超选择性肾动脉栓塞治疗医源性肾损伤

目的 探讨超选择性肾动脉栓塞治疗医源性肾损伤的临床应用价值.方法 15例医源性肾损伤患者,首先行数字减影肾动脉造影,明确肾动脉破裂或损伤的部位及程度,在导丝引导下用吸收性明胶海绵颗粒进行超选择性插管栓塞治疗.结果 15例患者经数字减影肾动脉造影后均可明确肾动脉出血部位,经超选择性插管吸收性明胶海绵颗粒栓塞后均能有效止血,栓塞后造影显示出血动脉中断闭塞,造影剂外溢消失,术后1～3 d肉眼血尿消失.结论 超选择性肾动脉栓塞治疗医源性肾损伤定位准确、止血迅速、创伤小、并发症较少,能最大限度地保护肾功能,是治疗医源性肾损伤出血的有效方法.

Abstract：

Objective To evaluate the clinical application of superselective renal artery embolization in the treatment of iatrogenic renal hemorrhage. Methods The iatrogenic renal hemorrhage in fifteen patients was first demonstrated by renal arterigraphy to diagnose the rupture site and degree of injury. And then they were treated by percutaneous catheterized superselective renal arterial embolization through guidance of guide wire. Results In all 15 patients, the occlusive ruption of bleeding arteries and disappearance of extravasation staining were found after the superselective catheterized renal arterial embolization. Clinically, the bloody urine turned clear without macroscopic hematuria during 1-3 days in all patients after the procedure. Conclusions Superseclective renal arterial embolization treatment signified a less invasion, less complications, good hemostatic efficacy, and maximal preservation of renal tissue and function for iatrogenic renal hemorrhage. The treatment is worthy to be recommended.     

介入栓塞治疗在高龄难治性前列腺癌出血中的临床效果

目的观察介入栓塞治疗在高龄难治性前列腺癌出血中的临床效果。方法前列腺癌合并持续性出血患者共80例,其中采用超选择性髂内动脉栓塞治疗患者58例,采用止血药物进行保守治疗患者22例。对比分析两组患者的成功止血时间、并发症等不良反应和复发出血的发生情况,评估超选择性介入栓塞治疗高龄难治性前列腺癌出血的疗效和安全性。结果介入栓塞治疗技术成功率100%,58例患者中,47例平均3 d血尿停止,8例转为镜下血尿,3例经第二次栓塞术后停止出血。栓塞术后无严重不良反应。术后平均随访12个月,复发出血5例。药物保守治疗22例患者中,5例平均7 d血尿停止,9例平均15 d转为镜下血尿,8例保守治疗失败,转为采用介入栓塞治疗后止血成功。保守治疗有效的14例患者中8例12个月内出血复发。结论超选择性介入栓塞治疗高龄难治性前列腺癌出血安全且有效。     

肾动脉栓塞术治疗外伤性肾出血3例报告

2009年1—8月,我们采用血管栓塞术治疗肾创伤出血患者3例,效果满意。现报告如下。 资料与方法：本组男2例,女1例,年龄分别为42、52、34岁;右侧2例,左侧1例;坠落伤2例,车祸伤1例（合并胸腹部伤）。均有腰痛史伴肉眼血尿,受伤至入院治疗时间为1h～5d,均行B超及CT检查。损伤程度按Sargent分类,     

肾动脉栓塞术在肾脏疾病中的应用

一、肾动脉栓塞的方法采用Seldinger技术经皮穿刺股动脉插管,可先行腹主动脉造影,用7～8F多侧孔导管,其末端置于胸_(12)～腰_1椎体平面,用76%泛影葡胺45ml,     

急性消化道出血的介入诊断和治疗

目的：探讨介入诊断和治疗对急性消化道出血的应用及其价值。方法：急性消化道出血病例34例,常规在腹腔动脉和肠系膜上、下动脉插管造 影并作出出血的定位和定性诊断。造影后停留导管持续灌注垂体后叶素,或行栓塞治疗,追踪手术病理结果和观察止血情况。结果：定位和定性位诊断的准确率为100％。23例行灌注,11例行栓塞治疗。33例在介入治病结果和观察止血情况。结果：定位和定性诊断的准确率为100％。23例行灌注,11例行栓塞治疗。33例在介入治疗后止血,1例死亡。结论：动脉造影是急性消化道出血最直观又最准确的诊断方法,介入灌注血管加压素和治疗安全有效,可作为外科手术的补充疗法。     

