彩色多普勒对医源性假性动脉瘤的诊断及引导压迫治疗价值

目的探讨彩色多普勒超声对医源性假性动脉瘤的诊断价值及在其引导下压迫治疗的方法及疗效。方法35例动脉穿刺术后穿刺部位发现肿块,并经彩色多普勒超声确诊为假性动脉瘤,随后在超声引导下压迫治疗。结果35例假性动脉瘤中31例在超声引导下压迫20～60min,修复成功;4例压迫40min,仍可见分流,放弃治疗。治疗过程中未出现并发症。结论彩色多普勒是医源性假性动脉瘤诊断准确实用的方法;超声引导下压迫修复假性动脉瘤操作简便、安全高效,是治疗方法的首选。     

外周血管假性动脉瘤的介入治疗

目的 介绍不同类型外周血管假性动脉瘤的不同治疗方法。方法 13例假性动脉瘤，3例终末型动脉的假性动脉瘤采用明胶海绵进行栓塞，其中1例巨大血肿伴假性动脉瘤经栓塞后作手术血肿清除加动脉结扎术进行治疗；1例支干型假性动脉瘤采用两端弹簧圈栓塞；9例主干性外周动脉假性动脉瘤采用覆膜支架隔绝术。结果 所有假瘤均完全闭合，置人覆膜支架者其远端动脉搏动均正常。1例患者由于其他特殊原因，致穿刺部位又出现假性动脉瘤。其他患者无明显并发症。结论 采用介入技术可使各种外周血管假性动脉瘤得到有效治疗，多数情况下可以代替外科治疗。     

17例四肢创伤性假性动脉瘤的外科治疗

目的 探讨不同类型四肢创伤性假性动脉瘤的外科治疗方法。方法 回顾分析1990年1月—2006年4月收治的创伤性假性动脉瘤17例。，其中14例手术治疗，血肿清除后分别行血管侧壁缝合术7例，端端吻合术1例，人工血管移植术1例，自体血管移植术1例，近远端血管结扎4例。采用非手术治疗局部加压包扎3例。结果 本组患者无死亡或肢体坏死，治疗后临床症状消失。患者平均随访13.2个月，患肢功能良好。 结论 四肢创伤性假性动脉瘤诊断明确后，应根据不同类型采取不同的治疗方法。     

超声引导下压迫修复股动脉假性动脉瘤

目的：探讨彩色多普勒超声引导下压迫修复股动脉穿刺术后假性动脉瘤的疗效。方法：股动脉穿刺术后假性动脉瘤24例。在彩色多普勒血流显像的监测下，利用探头行持续加压修复。结果：23例假性动脉瘤一次性压迫修复成功，治愈率96％。结论：彩色多普勒超声监测下加压治疗股动脉穿刺术后假性动脉瘤是一种简单、有效、经济、安全的方法，有较高的临床价值。     

彩色多普勒超声对假性动脉瘤的诊断价值

目的：探讨彩色多普勒超声对假性动脉瘤的诊断价值。方法：回顾性分析12例假性动脉瘤的大小、形态、二维、彩色及频谱多普勒超声图像特点,并比较超声诊断与手术及CTA结果。结果：12例均行超声检查且经CTA证实,超声诊断准确率为100%,其中外科手术治疗4例,保守加压治疗6例,超声引导下注入抗凝剂2例。彩色多普勒超声检查于病变段血管旁见一搏动性囊性或囊实性包块,周边为薄厚不均的血肿,彩色多普勒超声囊性部分内可见红蓝相间的涡流血流信号,其旁可见一破口与相邻动脉相通,频谱多普勒于动脉破口处测及双期双向血流信号为其特征性表现。结论：彩色多普勒超声对假性动脉瘤的诊断具有特征性,且准确率高、无创伤性,是假性动脉瘤首选的检查方法。     

股动脉假性动脉瘤彩色多普勒超声诊断及监测分析

目的：探讨彩色多普勒超声对股动脉假性动脉瘤诊断及监测疗效的价值。方法：经股动脉穿刺行冠状动脉介入术后发生股动脉假性动脉瘤37例,包括冠状动脉造影术后30例,冠状动脉支架置入术后7例,所有患者都用高频彩色多普勒超声诊断。在超声监控下,探头垂直加压压迫假性动脉瘤通道或破口直至内无血流通过。压迫失败后在超声引导下瘤腔内注射凝血酶,24h、1个月后复查超声。结果：37例中有27例一次性压迫2h后假性动脉瘤瘤腔闭合;6例一次压迫2h后超声显示瘤腔明显变小,动脉与瘤腔仍有少许血流相通,再次压迫2h后瘤腔闭合;4例压迫2次失败后在超声引导下瘤腔内注射凝血酶,其中3例取得较满意的效果,1例经验不足失败。结论：彩色多普勒超声诊断股动脉假性动脉瘤准确、简便、无创。且可在超声引导下行安全无创治疗。     

