创伤性动脉瘤和动静脉瘘

目的：为了进一步探讨创伤性动脉瘤和动静脉瘘的手术方法，我院血管外科分析了１９６３年６月～１９９５年１２月，经手术治疗的创伤性动脉瘤和动静脉瘘９６例。其中创伤性动脉瘤５５例，含６３个动脉瘤，动静脉瘘４１例，含４３个动静脉瘘。方法：根据血管造影和手术发现，将创伤性动脉瘤和动静脉瘘各分为四个类型。手术方法包括直接修补、单纯或四头结扎、瘤或瘘切除然后行对端吻合或大隐静脉或人造血管移植。结果：除１例左颈总动脉根部动脉瘤伴左颈总动脉—无名静脉瘘术后１９小时死于弥漫性血管内凝血外，其余无死亡。动脉瘤和动静脉瘘得到随访的分别为７９．６％和７８．０％。远期随访效果较佳。结论：不同类型的创伤性动脉瘤和动静脉瘘，应采用不同的手术方法。     

四肢创伤性动脉瘤及动静脉瘘（附56例治疗报告）

1980～1984我院外科治疗四肢创伤性动脉瘤及动静脉瘘56例，以动脉瘤切除用静脉移植，重建血管连续性为最好的手术方式。单纯的动脉结扎要慎重，否则会发生肢体的缺血坏死。     

吲哚菁绿荧光血管造影技术对神经外科手术效果的影响

目的:研究在神经外科血管性疾病的手术中应用吲哚菁绿(ICG)荧光血管造影技术对手术效果的影响。方法:不同的神经外科血管性疾病患者47例,男性21例,女性26例;年龄16～73岁,平均57岁。在手术中进行ICG荧光造影,以进一步指导及评估手术效果。其中,颅内动脉瘤患者37例(后交通动脉瘤12例,前交通动脉瘤14例,大脑中动脉动脉瘤11例);颞浅动脉-大脑中动脉吻合术7例;脊髓动静脉瘘3例。上述患者均在术后行DSA血管造影或CTA以明确手术效果。结果:37例动脉瘤术中经ICG血管造影,发现动脉瘤颈夹闭后载瘤动脉狭窄3例,动脉瘤颈残留4例,远端分支狭窄2例,均根据术中吲哚菁绿血管造影情况重新调整瘤夹位置后,瘤颈夹闭满意,术后DSA血管造影及CTA显示载瘤动脉通畅,远端分支无狭窄,术后早期CT检查显示无脑梗死。7例颞浅动脉-大脑中动脉吻合术中行ICG造影见1例吻合口狭窄,予以拆除吻合线重新缝合,再次ICG造影显示吻合血管通畅。3例脊髓动静脉瘘切除病变前均可发现畸形血管轮廓、供血动脉、引流静脉情况,引导精准的切除动静脉瘘,术后血管造影显示3例畸形血管团均被彻底切除。结论:吲哚菁绿荧光血管造影可以准确判断动脉夹闭后瘤颈是否有残留、穿通动脉是否闭塞;可以及时发现血管吻合是否通畅;可以明确脊髓动静脉瘘的轮廓及其供血动脉、引流静脉;能显著提高上述血管性疾病的手术效果。     

创伤性颈内动脉海绵窦瘘的介入治疗

目的:探讨不同类型的创伤性颈内动脉海绵窦瘘的介入治疗方法。材料和方法:回顾性分析63例经全脑数字减影血管造影(DSA)诊断的创伤性颈内动脉海绵窦瘘的治疗方法:血管内栓塞、栓塞结合手术孤立瘘口或瘘口所在的颈内动脉内覆膜支架置入等方式。结果:63例创伤性颈动脉海绵窦瘘中,术后59例动静脉瘘完全闭塞,4例大部分闭塞;临床症状消失62例,好转1例。本组无并发症发生。结论:创伤性颈内动脉海绵窦瘘治疗的关键在于闭塞瘘口。根据其动静脉瘘的部位、供血动脉及瘘口的数量、引流静脉的特点等综合考虑栓塞材料的选择是保证治疗成功的重要因素。     

硬脑膜动静脉瘘的综合治疗探讨

目的:探讨不同部位、不同类型的硬脑膜动静脉瘘的治疗方法.材料和方法:对29例经全脑数字减影血管造影(DSA)诊断为硬脑膜动静脉瘘患者采用血管内栓塞、手术夹闭瘘口-瘘口端引流静脉或静脉窦以及瘘口所在的静脉窦内支架置入等方法治疗.结果:29例硬脑膜动静脉瘘患者中,15例术后动静脉瘘完全闭塞,14例大部分闭塞;15例临床症状消失,余14例症状明显改善.无并发症发生.结论:硬脑膜动静脉瘘治疗的关键在于闭塞瘘口.根据其动静脉瘘的部位、供血动脉及瘘口的数量、引流静脉的特点等综合考虑是治疗成功的关键.     

