医用X-TH胶栓塞支气管动脉治疗大咯血

本文报道应用X-TH胶栓塞支气管动脉治疗大咯血患者11例。10例在支气管动脉栓塞后立即止血。所有患者无严重并发症。9例随访4～19个月未见复发。2例栓塞后8～14个月复发,但咯血程度明显减轻。说明X-TH胶对严重咯血患者为一有效栓塞剂。     

Transcatheter Coil Embolization of Splenic Artery Aneurysm

The purpose of this study was to evaluate clinical results and technical problems of transcatheter coil embolization for splenic artery aneurysm. Subjects were 16 patients (8 men, 8 women; age range, 40-80 years) who underwent transcatheter embolization for splenic artery aneurysm (14 true aneurysms, 2 false aneurysms) at one of our hospitals during the period January 1997 through July 2005. Two aneurysms (12.5%) were diagnosed at the time of rupture. Multiple splenic aneurysms were found in seven patients. Aneurysms were classified by site as proximal (or strictly ostial) (n = 3), middle (n = 3), or hilar (n = 10). The indication for transcatheter arterial embolization was a false or true aneurysm 20 mm in diameter. Embolic materials were fibered coils and interlocking detachable coils. Embolization was performed by the isolation technique, the packing technique, or both. Technically, all aneurysms were devascularized without severe complications. Embolized aneurysms were 6–40 mm in diameter (mean, 25 mm). Overall, the primary technical success rate was 88% (14 of 16 patients). In the remaining 2 patients (12.5%), partial recanalization occurred, and re-embolization was performed. The secondary technical success rate was 100%. Seven (44%) of the 16 study patients suffered partial splenic infarction. Intrasplenic branching originating from the aneurysm was observed in five patients. We conclude that transcatheter coil embolization should be the initial treatment of choice for splenic artery aneurysm.     

Bronchial Artery Embolization in the Management of Pulmonary Parenchymal Endometriosis with Hemoptysis

Pulmonary parenchymal endometriosis is extremely rare and usually manifests itself with a recurrent hemoptysis associated with the menstrual cycle. The therapies proposed for women with endometriosis consist of medical treatments and surgery. Bronchial artery embolization has become a well-established and minimally invasive treatment modality for hemoptysis, and to the best of our knowledge, it has not been reported in pulmonary endometriosis. We report a case of pulmonary parenchymal endometriosis treated with embolotheraphy for hemoptysis.     

Renal and Splenic Micro-Infarctions Following Bronchial Artery Embolization with Tris-Acryl Microspheres

A bronchial artery embolization (BAE) is an important therapeutic method used to control acute and chronic hemoptysis. We report a case of multiple micro-infarcts involving both the kidneys and spleen, following a BAE with 500-700 µm crossed-linked tris-acryl microspheres (Embospheres) in a patient with bronchial artery pulmonary vein shunts. The superior penetration characteristics of the microspheres may have resulted in the greater tendency to cross the bronchial artery pulmonary vein shunts, which subsequently caused the systemic infarcts in our patient. We propose the use of larger sized microspheres (700-900 µm), which may aid in avoiding this complication.     

Bronchial Artery Embolization for Life-Threatening Hemoptysis Using Tris-Acryl Microspheres: Short-Term Result

A prospective study of 70 patients with life-threatening hemoptysis who had bronchial and systemic artery embolization with tris-acryl linked microspheres was performed over 15 months. The procedure was technically successful in 90% of patients and at 24 hr after the procedure (87%). Recurrent hemoptysis occurred in 13% of patients within the first week. Chest pain was experienced following embolization in 7% of patients. The mortality was 10% due to the inclusion of patients with pulmonary metastases. Bronchial artery embolization using microspheres is an effective and well-tolerated treatment for patients with life-threatening hemoptysis who are not surgical candidates.     

Cryptogenic Hemoptysis: Effectiveness of Bronchial Artery Embolization Using N-Butyl Cyanoacrylate

Purpose

To describe angiographic findings and assess safety and effectiveness of bronchial artery embolization (BAE) with N-butyl cyanoacrylate (NBCA) in patients with cryptogenic hemoptysis (CH).

Internal Iliac Artery Embolization during an Endovascular Aneurysm Repair with Detachable Interlock Microcoils

Objective

The purpose of this study was to evaluate the effectiveness of detachable interlock microcoils for an embolization of the internal iliac artery during an endovascular aneurysm repair (EVAR).