超声引导在经桡动脉冠脉介入术后前臂血肿治疗中的应用

目的探讨超声引导下改良加压包扎在经桡动脉冠脉介入(TRI)术后前臂血肿治疗中的价值。方法将126例TRI术后出现非穿刺点前臂血肿的患者根据治疗方法的差异分为超声指导下改良加压包扎组和单纯改良加压包扎组,比较其临床情况和治疗效果。结果两组临床情况匹配。与单纯改良加压包扎组比较,超声指导下改良加压包扎组在一次性止血成功率(96.8%vs.85.7%,P=0.027)和张力性水疱发生率(4.8%vs.17.5%,P=0.023)均有显著的优势,并且没有病例需进一步行CTA检查(0 vs.6.3%,P=0.127)或介入止血(0 vs.3.2%,P=0.476)。两组均没有病例发生骨筋膜室综合征。结论超声指导下改良加压包扎操作简单经济,效果显著,可作为治疗TRI术后非穿刺点前臂血肿的首选方法。     

超声引导下凝血酶注射治疗假性动脉瘤疗效观察

假性动脉瘤是局部动脉壁全层破损,引起局限性出血及动脉旁血肿形成。血肿中心呈液化状态,周围组织机化吸收形成纤维组织外层．其内衬以一层上皮细胞。医源性假性动脉瘤是指经皮穿刺血管后,     

超声引导下血管腔内缝合术在医源性股动脉假性动脉瘤的临床应用

目的 探讨医源性股动脉假性动脉瘤在超声引导下行血管腔内缝合术的临床应用价值。方法 2020年3月至2021年9月曲靖市第一人民医院因介入手术穿刺股动脉后导致假性动脉瘤患者12例。在超声引导下使用Perclose ProGlide缝合器缝合医源性股动脉破口,分析患者的基线特征、假性动脉瘤特征,比较术前术后股动脉直径。结果 12例患者瘤体最大直径为（42.32±13.81） mm,瘤颈直径为（2.40±0.49） mm,瘤颈长度为（5.89±2.37） mm,瘤颈内最大流速为（256.67±42.62） cm/s。11例患者成功经超声引导下血管腔内缝合股动脉破口,1例患者成功穿刺股动脉破口后导丝无法选择入股动脉,行解剖股动脉修补术。11例患者术前、术后24 h、术后1个月股动脉直径比较差异无统计学意义（P=0.474）,患者术后无复发、瘤体破裂及股动脉狭窄。结论 医源性股动脉假性动脉瘤在超声引导下血管腔内缝合术可行、安全、有效,值得临床推广应用。     

四肢主要动脉创伤性假性动脉瘤的外科治疗

目的 总结四肢主要动脉创伤性假性动脉瘤的外科治疗和疗效。方法 1998～2004年收治四肢主要动脉创伤性假性动脉瘤31例，均采用手术治疗，其中直接修补6例，端-端吻合5例，大隐静脉移植16例。人造血管移植3例，血管结扎1例。获随访23例，随访时间6个月～5年（平均18个月）。结果 28例一期治愈出院，其余3例术后血管闭塞二期再行自体静脉移植治愈。随访未见假性动脉瘤复发和肢体缺血症状。结论 四肢主要血管创伤性假性动脉瘤应强调尽早手术治疗；术中阻断动脉远近端血流是手术成败的关键；损伤血管直接或间接重建具有较好的治疗效果。     

The management of peripheral arterial aneurysms using percutaneous injection of fibrin adhesive.

Most peripheral arterial aneurysms are pseudoaneurysms and are iatrogenic or related to trauma. They can be treated by several techniques that can be performed by the radiologist, negating the need for surgery. Ultrasound guided compression repair is usually the treatment of choice, but is not always successful. The number of available treatment options reflects the varying site and nature of pseudoaneurysms and perhaps the lack of a consistently reliable method. We have successfully treated 13 patients with peripheral aneurysms (11 femoral, 1 popliteal and 1 posterior tibial aneurysm) using a commercial fibrin tissue adhesive. The method involves percutaneous injection of the adhesive components using ultrasound and screening control, following successful occlusion of the aneurysm neck by angioplasty balloon.     

