Multi-Detector CT Findings of Celiac Ganglia

目的 探讨腹腔神经节多层螺旋CT(MDCT)的表现.资料与方法 回顾分析133例上腹部CT平扫和增强扫描无异常患者的CT资料,记录和测量腹腔神经节的位置、形态及大小.结果 左侧腹腔神经节124例显示,9例显示不清;右侧115例显示,18例显示不清,两侧显示率的差异无统计学意义(左侧,93.2％;右侧,86.5％;x2＝3.339,P＝0.068).双侧腹腔神经节位于腹腔干及肠系膜上动脉水平,左侧者位于左侧肾上腺与左侧膈肌脚之间,右侧者位于下腔静脉后方、右侧肾上腺内侧,主要为长条状(74.5％,178/239)、分叶状(25.5％,61/239).腹腔神经节的左、右侧长径分别为(26.1±12.3) mm、(29.5±9.2) mm,短径分别为(4.1±1.0) mm、(3.1±0.9)mm,左侧腹腔神经节长径小于右侧(t＝-4.208,P＜0.001),左侧短径大于右侧(t＝13.635,P＜0.001).结论 MDCT能显示腹腔神经节的位置、大小及形态特征,左侧腹腔神经节的显示率略高于对侧,但差别无统计学意义.     

多层螺旋CT血管成像显示胃网膜右动脉的临床价值

目的 评价多层螺旋CT血管成像(MSCTA)显示胃网膜右动脉(RGEA)的临床价值. 方法 回顾性分析80例符合入组标准病例资料的16层螺旋CT腹部增强扫描图像,采用最大密度投影(MIP)、薄层最大密度投影(TSMIP)及容积再现(VR)图像观察RGEA的走行规律、长度类型,并测量血管起始端及远端内径. 结果 80例RGEA显示率为100%,其中长型RGEA 22例(占27.50%),中型RGEA 53例(占66.25%),短型RGEA 5例(占6.25%).RGEA平均长度为(19.5±4.5) cm,3型RGEA起始端平均内径分别为(2.69±0.26) mm、(2.70±0.18) mm、(2.68±0.12) mm,3型RGEA远端平均内径分别为(1.76±0.17) mm、(1.75±0.18) mm、(1.74±0.05) mm.3型RGEA的起始端、远端平均内径无统计学意义(P>0.05).结论应用MSCTA可以为原位RGEA冠状动脉旁路移植术作术前评估.     

中国人卵巢动脉的血管造影研究

目的观察国人卵巢动脉（OVA）的血管造影解剖,为选择性OVA插管治疗提供信息。资料与方法对138例进行了前瞻性OVA造影。96例（盆腔疾病组）因盆腔或妇科疾病行髂内动脉-子宫动脉化疗栓塞,42例（无盆腔疾病组）为无盆腔或妇科疾病患者。针对患者的原发疾病,按常规完成血管造影检查后行腹主动脉造影和选择性OVA造影,观察OVA的起源、走行、管径及参与盆腔疾病的供血情况。结果138例中,102例行两侧OVA选择性插管成功,96．1％的OVA发自腹主动脉前外侧壁,异位开口发生率占3．9％。两侧OVA开口在同一水平者占41．2％,左侧OVA开口高于右侧者占56．9％,右侧高于左侧者占2．0％。96．4％的OVA开口于L2椎体上缘至L3椎体下缘之间,98．6％开口低于肠系膜上动脉、98．2％低于肾动脉开口,左侧OVA开口高于肠系膜下动脉开口者占96．9％、右侧OVA开口高于肠系膜下动脉开口者占81．3％。在盆腔疾病组,至少有一侧OVA参与盆腔疾病供血者占34．4％。无盆腔疾病组OVA直径左侧为（0．9±0．3）mm（98．6％≤1．1mm）,右侧为（0．8±0．3）mm（95．6％≤1．1mm）;盆腔疾病组,左侧OVA直径为（1．7±0．6）mm,右侧直径为（1．8±0．8）mm;有盆腔疾病组与无盆腔疾病组之间的OVA直径差异有统计学意义（χ^2=75．29,P=0．00001）。结论卵巢动脉造影所见,包括其起源、开口与椎体的相对位置、管径及分支供血分布等,对介入治疗具有重要参考价值。     