Materials and Methods

A retrospective review was conducted on 40 patients with aortic aneurysms, who had undergone an EVAR between January 2010 and March 2012. Among them, 16 patients were referred for embolization of the internal iliac artery for the prevention of type II endoleaks. Among 16 patients, 13 patients underwent embolization using detachable interlock microcoils during an EVAR. Computed tomographic angiographies and clinical examinations were performed during the follow-up period. Technical success, clinical outcome, and complications were reviewed.

Results

Internal iliac artery embolizations using detachable interlock microcoils were technically successful in all 13 patients, with no occurrence of procedure-related complications. Follow-up imaging was accomplished in the 13 cases. In all cases, type II endoleak was not observed with computed tomographic angiography during the median follow-up of 3 months (range, 1-27 months) and the median clinical follow-up of 12 months (range, 1-27 months). Two of 13 (15%) patients had symptoms of buttock pain, and one patient died due to underlying stomach cancer. No significant clinical symptoms such as bowel ischemia were observed.

Conclusion

Internal iliac artery embolization during an EVAR using detachable interlock microcoils to prevent type II endoleaks appears safe and effective, although this should be further proven in a larger population.     

经导管组织黏合剂结合弹簧圈栓塞脾动脉瘤

目的 探讨采用组织黏合剂NBCA结合弹簧圈经导管栓塞脾动脉瘤的可行性及安全性.方法 3例脾动脉瘤患者,2例位于脾动脉主干,1例位于脾动脉分支.均先经导管置入弹簧圈栓塞载瘤动脉的远端,再以NBCA与碘化油混合物栓塞载瘤动脉的近端包括瘤体.术后采用CT增强扫描随访4~20个月.结果 3例脾动脉瘤均成功栓塞,未出现严重并发症...     

支气管动脉栓塞治疗肺大咯血

目的　探讨支气管动脉栓塞治疗大咯血的方法及疗效。方法　对 36例大咯血或长期反复咯血的病人用明胶海绵颗粒栓塞支气管动脉。 36例病人中 ,单侧 31例 ,双侧 5例。肺癌 1 7例 ,支气管扩张 8例 ,肺结核 1 1例。先行支气管动脉造影 ,确定出血血管后 ,用明胶海绵颗粒栓塞 ,直到支气管动脉闭塞为止。结果　即刻止血 31例 ,出血完全控制。 5例咯血明显减少 ,内科治疗后咯血完全停止。随访 3月～ 5年 ,再出血 2例。结论　支气管动脉栓塞是治疗大咯血的有效方法 ,效果确切 ,止血迅速     

合并支气管动脉-肺循环瘘大咯血的介入治疗

目的 探讨大咯血患者合并支气管动脉-肺循环瘘介入栓塞治疗策略及临床疗效. 资料与方法 66例大咯血患者经DSA检查显示20例合并支气管动脉-肺循环瘘,采用长效栓塞剂PVA和丝线对靶血管进行栓塞治疗,部分辅以明胶海绵颗粒(条). 结果 16例1周内咯血消失,4例首次治疗无效者均为病变广泛分流量大或主干血管细小扭曲,1例病变血管栓塞不全,3例1～3天复发再次造影显示瘘口完全或部分再通,栓塞后2例仍咯血改行手术治疗.术后5个月及11个月复发各1例,首次治疗有效率80%,1年内复发率26.3%. 结论 介入栓塞治疗合并支气管动脉-肺循环瘘的大咯血安全、有效,但主干血管细小扭曲及病变广泛分流量大者瘘口易早期再通复发咯血.     

支气管动脉栓塞治疗咯血短期疗效影响因素分析

目的：分析影响支气管动脉栓塞（BAE）治疗咯血短期疗效的风险因素。方法：支气管扩张或肺结核伴咯血的患者104例,行BAE介入手术。以短期疗效为因变量,年龄、性别、病因、病变是否累及胸膜、栓塞剂种类为自变量,进行Logistic回归分析,确定影响BAE短期疗效的风险因素。结果：78例患者被成功治疗,BAE的有效率是75%。年龄、病变是否累及胸膜是影响BAE治疗咯血短期疗效的风险因素。结论：支气管动脉和支气管外的体循环动脉充分栓塞是BAE成功的关键,术前评价患者年龄、胸膜受累的程度,有助于预测术后疗效。     

支气管动脉栓塞术治疗非肿瘤性大咯血

目的探讨支气管动脉栓塞术对非肿瘤性大咯血的治疗效果。方法46例患者术前均经影像检查明确诊断,术中先行胸主动脉造影,再选择支气管动脉或肋间动脉造影确认出血动脉,经导管送入真丝线段及明胶海绵(GS)栓塞。结果45例支气管动脉栓塞成功,1例栓塞失败。术中肺咯血即刻停止39例,6例肺咯血量明显减少,有5例术后复发。即刻止血率84.8%,有效率97.8%,复发率10.9%。结论支气管动脉栓塞术是治疗非肿瘤性大咯血的有效手段。     