子宫动脉栓塞治疗剖宫产术后晚期产后出血22例临床分析

目的探讨子宫动脉栓塞术治疗剖宫产术后晚期产后大出血的疗效和并发症。方法 2010年1月至2013年6月,对22例剖宫产术后晚期产后大出血患者,采用seldinger技术行双侧子宫动脉插管和造影,明确出血部位及出血动脉分支,用明胶海绵颗粒栓塞双侧子宫动脉。结果 22例患者均30~70分钟内完成栓塞治疗,12例术后立即止血,10例出血明显减少,术后均生命体征平稳,经一周对症治疗后,出血均完全停止,复发1例经再次介入栓塞后治愈。栓塞后19例出现下腹部及会阴部疼痛;16例出现发热,经对症治疗后均得到有效缓解。结论使用子宫动脉栓塞介入治疗剖宫产术后晚期产后大出血,具有止血快、创伤小、可保留生育功能等优点,疗效好、不良反应少,有较高的临床应用价值。     

超选择性肾动脉化疗栓塞术在肾癌根治术前的临床应用

对30例肾癌患者在肾癌根治术前行超选择性肾动脉造影及化疗栓塞。结果患者均成功实施术前栓塞,栓塞后出现轻度栓塞反应。粮治术中可见肿瘤血供基本中断．肿瘤周围界限清楚,易于剥离;术中出血量明显减少;镜下可见肿瘤坏死明显且与周围组织界限清楚。提示肾癌根治术前超选择性肾动脉化疗栓塞安全、有效。     

急性消化道出血的介人诊断和治疗

目的探讨介入诊断和治疗对急性消化道出血的应用及其价值。方法急性消化道出血病例34例,常规在腹腔动脉和肠系膜上、下动脉插管造影并作出出血的定位和定性诊断。造影后停留导管持续灌注垂体后叶素,或行栓塞治疗,追踪手术病理结果和观察止血情况。结果定位和定性诊断的准确率为100％。23例行灌注,11例行栓塞治疗。33例在介入治疗后止血,1例死亡。结论动脉造影是急性消化道出血最直观又最准确的诊断方法,介入灌注血管加压素和栓塞治疗安全有效,可作为外科手术的补充疗法。     

超选择性动脉栓塞术在急性胆管出血治疗中的应用

目的观察超选择性动脉栓塞术在急性胆管出血治疗中应用效果。方法急性胆管出血患者10例,采用Seldinger技术进行选择性肝动脉及其分支造影并实施超选择性动脉栓塞术。结果造影发现肝动脉假性动脉瘤7例、肝动脉终末支出血1例、肝左动脉胆管瘘呈胆管铸型1例、胆囊动脉出血1例,实施超选择性肝动脉栓塞术后胆管出血均停止。随访6～24个月,未见胆管再出血。结论超选择性动脉栓塞术用于急性胆管出血的治疗安全有效。     

支气管动脉栓塞术治疗大咯血29例临床分析

大咯血是临床常见的一种急症,长期反复的大咯血,又无手术治疗的指症,临床处理乏策,死亡率高,及时而有效地控制出血对挽救病人生命至关重要.1974年Remg等首先应用支气管动脉栓塞（BAE）治疗大咯血获得成功.近年来,有不少报道认为它是有效控制大咯血的介入放射学治疗方法.现就我院用此法治疗的29例病人进行回顾性分析,以探讨支气管动脉栓塞术对大咯血的治疗价值和影响因素.     

Selective embolization of a renal artery aneurysm

The treatment modalities for renal artery aneurysm have changed. The aim in the presented case was to evaluate the endovascular therapy in a 52-year-old woman (with hematuria as the only symptom) with a saccular aneurysm at the first bifurcation of the right main renal artery, which was diagnosed with contrast-enhanced computerized tomography and angiography. We approached the aneurysm with minimally invasive supraselective embolization. There were no postoperative complications, as confirmed with control angiography, during the intervention and after an interval of 4 weeks. In conclusion, selective coil embolization as first-line therapy to treat saccular renal artery aneurysm is feasible. In this case, minimally invasive procedure provided maximum functioning kidney tissue.     

Selective embolization of the internal iliac arteries for the treatment of severe hemorrhagic cystitis following hematopoietic SCT

Hemorrhagic cystitis (HC) is a frequent and sometimes life-threatening complication after hematopoietic SCT (HSCT). Many therapeutic approaches have been performed to control HC, but their effect is still limited. The present study investigated the role of selective embolization of the internal iliac arteries in patients with severe HC after HSCT. Among 324 patients treated in our hospital by HSCT, 10 patients with late-onset HC were enrolled in this study. All the patients underwent allogeneic transplantation and CY for preconditioning, no improvement in routine management. A retrograde arterial catheterization of the femoral artery by modified Seldinger's technique was used to perform digital angiography of the aortoiliac sector. Selective embolization of the internal iliac arteries was then performed with gelatin sponge to confirm the occlusion of the vesical hypervascularization. Eight patients achieved complete response (CR), their hematuria and symptoms ceased after embolization treatment, including six from first treatment of embolization and two from second treatment. Two other patients obtained no response to embolization treatment. Our study showed that selective embolization of the internal iliac arteries is an effective treatment option in patients with severe HC after HSCT.     