肝血管瘤合并动静脉瘘的DSA表现及介入治疗

目的:回顾性分析肝海绵状血管瘤(CHL)合并动静脉瘘(AVF)的数字减影血管造影(DSA)的特征性表现并探讨合理的治疗方法。方法:分析合并AVF的26例CHL的完整DSA及经平阳霉素碘油乳剂肝动脉栓塞(PLE-TAE)治疗的资料。改进造影技术采集DSA图像,采取超选择插管行PLE-TAE后再用明胶海绵颗粒栓塞瘘口及少量无水酒精闭塞瘘口后再行PLE-TAE等处理方法。结果:CHL合并的AVF的DSA的特征性表现为瘘口较为局限,多位于瘤周近供血动脉处;以周围型动-门静脉瘘(APVF)为多见;分流量多较小;AVF供血动脉无浸润破坏现象。对瘘口采取适当的处理措施后,AVF中碘油沉积静脉数较TAE前DSA显著减少(P<0.01),邻近肝组织亦未见明显碘油异常沉积。结论:CHL中AVF有较高的发生率且有特征性DSA表现。通过适当处理可以显著减少或避免PLE异常沉积及其可能造成的肝脏和肺脏纤维化。     

肝癌合并动静脉瘘的DSA表现及介入治疗方法的探讨

目的探讨肝癌合并动静脉瘘的DSA表现及介入治疗方法。方法对673例经证实的肝癌患者先行(肠系膜上动脉)间接门脉造影及腹腔动脉或肝总动脉造影,再行肝动脉内灌注化疗和/或栓塞治疗。结果合并动静脉瘘者有151例(22.4%),其中动门静脉瘘127例,动肝静脉瘘有15例,混合型有9例;131例(86.8%)动静脉瘘患者施行了1次或多次肝动脉栓塞治疗,20例因动静脉瘘口不能有效栓塞和/或合并门静脉主干瘤栓而行单纯灌注化疗。结论DSA影像是肝癌合并动静脉瘘直观可靠的诊断方法,肝动脉灌注栓塞治疗是肝癌动静脉瘘患者最有效的治疗方法之一。     

创伤性动脉瘤的治疗

目的：探讨创伤性动脉瘤的外科手术治疗方法。方法：对近6年收治的创伤性动脉瘤39例进行回顾性分析。结果：24例行急诊手术治疗，动脉瘤切除后，10例作单纯动脉结扎，3例作动脉修补，26例用自体大隐静脉或人工血管移植重建血运，手术治愈37例，高位截肢2例，治愈率94．9％，术后随访26例（2个月－6年），均保存肢体。结论：外科手术仍是目前首选的外周创伤性动脉瘤治疗方法，应视具体情况选择手术方式，并重视感染性假性动脉瘤的治疗。     

头颈部动静脉瘘的手术与栓塞治疗

目的：探讨头颈部动静脉瘘的手术及栓塞治疗效果。方法：回顾性分析74例头颈部动静脉瘘的手术与栓塞治疗;手术治疗14例其中颈动脉结扎2例、瘘口孤立5例、铜丝填塞6例、颅内眼上静脉夹闭1例;可脱球囊栓塞治疗60例。结果：手术治疗的14例,治愈6例,好转6例,复发1例,死亡1例;可脱球囊血管内栓塞治疗60例,治愈59例,好转1例。结论：头颈部动静脉瘘的治疗方法中,血管内栓塞应作为首选的治疗方法。     