Percutaneous Ablation of Peripheral Pseudoaneurysms Using Thrombin: A Simple and Effective Solution

Purpose: To assess the effectiveness of tissue adhesive and thrombin solution in the percutaneous ablation of peripheral artery pseudoaneurysms. Methods: Twenty-five pseudoaneurysms were treated over a 33-month period; all had failed ultrasound-guided compression. Tissue adhesive or thrombin solution was injected percutaneously, with needle tip position and changes within the aneurysm confirmed with color Doppler ultrasound. In 19 cases we utilized a protective balloon inflated across the aneurysm neck prior to the injection of tissue adhesive and in six cases used thrombin injection alone. Seven patients were anticoagulated. Patients were followed up after the procedure. Results: All 25 aneurysms were treated successfully; two patients required a return visit and there were no immediate complications or peripheral emboli detected. One patient developed a contralateral pseudoaneurysm. Conclusions: The percutaneous injection of pseudoaneurysms is a safe, atraumatic, and effective treatment for femoral artery pseudoaneurysms in the peripheral circulation. There are significant advantages over ultrasound-guided compression or surgical repair.     

医源性尿道直肠损伤

目的 探讨医源性尿道直肠损伤的治疗方法。方法 分析13例医源性尿道直肠损伤的临床资料，治疗包括：一期尿道直肠修补4例；耻骨上膀胱造瘘＋乙状结肠造瘘8例；单纯耻骨上膀胱造瘘1例；二期经会阴或联合肛直肠睡行尿道直肠瘘修补6例。结果 一期尿道直肠修补4例均未发生尿道直肠瘘，3例治愈，1例发生尿道狭窄。9例尿道直肠瘘经粪尿分流，3例（33％）尿道直肠瘘愈合，其中2例发生尿道狭窄。6例经会阴或联合肛直肠径路行瘘修补或瘘修补＋尿道吻合术，均治愈。结论 尿道直肠损伤后应尽早发现并作一期缝合修补，可避免尿道直肠瘘发生；粪尿分流可使部分瘘闭合；经会阴联合肛直肠径路行尿道直肠瘘修补具有损伤小、暴露好等优点，特别适于合并后尿道狭窄的患者。     

WOLTER钢板治疗陈旧性肩锁关节脱位

目的 探讨治疗陈旧性肩锁关节脱位的新方法。方法 应用Wolter肩锁钩钢板治疗陈旧性肩锁关节脱位5例,术后随访5～22个月,平均13个月。结果 所有病例均解剖复位,术后4周～3个月肩关节外观及功能恢复满意,随访未见钢板断裂和松动的表现,2例去除内固定后未见脱位复发。疗效优4例,良1例。结论 Wolter肩锁钩钢板治疗陈旧性肩锁关节脱位是一种较好的手术方法。     

Closing the loop: the role of audit in reducing groin complications associated with coronary angiography

BACKGROUND: Local vascular complications of coronary angiography present a significant but often ignored clinical problem. This audit was performed because of a perception that the number of false aneurysms requiring surgical repair was increasing. STANDARD: An acceptable incidence of false aneurysm was derived from series in which ultrasound examinations were only performed if a false aneurysm was suspected (0.06-0.7%). The success rate of ultrasound (US) directed compression ranged from 50% to 93%. ASSESSMENT OF LOCAL PRACTICE: Data were retrieved from cardiology, radiology and vascular surgery databases in addition to case note review. The incidence of false aneurysm was significantly higher than that of historical control groups from the authors' institution (1.5% vs 0.5%, P < 0.05) and in published series used as the standard. The success rate of US directed compression was also poor compared to historical controls (25% vs 55%,P < 0.05) and previously published series. IMPLEMENTATION OF CHANGE: Recommended changes included the use of fluoroscopy to identify the femoral head to avoid low puncture, strict adherence to the existing protocol for sheath removal and the use of adequate analgesia and sedation prior to attempted US compression. REASSESSMENT OF LOCAL PRACTICE: The incidence of false aneurysm fell to that of the standard set by previous studies. US directed compression was successful in 100%. CONCLUSIONS: The audit was successful in that the incidence of false aneurysm fell and the success rate of US directed compression increased, but the specific reasons for the improvements remain unclear.     