Selective embolization for bleeding visceral artery pseudoaneurysms in patients with pancreatitis

BACKGROUND:Pancreatitis is associated with arterial complications in 4%-10%of patients,with untreated mortality approaching 90%.Timely intervention at a specialist center can reduce the mortality to 15%.We present a single institution experience of selective embolization as first line management of bleeding pseudoaneurysms in pancreatitis. METHODS:Sixteen patients with pancreatitis and visceral artery pseudoaneurysms were identified from searches of the records of interventional angiography from January 2000 to June 2007.True visceral artery aneurysms and pseudoaneurysms arising as a result of post-operative pancreatic or biliary leak were excluded from the study. RESULTS:In 50%of the patients,bleeding complicated the initial presentation of pancreatitis.Alcohol was the offending agent in 10 patients,gallstones in 3,trauma,drug-induced and idiopathic pancreatitis in one each.All 16 patients had a contrast CT scan and 15 underwent coeliac axis angiography. The pseudoaneurysms ranging from 0.9 to 9.0 cm affected the splenic artery in 7 patients:hepatic in 3,gastroduodenal and right gastric in 2 each,and left gastric and pancreatico-duodenal in 1 each.One patient developed spontaneous thrombosis of the pseudoaneurysm.Fourteen patients had effective coil embolization of the pseudoaneurysm.One patient needed surgical exclusion of the pseudoaneurysm following difficulty in accessing the coeliac axis radiologically.There were no episodes of re-bleeding and no in-hospital mortality. CONCLUSIONS:Pseudoaneurysms are unrelated to the severity of pancreatitis and major hemorrhage can occur irrespective of their size.Co-existent portal hypertension and sepsis increase the risk of surgery.Angiography and selective coil embolization is a safe and effective way to arrest the hemorrhage.     

Selective gelfoam embolization of primary racemose haemangioma of the bronchial artery

A 54-year-old male presented with haemoptysis. Bronchial arteriography revealed a bent, meandering and dilated bronchial artery with vascular hyperplasia in multiple locations. The patient was diagnosed as having primary racemose haemangioma of the bronchial artery. Using a microcatheter, TorconNB (5 Fr) and Progreat (2.7 Fr), selective gelfoam embolization of the descending branch of the right bronchial artery was performed using the double catheter method. This approach would allow effective treatment of the haemorrhage and avoid spinal cord injury.     

Selective embolization therapy for intrarenal artery stenosis causing renovascular hypertension: Efficacy and follow‐up renal imaging

We report the case of a young woman treated with selective renal embolization for renovascular hypertension caused by intrarenal artery stenosis and show follow‐up imaging of the treated kidney. An 18‐year‐old woman had renin‐dependent hypertension with intrarenal artery stenosis caused by fibromuscular dysplasia. A middle branch artery was nearly occluded, resulting in segmental renal ischemia with excessive renin secretion. Because our angioplasty attempt for revascularization failed as a result of technical difficulty, we performed selective embolization of the diseased vessel by anhydrous ethanol. The embolization promptly ameliorated hyperreninemia and resistant hypertension without deterioration of renal function. Findings from magnetic resonance imaging showed disappearance of the blood flow in the embolized area corresponding to the ischemic lesion that had been revealed by diffusion‐weighted imaging. Thus, selective embolization can be effective in treating renovascular hypertension by intrarenal stenosis for which angioplasty is not feasible. Additionally, renal magnetic resonance imaging is useful for evaluating the causative ischemic lesion and embolized area.     

Management of a renal artery aneurysm with coil embolization

We describe a case of a 51-year-old female who was incidentally noted to have a renal artery aneurysm on computed tomography (CT). The aneurysm was not seen on an abdominal CT performed 4 years prior, so the patient underwent successful percutaneous coil embolization. The indications for repair of such aneurysms are unknown, and there are a myriad of surgical and percutaneous management options. Because of the increase in abdominal imaging, the incidence of renal artery aneurysms is likely to rise. We describe the case and review the literature surrounding the epidemiology, outcome and management of renal artery aneurysms.