甲状腺功能亢进时甲状腺的血供分析

目的　研究甲状腺功能亢进 (甲亢 )时各支甲状腺动脉的粗细及其供应甲状腺组织的多少 ,为甲亢的动脉栓塞治疗提供相关的理论依据。方法　对 5 5例甲亢患者行甲状腺动脉造影 ,测量各支甲状腺动脉的直径及其供应的甲状腺组织所占单侧甲状腺的比例 ,供应比例 >6 0 %时定义为主要供血 ,占 4 0 %～ 6 0 %时为上下动脉供血相当。结果　右侧甲状腺上动脉内径 2 .2～ 6 .0mm ,平均 (3.8±0 .90 )mm ,1例缺如 ;右侧甲状腺下动脉内径 1.7～ 5 .6mm ,平均 (3.5± 1.3)mm ,2例缺如。左侧甲状腺上动脉内径 2 .4～ 6 .0mm ,平均 (3.7± 0 .9)mm ,1例缺如 ;左甲状腺下动脉内径 1.0～ 5 .2mm ,平均 (2 .9± 1.0 )mm ,3例缺如。左右侧甲状腺最下动脉各有 1例显示。双侧甲状腺上动脉相比 ,其粗细相差不明显 (t=0 .2 74 1,P >0 .0 5 ) ,双下动脉相比 ,右侧较左侧粗 (t=2 .3917,P <0 .0 2 ) ;右上下动脉相比 ,相差不明显 (t=0 .95 5 6 ,P >0 .0 5 ) ,左上下动脉相比 ,上动脉明显较下动脉粗 (t =3.7796 ,P <0 .0 1)。右侧甲状腺由右上动脉供血为主者占 5 6 .4 % (31/ 5 5 ) ,上、下动脉供血相当者占 4 0 % (2 2 / 5 5 ) ,右下动脉为主者 3.6 % (2 / 5 5 ) ,后两者合计占 4 3.6 % ;左侧甲状腺由左上动脉供血为主者占 4 9.1% (2     

飞行学员椎动脉二维及彩色多普勒超声检测分析

目的 了解2010年度招收的飞行学员椎动脉发育情况,为椎动脉超声检查列入招飞体检提供依据.方法 利用二维及彩色多普勒超声回顾性分析722名飞行学员的椎动脉起始位置、内径、走行及血流动力学变化等,总结飞行学员中椎动脉先天发育异常的比例.结果 722名飞行学员左侧椎动脉起始段(Dl)与椎动脉椎间段(D2)内径(分别为3.624±0.017、3.623±0.018mm)宽于右侧(分别为3.489±0.018、3.438±0.019mm,P＜0.05),左侧椎动脉椎间段收缩期峰值流速(53.547±0.412cm/s)高于右侧(48.463±0.405cm/s,P＜0.05).椎动脉直径在2.5 ～3.0mm的比例较大,为17.5％,而小于2.5mm比例稍低,为6.9％;右侧椎动脉窄细者(16.0％,116/722)多于左侧(8.3％,60/722),差异有统计学意义(P＜0.05).双侧椎动脉走行异常者24例(占3.3％),其中双侧椎动脉起始位置正常,仅走行异常者19例,起始部伴走行异常者5例.19例仅走行异常者左右侧之间无明显差异(P＞0.05),5例起始部伴走行异常者中2例伴有同侧椎动脉窄细.结论 飞行学员中存在多种椎动脉先天发育异常,应早日将椎动脉的超声检查列入招飞体检项目中.     

活体肾动脉解剖的多层螺旋CT研究

目的 研究肾动脉的活体解剖及其变异规律.方法 随机选择202例因腹部病变而行64层螺旋CT增强扫描的患者作回顾性肾动脉系相关参数的分析研究.在Siemens Sensation Cardic 64 CT工作站采用层厚1.0 mm、重建间隔0.7 mm动脉期图像做3D (VR,MIP)图像后处理.结果 肾动脉变异率为67.3%(136/202),包括肾动脉型肾副动脉(ⅡB)占43.4%(59/136),AA型肾动脉(ⅠA)占40.4%(55/136),AA型肾副动脉(ⅡA)占34.6%(47/136),肾门前动脉(ⅠB)占26.5%(36/136),其他型肾动脉(ⅠC)发生率仅为0.7%(1/136).肾动脉变异率在双肾及男女之间无显著性差异.右侧肾动脉高于左侧者占71.8%,左侧高于右侧占24.3%,双侧等高54.0%,且无明显的性别差异.正常成年男性右 侧肾动脉管径为(0.69±0.14) cm,左侧为(0.74±0.16) cm,正常成年女性右侧肾动脉管径为(0.65±0.16) cm,左侧为(0.64±0.13) cm,男性两侧肾动脉管径有统计学差异,女性两侧肾动脉管径无统计学差异.肾动脉管径与相应肾体积相关系数r均＜0.4,呈低度线性相关.结论 肾动脉多层螺旋CT血管成像(MSCTA)已成为肾动脉检查的首选方法.     

