Angiography in vascular injuries of the extremities.

Angiographic findings in 31 cases of vascular injuries of the extremities sustained to a variety of traumas are reported. Angiography will usually demonstrate the type and site of the lesion as well as the presence and extent of collaterals. Its value in cases with obscure clinical findings as well as its importance for the therapeutic approach is stressed.     

Angiography in the evaluation of injuries of the peripheral arteries

The authors present the results achieved with angiographic evaluation of 34 patients suffering from extremity injuries. In spite of the improvements of various diagnostic techniques, especially ultrasound studies, they believe that emergency arteriography is the only way to obtain an ultimate answer in vascular traumas caused by extremity injuries.     

Stanford type A aortic dissection with pulmonary arterial intramural hematoma and pulmonary hemorrhage

A rare complication of a Stanford type A aortic dissection is extension along the pulmonary arteries. We present a case that shows main and right pulmonary artery intramural hematoma and pulmonary hemorrhage in an 80-year-old woman who presented with a type A Stanford aortic dissection. The 11-month follow-up multidetector CT angiogram for this patient showed that the right pulmonary artery had become aneurysmal.     

双向内膜下血管成形术治疗下肢动脉闭塞性疾病的临床应用

目的：探讨双向内膜下血管成形术治疗下肢动脉闭塞性疾病的近期和远期效果。 方法：回顾性分析2012年6月—2015年8月在我院行双向内膜下血管成形术（SAFARI）治疗的32例下肢动脉闭塞患者的临床资料。 结果：术后治疗成功率为100%,术后Fontaine分级I级5例,II级27例,与术前比较差异有统计学意义（Z=5.293,P<0.05）,术后ABI为（0.86±0.13）,与术前（0.41±0.12）比较差异有统计学意义（t=4.923,P<0.05）。32例患者术后13~29个月,失访2例,1年保持通畅20例,2年保持通畅16例,经Kaplan-Meier曲线分析1年、2年通畅率分别为60.93%、45.28%。 结论：双向内膜下血管成形术治疗下肢动脉闭塞性疾病安全有效。     

颅底动脉损伤的介入治疗

目的 探讨多种血管腔内手段治疗颅底动脉损伤的临床价值.方法 2004年10月至2007年5月间我院收治各类型颅底动脉损伤患者共53例,均有头颈部外伤史.主要症状为搏动性突眼和颅内血管杂音(39例)、声嘶或吞咽不适(9例)、鼻出血(5例)等;DSA检查证实颈动脉海绵窦瘘(carotid cavemous fistulae,CCF)39例,颈内动脉假性动脉瘤14例;针对上述53例患者不同的病变特点采用不同的血管腔内治疗,并通过电话或门诊随访.结果 对53例患者56支颈内动脉进行了腔内介入治疗,采用单纯可脱球囊栓塞治疗CCF'33例34支血管,可脱球囊联合弹簧圈栓塞3例,植入覆膜支架封堵CCF3例;采用单纯可脱球囊闭塞颈内动脉治疗假性动脉瘤8例,可脱球囊联合弹簧圈孤立假性动脉瘤2例,植入覆膜支架腔内隔绝治疗4例;平均随访时间9.5个月(2～25个月),85%(45/53)患者主诉症状于6个月内消失,12个月随访15%(8/53)患者遗留眼球运动受限或视力障碍.复查显示存在假性动脉瘤6例,残瘘3例,其中2例因海绵窦区的硬脑膜动静脉瘘而分别于术后第2、3个月行再次介入治疗.结论 对各型颅底动脉损伤,血管腔内介入治疗创伤小且安全有效.尽管存在缺陷,可脱球囊仍是治疗CCF和颈动脉假性动脉瘤的首选方法,在特殊情况下必需联合应用弹簧圈栓塞和覆膜支架植入等多种治疗手段.     

Management of arterial and venous injuries in the dislocated knee

Although uncommonly encountered, knee dislocation is frequently associated with major vascular injury. Serious injuries resulting in ischemia demand prompt recognition and efficient management to prevent devastating long-term sequelae. In this review, we detail mechanisms of knee dislocation and associated popliteal vascular injuries. Diagnostic modalities used to evaluate the extent of vascular injury are individually discussed. Appropriate initial management of vascular injuries is crucial and an algorithm for diagnosis and management will be reviewed. We elaborate on the salient points of vascular reconstruction in the context of the dislocated knee: surgical approach, conduct of the procedure, and adjunctive maneuvers are described.     