108例创伤性动静脉瘘的介入诊疗分析

目的分析创伤性动静脉瘘（AVF）的临床特点、造影表现、造影技术及治疗方式的选择。方法回顾性分析纽约Kings County医疗中心25年间全部确诊的108例创伤性AVF的介入相关诊疗资料。分析内容包括患者外伤种类、临床表现、损伤部位、血管造影异常特征、AVF血流动力学特征（分5个类型）、治疗方式的选择等。结果 108例患者中共发现117处AVF,大多数患者临床特征不明确。创伤种类包括枪伤（导致72处AVF）、刺伤（24处）、钝性伤（8处）、高处坠落伤（3处）、医源性损伤（2处）。损伤部位常见于肢体（46例）、颈部（19例）、肝脏（13例）和锁骨下血管（11例）。所有病变均可见静脉早显,显示动脉横断52处,撕裂37处,49.6%的AVF与假性动脉瘤有关。最常见的血流特点是Ⅰ型,即瘘口所在的动脉近段和远段、静脉的近段和远段都显示,伴远侧段静脉瓣功能不全,共40处瘘（34.2%）,其次是Ⅲ型22个（18.8%）,Ⅴ型最不常见（4.3%）。34例接受手术治疗,61例栓塞治疗,7例临床观察。分别采用弹簧圈（47例）、明胶海绵（9例）、无水乙醇（3例）、可脱球囊（2例）,其中弹簧圈效果理想、并发症少。6例采用覆膜支架效果好。结论血管造影是诊断创伤性AVF的金标准,造影时准确观察动脉损伤的性质,瘘口的解剖和血流特点及所有进入瘘口的动脉分支,对于选择治疗方式及保证介入治疗的成功完成至关重要。     

20例心脏大血管创伤后晚期后遗症的诊断与治疗

目的：报告心脏大血管创伤后晚期后遗症的诊断和治疗。方法：收集我科１９５４年６月～１９９５年４月治疗２０例心脏大血管损伤后遗症，其中穿入性损伤９例，闭合性损伤６例和医源性损伤５例。病变有瓣膜损伤８例，心脏异物５例，假性动脉瘤和动静脉瘘４例，右心室动脉瘤加心室间隔缺损（ＶＳＤ）、晚期心脏压塞和右下肺弹头、术后缩窄性心包炎各１例。施行手术早期取出心脏异物和心包腔引流４例。择期手术１５例，其中施行瓣膜替换术６例，瓣膜成形术２例，假性动脉瘤和动静脉瘘缝补术３例，心室间隔缺损加右心室室壁瘤缝补术、心腔内异物、血心包和缩窄性心包炎各１例。结果：１９例经手术治疗痊愈出院，１例因动脉导管结扎后假性动脉瘤，控制感染时突然瘤体破裂出血死亡。结论：早期诊断、早期或择期手术可取得良好效果。     

Crural Artery Traumatic Injuries: Treatment with Embolization

The purpose of this paper is to report our experience with the endovascular treatment of crural arterial injuries using transcatheter and direct embolization techniques. A total of eight consecutive patients have been treated during a 7-year period. Six males and two females, mean age 32 years (range, 15–56 years), presented with penetrating trauma to the lower extremities. Mechanisms of injuries were stab wounds in six patients, gun shot wound in one patient, and iatrogenic injury in one patient. Five patients presented with acute trauma, while three patients presented with delayed injuries. Crural arterial injuries encountered included pseudoaneurysms with arteriovenous fistulas (n = 6), pseudoaneurysms with vessel transections (n = 2), and pseudoaneurysm (n = 1). Proximal and distal embolization with coils was used in three cases, proximal embolization with coils in three cases, percutaneous thrombin injection in one case, and liquid n-butyl cyanoacrylate in one case. Complete exclusion of the lesions was accomplished by sacrifice of one crural vessel in seven cases and of two crural vessels in one case. Two cases of delayed injuries required combined coil and liquid embolization techniques for lesion exclusion. A minor complication (groin hematoma) occurred in one patient, no distal ischemia was seen, and no amputations were required. Mean follow-up was 61 days (range, 1–180 days). One pseudoaneurysm treated with thrombin injection recurred and required surgical excision. We conclude that transcatheter embolization alone or in combination with different endovascular techniques is useful in the treatment of traumatic crural vessel injuries.     

Interventional neurovascular treatment of traumatic carotid and vertebral artery lesions: results in 234 cases

Traumatic injuries to the head and neck that result in arteriovenous fistulae are often difficult to treat by direct surgical access. This is because of anatomic location, instability of the acutely injured patient, and difficulty in localizing the exact site of injury. Between 1974 and 1988, 234 consecutive cases of traumatic injuries to the carotid or vertebral artery were evaluated by our group for intravascular embolization therapy. This included 206 cases of direct and seven cases of indirect carotid-cavernous sinus fistulae and 21 cases of traumatic vertebral fistulae. A variety of devices including detachable balloons, liquid tissue adhesives, microcoils, and silk suture were used with the goal of fistula occlusion and preservation of the parent vessel. This was achieved in 193 cases (82%). In the remaining 41 cases (18%), the carotid or vertebral artery had to be occluded by endovascular occlusion techniques because of extensive vascular injury in 28 cases and subtotal occlusion of the fistula in 13 cases. Complications included transient cerebral ischemia in six cases, pseudoaneurysm formation in five cases, stroke in five cases, and peripheral nerve injury in one case. The development of interventional neurovascular techniques has altered the management of these acutely injured patients. The preferred method for treatment has shifted from direct surgical access under general anesthesia to endovascular therapy under local anesthesia.     