面动脉的彩色多普勒解剖分型及临床意义

目的 研究面动脉的彩色多普勒解剖分型及其临床意义.方法 利用彩色多普勒超声检查患者54例,共102条面动脉,根据面动脉的走行进行解剖分型,并测量面动脉内径、收缩期峰值速度、舒张末期速度及阻力指数等.结果 ①103条面动脉中,其中101条面动脉起自颈外动脉,2例起源于颈总动脉;②左侧面动脉主干管径宽约(2.83±0.77)mm,右侧面动脉管径宽约(2.93±0.79)mm,两者之间有统计学意义;③面动脉频谱为高阻的双相频谱.结论 彩色多普勒超声可以无创方便的评价面动脉,有利于外科皮瓣设计和显微血管外科手术的术前评价.     

股骨头缺血性坏死伴旋股外侧动脉动静脉畸形介入治疗效果和安全性北大核心CSCD

目的探讨介入手术治疗股骨头缺血性坏死(ANFH)伴旋股外侧动脉(LCFA)动静脉畸形的效果和安全性。方法回顾性分析2016年4月至2021年9月在漳州市中医院接受介入手术治疗的22例ANFH伴LCFA动静脉畸形患者临床资料。先行超选择栓塞动静脉畸形供血动脉LCFA,尔后对股骨头滋养动脉旋股内侧动脉、LCFA及闭孔动脉的主干和主要分支行超选择经导管动脉灌注(TAI)治疗,7~14 d后再次行TAI。比较手术前后股骨头滋养动脉DSA表现、Harris髋关节功能评分及多层螺旋CT(MSCT)影像上股骨头骨质改变。结果所有患者动静脉畸形瘘口均成功封堵,TAI顺利完成,技术成功率为100%。血管造影显示术后LCFA动静脉畸形消失,股骨头滋养动脉明显增多,侧支循环形成。发生异位栓塞8例,均未产生严重后果。随访3~24个月,末次随访Harris髋关节功能评分与第1次手术前相比差异有统计学意义(P<0.05),MSCT检查显示股骨头坏死区病灶稳定,周围骨质增生、边缘硬化及囊变缩小。治疗有效率为100%。结论介入治疗ANFH伴LCFA动静脉畸形微创、安全有效,有助于保留股骨头。     

体动脉侧支血管参与咯血供血的影像学研究

目的 探讨非支气管性体动脉侧支(NBSC)在支气管咯血病变中的意义,及其对支气管动脉(BA)的影响.方法 回顾分析124例支气管咯血患者的多层螺旋CT(MSCT)血管造影.采用实时螺旋薄层CT增强扫描,在独立工作站行胸部体动脉三维重建,统计NBSC和BA数目,测量其内径及病变区域邻近胸膜厚度.根据NBSC发现情况,资料分别归入NBSC组和无NBSC组作统计学分析.结果 NBSC参与供血36例,BA内径平均值为(1.850±0.631)mm,其中病灶附近胸膜增厚22例(61%),厚度为2.7～16.0 mm,平均(7.71±4.12)mm;无NBSC供血88例,BA内径的平均值为(2.200±0.528)mm,病灶附近胸膜增厚7例(8%),厚度为1.1～2.4 mm,平均(1.7±0.53)mm,两组间BA平均值和伴有胸膜增厚差异均有统计学意义(P值均＜＜0.05).结论 NBSC能分流支气管动脉向咯血病变的供血,成为咯血的主要供血来源.显著的胸膜增厚是产生NBSC供血的重要原因.     

三维增强MRA在股前外侧皮瓣术前设计中的应用价值

目的:目前创伤和肿瘤引起的皮瓣移植手术开展明显增多,术前定位对手术成功率尤为关键,探讨三维增强磁共振血管成像(CE-MRA)在股前外侧皮瓣术前的临床应用价值。方法:对68例供体进行双下肢3DFLASH序列CE-MRA检查,数据采集后使用层块最大强度投影(TS-MIP)进行图像重组,观察和评价与供体皮瓣相关的旋股外侧动脉的起始、分支类型、穿支血管分布情况和覆盖范围等。结果:所查患者旋股外侧动脉获得良好显示,其中Ⅰ型101侧(101/136,74.3%)、Ⅱ型20侧(20/136,14.7%)、Ⅲ型3侧(3/136,2.2%)和Ⅳ型12侧(12/136,8.8%);94侧(94/136,69.1%)旋股外侧动脉显示了3级分支。CE-MRA图清晰显示了粗大穿支血管的起始及在皮下和肌肉间的走行,TS-MIP显示细节最好。结论:3DCE-MRA结合TS-MIP可准确、直观地显示供体股前外侧皮瓣血供及其分布的三维立体信息,有效指导皮瓣的设计。     