应用微导管同轴导管系统行超选择性支气管动脉栓塞治疗大咯血

目的 探讨经微导管同轴导系统使用丝线微屑行超选择性支气管动脉栓塞,以达到安全有效的治疗大咯血的目的。材料与方法 36例大咯血患者（女8例,男28例,年龄21-76岁,平均38.5岁。咯血量300ml/24h)均采用经微导管同轴导管系统行超选择性支气管动脉栓塞,栓塞剂为丝线微屑和/或明胶海绵微屑,全部病例随访6-18个月。结果 即刻止血31例,咯血明显减少4例,有效率97%（35/36）,1例无法止血。无严重并发症（主要是脊髓损伤）发生。结论 经微导管同轴导管系统使用丝线微屑进行超选择性支气管动脉栓塞治疗大咯血是安全有效的治疗方法。     

Bronchial Artery and Systemic Artery Embolization in the Management of Primary Lung Cancer Patients with Hemoptysis

Purpose To assess the safety and effectiveness of arterial embolization in lung cancer patients with hemoptysis. Methods Nineteen primary lung cancer patients with hemoptysis underwent bronchial artery and systemic artery embolization from April 2002 to March 2005. There were 17 men and 2 women, with a mean age of 59 years. Histologic analysis revealed squamous cell carcinoma in 10 patients and poorly differentiated adenocarcinoma in 9 patients. The amount of hemoptysis was bleeding of 25–50 ml within 24 hr in 8 patients, recurrent blood-tinged sputum in 6, and bleeding of 100 ml or more per 24 hr in 5. Embolization was done with a superselective technique using a microcatheter and polyvinyl alcohol particles to occlude the affected vessels. Results Arterial embolization was technically successful in all patients and clinically successful in 15 patients (79%). The average number of arteries embolized was 1.2. Bronchial arteriography revealed staining (all patients), dilatation of the artery or hypervascularity (10 patients), and bronchopulmonary shunt (6 patients). The recurrence rate was 33% (5/15) and 11 patients were alive with a mean follow-up time of 148 days (30–349 days). Conclusion Arterial embolotherapy for hemoptysis in patients with primary lung cancer is an effective, safe therapeutic modality despite the fact the vascular changes are subtle on angiography.     

支气管动脉灌注、栓塞并发高位截瘫的有关问题探讨

目的 探讨肺癌支气管动脉灌注、栓塞术后并发高位截瘫的原因、预防及治疗措施。资料与方法采用支气管动脉灌注、栓塞治疗中晚期肺癌350例，其中发生高位截瘫3例(0．86％)。结果 经及时扩张血管、溶栓及应用神经营养药物治疗，2例病情逐渐减轻，15天后恢复，l例无明显改善。结论 支气管动脉灌注、栓塞治疗肺癌的严重并发症是高位截瘫，及时扩张血管、溶栓及神经营养治疗是其关键。     

Transcatheter Coil Embolization of an Aneurysm of the Pancreatico-duodenal Artery with Occluded Celiac Trunk

We report on a case of a wide-necked aneurysm of the pancreatico-duodenal artery with occlusion of the celiac trunk in an asymptomatic patient. The aneurysm was considered to be at high risk of rupture. Successful embolization after interdisciplinary consultation was followed with color-coded duplex ultrasound (CCDS) demonstrating significant flow reduction. Three weeks later CCDS and angiography demonstrated exclusion of the aneurysm and a patent arterial supply of the liver and spleen fed by superior mesenteric artery (SMA) collaterals. The patient has done well so far, without major adverse clinical events or evidence for tissue necrosis of the liver, pancreas or spleen. Discussion of the case and review of the literature indicate that transcatheter embolization is the therapy of choice even in complicated cases.     

支气管动脉CT血管造影

支气管动脉起始、分布、走行等解剖变异较大,正常支气管动脉管径细小,疾病状态下支气管动脉发生解剖学重塑,并可与肺循环、肺外体循环等发生交通吻合.16层CT血管造影可以清晰显示支气管动脉的三维形态学特征,解释各种生理和病理状态.     

Bronchial Artery Embolization for Hemoptysis in Primary Lung Cancer: A Retrospective Review of 84 Patients

Purpose

To evaluate the safety and efficacy of bronchial artery embolization (BAE) in patients with primary lung cancer-related hemoptysis and to identify factors associated with hemoptysis-free survival.