脉栓塞治疗医源性肝动脉出血

目的探讨医源性肝动脉出血的急诊肝动脉造影表现及经导管动脉栓塞(TAE)治疗的疗效。方法对38例医源性肝动脉出血患者行急诊肝动脉造影,确定出血动脉后,以明胶海绵、PVA颗粒和弹簧圈进行急诊栓塞治疗;对其急诊肝动脉造影表现及TAE疗效进行回顾性分析。结果 38例中,21例肝动脉造影可见对比剂外溢,5例肝动静脉瘘,9例肝动脉假性动脉瘤,3例肝动脉假性动脉瘤合并肝动静脉瘘。急诊TAE后38例出血均停止,总有效率为100%(38/38)。1例术后10天复发出血,再次栓塞治疗后出血停止。随访12个月,所有患者均无肝脏坏死及异位栓塞等严重并发症发生。结论急诊TAE治疗医源性肝动脉出血安全、有效。     

Endovascular occlusion of a carotid pseudoaneurysm complicating deep neck space infection in a child. Case report.

Pseudoaneurysm formation of the cervical internal carotid artery (ICA) is a rare, potentially lethal complication of deep neck space infection. This entity typically occurs following otolaryngological or upper respiratory tract infection. The pseudoaneurysm is heralded by a pulsatile neck mass, Homer's syndrome, lower cranial neuropathies, and/or hemorrhage that may be massive. The recommended treatment includes prompt arterial ligation. The authors present a case of pseudoaneurysm of the cervical ICA complicating a deep neck space infection. A parapharyngeal Staphylococcus aureus abscess developed in a previously healthy 6-year-old girl after she experienced pharyngitis. The abscess was drained via an intraoral approach. On postoperative Day 3, the patient developed a pulsatile neck mass, lethargy, ipsilateral Horner's syndrome, and hemoptysis, which resulted in hemorrhagic shock. Treatment included emergency endovascular occlusion of the cervical ICA and postembolization antibiotic treatment for 6 weeks. The patient has made an uneventful recovery as of her 18-month follow-up evaluation. Conclusions drawn.from this experience and a review of the literature include the following: 1) mycotic pseudoaneurysms of the carotid arteries have a typical clinical presentation that should enable timely recognition; 2) these lesions occur more commonly in children than in adults; 3) angiography with a view to performing endovascular occlusion should be undertaken promptly; and 4) endovascular occlusion of the pseudoaneurysm is a viable treatment option.     

Successful treatment of pseudoaneurysms of celiac and superior mesenteric arteries by combined endovascular and surgical approach

Pseudoaneurysm after pancreas resection poses serious complications, including rupture and hemorrhage. Here we report a case of delayed massive hemorrhage from celiac and superior mesenteric arteries, which was successfully treated with a combined endovascular and surgical approach. The patient was a 52-year-old man who presented with pseudoaneurysms of the celiac and superior mesenteric arteries after distal pancreatectomy. Following the detection of sentinel bleeding from the abdominal drain, emergency angiography of the celiac and superior mesenteric arteries revealed stenosis of the celiac artery and pseudoaneurysms in the superior mesenteric artery. We occluded these lesions with a platinum coil, using an interventional radiological technique combined with bypass grafting between the abdominal aorta and the SMA, using the saphenous vein. However, re-bleeding into the abdominal cavity occurred from the proximal SMA pseudoaneurysm. We inserted an endoluminal stent-graft into the abdominal aorta and completed bypass grafting between the aorta and bilateral renal arteries. The hemorrhage ceased and the postoperative course was uneventful. The patient was discharged 34 days after the treatment (149 days after the initial operation). In conclusion, this combined endovascular and surgical approach is feasible and seems appropriate for pseudoaneurysms arising from proximal sites in visceral arteries.