Prostatic Artery Perfusion from the Medial Circumflex Femoral Artery

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Combined Antegrade Femoral Artery and Retrograde Popliteal Artery Recanalization for Chronic Occlusions of the Superficial Femoral Artery

PurposeTo evaluate the efficacy and safety of a dual femoral–popliteal approach in the supine position after failed antegrade recanalization attempts in chronic total occlusion (CTO) of the superficial femoral artery (SFA).Materials and MethodsFrom May 2011 to October 2012, 21 patients underwent dual femoral–popliteal recanalization for CTO of the SFA, with a mean lesion length of 87.4 mm ± 5.8. When contralateral antegrade recanalization of SFA occlusions via the common femoral artery could not be achieved, the occlusions were intrainterventionally accessed by retrograde approach via the popliteal artery, which was punctured anteriorly with gently flexed knee and crus extorsion. When the SFA had been recanalized, further angioplasty and stent placement procedures were completed via the femoral artery.ResultsA technical success rate of 100% (entailing puncture of the popliteal artery and SFA recanalization) was achieved, and no hemorrhage, hematoma, pseudoaneurysm, arteriovenous fistula, or other complications developed. During a mean follow-up of 9.8 months ± 1.5, claudication severity, rest pain, and toe ulcers improved significantly. The pulse of the distal arteries, as well as the filling of the veins, could be distinctly felt. Ankle-brachial index changed from 0.48 ± 0.17 to 0.84 ± 0.11 at 1 year after intervention (P < .001), and patency rates at 1, 6, and 12 months after interventions were 100%, 80%, and 42%, respectively.ConclusionsA dual femoral–popliteal approach in the supine position is an alternative backup option after failed attempts at the antegrade approach for patients with proximal barriers in CTO or lesions with major extending collateral vessels.     

Transcatheter Embolization of Bronchial Artery Arising from Left Circumflex Coronary Artery in a Patient with Massive Hemoptysis

It has been reported that anastomoses between the bronchial and the coronary arteries can become dilated and functional in certain diseases, provoking angina pectoris through coronary steal syndrome. The condition can be treated with endovascular or surgical management. It is possible that this abnormality may be associated with hemoptysis in patients with parenchymal or vascular disease of the lung but this condition is very rare. We present the coronary CT angiographic findings of bronchial arteries arising from the left coronary artery and their treatment with transcatheter embolization for the control of massive hemoptysis.     

Arteriolymphatic Fistula Caused by Femoral Artery Puncture

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股动脉穿刺三指定位法

股动脉穿刺技术是血管造影和介入治疗的基本操作技术 ,如何能尽快准确的掌握股动脉穿刺技术 ,对初学者非常重要。现将三指定位股动脉穿刺技术的经验体会介绍如下。1　临床资料我院 1987-11将ＤＳＡ应用于全身各部位进行诊断性造影 ,并先后开展各个部位的介入治疗。 10年来诊断性造影及血管性介入治疗的患者多达 70 0 0余例次。如肝癌及全身各部位的恶性肿瘤、外周血管狭窄、溶栓等介入治疗时均采用三指定位股动脉穿刺技术。2　方法穿刺部位 (大腿根部 )常规消毒 ,铺消毒巾 ,术者常规站于患者右侧 ,用左手环指与中指触摸股动脉搏动。摸清股动…     

Feasibility and Safety of Vascular Closure Devices in an Antegrade Approach to Either the Common Femoral Artery or the Superficial Femoral Artery

Introduction

The purpose of the present study was to analyze complications following antegrade puncture of the common femoral artery (CFA) and the superficial femoral artery (SFA) using vascular closure systems (VCS).

Methods

A single-center, retrospective study was performed after obtaining approval from the institutional review board and informed consent from all patients. At our center, the CFA or SFA are used for arterial access. All patients were evaluated clinically on the same day. If there was any suspicion of an access site problem, Duplex ultrasound was performed.

Results

Access location was the CFA in 50 patients and the SFA in 130 patients. The sheath size ranged from 4F to 10F. Two patients had to be excluded because of lack of follow-up. Successful hemostasis was achieved in 162 of 178 cases (91?%). The following complications were observed in 16 patients (8.9?%): 4 pseudoaneurysms (2.2?%), 11 hematomas (6.2?%), and 1 vascular occlusion (0.5?%). The two pseudoaneurysms healed spontaneously, in one case an ultrasound-guided thrombin injection was performed, and one aneurysm was compressed manually. No further medical therapy was needed for the hematomas. The one vascular occlusion was treated immediately with angioplasty using a contralateral approach. No significant difference was noted between the CFA and the SFA group with respect to complications (p?=?1.000).

Conclusions

The use of closure devices for an antegrade approach up to 10F is feasible and safe. No differences in low complication rates were observed between CFA and SFA.