颅外颈内动脉损伤诊治方法的探讨

目的　探讨颅外颈内动脉损伤的早期诊断和治疗方法。方法　 1982～ 2 0 0 2年共收治颅外颈内动脉损伤 8例 ,其中颈内动脉破裂并休克 3例 ,并发栓塞 4例 ,假性动脉瘤 2例。行颈内动脉修补 2例 ,颈内动脉 -颈外动脉端端吻合 1例 ,颅内 -外动脉搭桥 2例 ,手术取栓 1例 ,瘤体切除加动脉修补 2例。结果无死亡 ,4例出现偏瘫失语等神经系统并发症 ,1例经颅内 -外动脉搭桥后完全康复 ,1例经取栓术后改善 ,2例经保守治疗症状轻度改善。余 4例除 1例遗有颈内动脉假性动脉瘤外 ,均痊愈。结论　早期诊断及颈内动脉修复重建是降低死亡率 ,减少神经系统并发症的关键     

Imaging of iatrogenic aneurysms and AV fistulas of the lower extremity with IV-DSA and sonography

Using IV-DSA and ultrasound (real-time), we demonstrated 13 false aneurysms, 2 isolated AV fistulas, 7 aneurysms of profunda patches and 8 aneurysms of bypass grafts. Aneurysms and AV fistulas developed in all 30 patients after different diagnostic and therapeutic procedures. Ultrasound showed partial thromboses of the aneurysms, perivascular changes and compression of the femoral vein, that could not be demonstrated by IV-DSA. On the other hand IV-DSA allowed the recognition of important findings not shown sonographically, such as AV fistulas and stenoses of the proximal and distal arteries. These findings were relevant for further surgical approach. It is therefore concluded that in patients with suspected aneurysm of the femoral or popliteal artery, IV-DSA and ultrasound should be used in conjunction rather than as alternative methods.     

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     

MR angiography and surgery for unruptured familial intracranial aneurysms in persons with a family history of cerebral aneurysms.

OBJECTIVE: We used MR angiography to determine prevalence of unruptured familial intracranial aneurysms in a prepaid medical care program. We compared surgical outcomes and the cost of treating unruptured versus ruptured aneurysms. We compared the cost of MR angiography with the cost of screening mammography and with the cost of surgically treating a ruptured aneurysm. SUBJECTS AND METHODS: During a 30-month period, we performed MR angiography to show cerebral aneurysms in 63 surgical candidates who had one or more first-degree relatives with an aneurysm. Unruptured aneurysms seen on MR angiography were evaluated by digital subtraction angiography (DSA) and treated surgically. RESULTS: MR angiography showed nine unruptured aneurysms in six patients. Eight aneurysms were seen on MR angiography and nine were seen on DSA. Seven unruptured aneurysms were treated surgically. The mean treatment cost was 50% lower for an unruptured aneurysm than that for a ruptured aneurysm. No patient surgically treated for an unruptured aneurysm required rehabilitation, unlike 25% of patients with ruptured aneurysms. The annual total cost of MR angiography was equivalent to 2.9% of the annual cost of screening mammography. The annual cost of MR angiography equaled half the cost of treating one patient after aneurysm rupture. CONCLUSION: MR angiography showed a 9.5% prevalence of unruptured aneurysms among persons who had one or more first-degree relatives with a cerebral aneurysm. DSA confirmed 88% of aneurysms found on MR angiography. Persons with unruptured aneurysms had better treatment outcomes at lower cost than did patients treated for aneurysm rupture. The annual MR angiography cost was low compared with the cost of screening mammography and with the cost of treating one patient with aneurysm rupture.     

Percutaneous treatment of pseudoaneurysms using fibrin adhesive

This study was performed to assess the safety and efficacy of treatment of iatrogenic pseudoaneurysms with fibrin adhesive. 28 patients with iatrogenic pseudoaneurysms were treated. The first 20 patients had either at least one previously unsuccessful treatment of ultrasound guided compression repair (UGCR), a contraindication to UGCR or could not tolerate the procedure. Diagnosis was confirmed on ultrasound and angiography and a balloon inflated across the neck of the pseudoaneurysm. Fibrin adhesive was injected under ultrasound control directly into the pseudoaneurysm sac. The balloon was deflated after 15 min and check ultrasound and angiography performed, with a further ultrasound at 24 h. The subsequent eight patients underwent embolisation as the first line treatment without use of a protective balloon. 16 of the first 20 patients (80%) and all of the subsequent 8 patients had successful embolisation of the pseudoaneurysm after a single treatment. Two pseudoaneurysms failed to thrombose despite two treatments in one case and three treatments in the other, and both required surgery. The only significant complication was the development of local cellulitis in one patient. In conclusion, embolisation of iatrogenic aneurysms with fibrin adhesive is a safe and effective treatment. It should be considered as an alternative to surgery and UGCR.