Pseudoaneurysm and renal arteriovenous fistula after nephrectomy: two cases treated by transcatheter coil embolization

Pseudoaneurysms and arteriovenous fistulas of renal arteries are rare clinical lesions. Invasive renal procedures may lead to pseudoaneurysm or arteriovenous fistulas (AVFs). We report two pseudoaneurysms and arteriovenous fistula cases that were treated by transcatheter embolization with metallic coils. The first case is left main renal artery pseudoaneurysm after nephrectomy in a patient with a solid renal tumor. The second case is right main renal artery AVF with giant pseudoaneurysm after both gunshot injury and nephrectomy. On the basis of color Doppler sonography and computed tomography (CT) findings, cases were diagnosed as pseudoaneurysm after nefrectomy. Contrast-enhanced CT scans showed a hyperdense area within the hematoma consistent with pseudoaneurysm. Endovascular treatment with coil embolization succeeds to total occlusion in renal artery pseudoaneurysm. Delayed hemorrhage related to postnephrectomy may be life-threatening conditions because of diagnostic difficulties. AVF and pseudoaneurysm can be treated safely and successfully by transcatheter arterial embolization.     

覆膜血管内支架在外周动脉瘤和动静脉瘘中的应用

目的探讨覆膜血管内支架在外周动脉瘤及动静脉瘘中的临床应用疗效及安全性。方法回顾性分析我院2000年5月至2006年11月14例接受覆膜血管内支架治疗患者的临床资料。14例患者主要的血管病变为真性或假性动脉瘤、动静脉瘘。结果覆膜血管内支架的置放技术成功率为100%,无严重并发症和围手术期死亡,术后临床症状明显改善。1例患者出现I型内漏,但临床症状仍有改善。平均随访时间10个月。随访期内除1例患者仍有内漏外余无内漏。未发现支架移位和狭窄等并发症。结论覆膜血管内支架治疗外周动脉瘤及动静脉瘘具有创伤小、疗效确切、安全等优点,短期随访效果满意。     

创伤性颈动脉海绵窦瘘合并蝶窦假性动脉瘤的诊断和治疗

目的 探讨创伤性颈动脉海绵窦瘘合并蝶窦假性动脉瘤的诊疗方法.方法 介入方法诊断和治疗6例创伤性颈动脉海绵窦瘘合并蝶窦假性动脉瘤患者.结果 5例出现反复鼻腔大出血;所有患者均行瘘口和假性动脉瘤球囊闭塞,2例颈内动脉保留,1例合并对侧间接型颈动脉海绵窦瘘行经面静脉-眼上静脉瘘口弹簧圈栓塞术.术后颅内杂音均即刻消失,结膜充血水肿2周～3个月内消退.无介入相关并发症.所有患者均行随访,无临床症状复发,均恢复工作.结论 车祸是致颈动脉海绵窦瘘合并蝶窦假性动脉瘤的主要原因;受力部位多集中在患侧眶额部到眶颧部的眶前外侧区;头颅MRI结合临床表现对于术前确诊该病非常有帮助;可脱球囊闭塞瘘口和假性动脉瘤或闭塞颈内动脉是安全、有效的治疗方法.     

创伤性假性动脉瘤的介入治疗

目的　介绍不同类型创伤性假性动脉瘤 (假瘤 )的几种不同治疗方法。方法　 8例不同部位、不同创伤原因引起的的假瘤 ,采用不同的方法进行治疗。 3例终末型动脉的假瘤采用明胶海绵栓塞 ,2例主干性外周动脉的假瘤采用覆膜支架置入术将其隔绝 ,1例支干型假瘤采用两端弹簧圈栓塞 ,1例股动脉穿孔型假瘤采用压迫法 ,另 1例巨大血肿伴假瘤经栓塞后作手术血肿清除加动脉结扎术进行治疗。结果　所有假瘤均完全闭合 ,置入覆膜支架者其远端动脉搏动正常。 1例患者因其他原因 ,致穿刺部位又出现假瘤。其他患者无并发症。结论　采用不同的介入技术能治疗各种假瘤 ,多数情况下可以代替外科治疗