动脉造影和栓塞治疗在动脉损伤中的临床应用

目的：探讨动脉造影检查和栓塞治疗在动脉损伤中诊断和治疗价值。方法：回顾性分析我院9年来87例疑有动脉损伤患者的DSA表现及其中15例栓塞治疗患者的临床疗效。结果：87例中84例患者血管造影见阳性征象,阳性率96．5％。84例血管造影阳性病例中,共有109支动脉出现异常表现：包括动脉闭塞40支,动静脉瘘21支,动脉瘤20支,动脉狭窄12支,对比剂外溢8支,动脉内充盈缺损5支,动脉壁龛影3支。造影后我们对其中15例患者进行了栓塞治疗,经保守治疗后均康复出院,以上病例未发生与DSA检查或治疗相关的严重并发症。结论：动脉造影和栓塞治疗在动脉损伤的临床应用中具有诊断准确、及时、安全的优点,并在一定程度上能达到临床外科手术治疗的相应疗效。     

Imaging findings and endovascular management of iatrogenic hepatic arterial injuries

Iatrogenic hepatic arterial injuries (IHAIs) include pseudoaneurysm, extravasation, arteriovenous fistula, arteriobiliary fistula, and dissection. IHAIs are usually demonstrated following percutaneous transhepatic biliary drainage, percutaneous liver biopsy, liver surgery, chemoembolization, radioembolization, and endoscopic retrograde cholangiopancreatography. The latency period between the intervention and diagnosis varies. The most common symptom is hemorrhage, and the most common lesion is pseudoaneurysm. Computed tomography angiography (CTA) is mostly performed prior to angiography, and IHAIs are demonstrated on CTA in most of the patients. Patients with IHAI are mostly treated by coils, but some patients may be treated by liquid embolic materials or stent-grafts. CTA can also be used in the follow-up period. Endovascular treatment is a safe and minimally invasive treatment option with high success rates.Iatrogenic hepatic arterial injuries (IHAIs) arising from percutaneous interventions, laparoscopic or open surgery include pseudoaneurysm (PA), extravasation, arteriovenous fistula (AVF), arteriobiliary fistula (ABF), and dissection (1–3). AVF can occur between hepatic artery and hepatic vein or between hepatic artery and portal vein, called arterioportal fistula (APF). Percutaneous interventions seem to have a higher incidence of IHAIs than surgery (4). The incidence of IHAIs is more than the incidence of traumatic hepatic arterial injuries (5). Hemorrhage following an invasive upper abdominal procedure such as hepatic, pancreatic, and biliary intervention may indicate an IHAI that requires early diagnosis and treatment. Angiography is not only the gold standard imaging modality but also the first suggested treatment option with the advantage of endovascular treatment (6).The etiologies of IHAIs are percutaneous transhepatic biliary drainage, percutaneous liver biopsy, liver surgery (pancreaticoduodenectomy, laparoscopic cholecystectomy, and mass excision), transcatheter chemoembolization, transcatheter radioembolization, and endoscopic retrograde cholangiopancreatography (1–3). Mean latency period between the intervention and the diagnosis of IHAI varies. The symptoms are hemorrhage, hemobilia, and pain. Computed tomography angiography (CTA) is mostly performed prior to angiography, and IHAIs are demonstrated on CTA in most patients. Due to technical limitations of the CTA, IHAI cannot be clearly demonstrated in some patients; however, CTA can show perihepatic hematoma in these patients. CTA findings and hemodynamic status of the patients are considered to determine the indication for angiography.     

Traumatic injuries: imaging and intervention of large arterial trauma

Traumatic vessel injury can cause bleeding, thrombosis, embolization, or malperfusion due to external compression and spasm. Non-traumatic causes of acute large arterial emergencies include rupture of an aneurysm and pseudoaneurysm, dissection, embolization, and thrombosis in hypercoagulability syndromes. Ultrasonography is, of course, the imaging modality of choice in emergency cases; however, in central vascular injuries, spiral CT with contrast enhancement is the imaging modality that provides the most information. Angiography may be necessary for detailed information and before intervention. Stent-grafts are used to close large vascular lacerations, ruptured aortic aneurysms, and the entry tear of dissections. Interventional radiology methods play a major role in managing vascular emergencies. Electronic Publication     

Emergency percutaneous treatment in iatrogenic hepatic arterial injuries

The purpose of this report is to present our experience in the emergency percutaneous treatment of patients with iatrogenic hepatic arterial injury (IHAI). Seven patients (six men, one woman; age range 19-78 years; mean age 63 years) with IHAI secondary to surgical or percutaneous procedures were treated with endovascular percutaneous procedures. We performed six transhepatic arterial embolization (TAE) and one placement of an endograft stent. Follow-up was carried out by ultrasound (US) or computed tomography (CT) after 1, 3, 6, and 12 months, yearly thereafter and by laboratory tests in the first 6 months to completely exclude occult and asymptomatic bleeding. All procedures had 100% technical success. No case of further bleeding was seen at follow-up. In one patient, we detected one abscess after 3 weeks, which was treated by antibiotic therapy. In conclusion, endovascular treatment currently represents a valid option in emergency settings, as it the enables diagnosis and treatment of IHAI in a single session.