前颅凹底的硬膜动静脉畸形

报告2例前颅凹底硬膜动静脉畸形。例1为男性,56岁。在饮含酒精饮料时突然昏迷。普通CT检查正常,增强CT 检查显示前颅凹近颅底有明显的圆点状增强。选择性右颈内动脉造影显示右眼动脉粗大,经右前筛动脉供血于前颅凹底硬膜动静脉畸形。引流静脉近段呈动脉瘤样扩张并经皮层静脉引流入上矢状窦。选择性右颈外动脉造影同样显示动静脉畸形和引流静脉。左颈总动脉造影显示粗大眼动脉和由筛前动脉供血于动静脉畸形。眶下动脉同样供血于动静脉畸形。例2为男性,64岁。早晨于床上发现昏迷。右颈动脉造影发现右额区巨大     

血管内栓塞治疗颅颈交界区硬脊膜动静脉瘘1例

硬脊膜动静脉瘘（spinal dural arteriovenous fistula,SDAVF）是临床最为常见的脊髓血管畸形之一,国外报道其发病率占脊髓血管畸形的80％～85％,常发生于胸部中段及腰段,颅颈交界区SDAVF极少见,而咽升动脉供血的颅颈交界区硬脊膜动静脉瘘介入栓塞治疗国内外文献报道不多。2013年3月本院收治1例。     

犬喉自体原位再植的实验研究

作者进行了犬喉自体原位再植的实验研究。结果显示，犬喉的血供主要源于发自颈总动脉的颅甲动脉及喉动脉，血液回流则主要是籍颅喉静脉及喉奇静脉通过舌骨静脉弓汇入颈外静脉。４只犬接受了喉切除及原位再植手术，离体犬喉保留有一侧颅甲动脉及相连的一段颈总动脉、颅喉静脉、喉奇静脉、舌骨静脉弓及相连的一段颈外静脉，通过对颈总动脉和颈外静脉原断端分别进行端－ 端吻合，成功地重建了再植喉的血运     

耳部动静脉畸形供血动脉的血管造影研究

目的研究耳部动静脉畸形的动脉供血情况。方法 2006年4月至2011年6月,对14例耳部动静脉畸形患者行双侧颈外动脉、颈内动脉和椎动脉造影,记录供血动脉的起源及分支,观察耳部动静脉畸形供血动脉及其分布特点。结果 14例耳部动静脉畸形患者共有供血动脉37支,其中耳后动脉14支、颞浅动脉14支,枕动脉7支,对侧颞浅动脉1支、椎动脉1支,未见颈内动脉及其分支向耳部动静脉畸形供血。结论耳部动静脉畸形血供主要来自颈外动脉的耳后动脉、颞浅及枕动脉,对侧颞浅动脉、椎动脉供血少见,少见供血动脉需引起注意。     

伴脑内动静脉畸形的正常大脑血管的脑膜侧枝循环的血管造影功能性方面的考虑

脑膜供血于颅内动静脉畸形并非少见。颈外动脉可经侧枝供血于因近端血管闭塞或因经动静脉畸形使血液分流所导致的功能上缺血而解剖上正常的脑组织,本文报告2例脑膜侧枝供血于动静脉畸形的邻近缺血的脑组织。例1为女性,56岁,CT及动脉造影显示左大脑中动脉供血的动静脉畸形。体检发现左乳突周围可听到与脉搏同期的杂音。再次造影显示巨大的脑膜中动脉前支供血于软膜的动静脉畸形。而其后支经硬膜吻合支供血于大脑中动脉的正常颞顶支。在脑膜中动脉及动静脉畸形闭塞术后,显示大脑中动脉颞后支充盈良好,左乳突区杂音及其它症状消失。例2男性,36岁,右半球动静脉畸形,曾行闭塞术。选择性血管造影显示脑膜中动脉与大脑中动脉远端分支吻合。进一步栓塞大脑     

实时磁共振成像引导下猪脑动脉溶栓治疗的实验研究

目的 探讨实时MR成像引导下治疗猪脑动脉栓塞的可行性.方法 选用10只美国产的雌性小型猪作为实验对象.经皮穿刺股动脉,在实时MR成像的引导下,将3 F主动追踪微导管分别插至双侧咽升动脉内.经3 F微导管注入血栓堵塞咽升动脉,30～60 min后,经3 F微导管注射50万～75万u尿激酶溶栓.动脉增强MRA和冠状位压脂的MR冠状位T1成像评估溶栓治疗效果.结果 MRA证实,猪主要由双侧咽升动脉在颅底形成微血管网供应脑的血供.在实时MR成像引导下,10只猪的双侧咽升动脉经股动脉插管均获得成功,并完全被血栓堵塞.经动脉溶栓治疗后,血管内的血栓被溶解,堵塞的咽升动脉完全再通.结论 在实时MR成像的引导下,进行猪的动脉溶栓治疗可行.     

喉罩通气对颈内静脉与颈总动脉解剖关系的影响

 目的 研究喉罩置入对颈内静脉与颈总动脉解剖关系的影响, 寻找喉罩全身麻醉下, 颈内静脉穿刺适合的入路, 提高穿刺成功率。方法 选择喉罩全身麻醉择期手术患者30例, 应用超声波扫描术, 在胸锁乳突肌三角顶点和锁骨上窝2 cm位置, 头部偏转0°、30°、60°和最大角度, 在喉罩置入前后分别测定双侧颈内静脉与颈总动脉的夹角和动脉重叠率。结果 胸锁乳突肌三角顶点和锁骨上窝2 cm位置, 随患者转头角度的增加, 双侧颈内静脉与颈总动脉的夹角逐渐减小(P<0.05), 动脉重叠率逐渐增高(P<0.05)。胸锁乳突肌三角顶点位置, 喉罩置入后, 与相同转头角度喉罩置入前比较, 动静脉夹角明显减小(P<0.05), 而动脉重叠率明显增高(P<0.05)。锁骨上窝2 cm位置, 喉罩置入对动静脉夹角和动脉重叠率均无明显影响(P>0.05)。结论 转头与喉罩置入充气可改变颈内静脉与颈总动脉解剖关系, 增加穿刺难度, 了解这一变化规律有助于选择适宜的穿刺路径, 降低颈内静脉穿刺时误伤颈总动脉的发生率。
     

动脉数字减影血管造影对脑动静脉畸形出血的预测分析

报告８３例经ＤＳＡ和手术证实的脑动静脉畸形。其中ＣＴ示出血者５８例，占６９．９％。笔者探讨脑动静脉畸形血管造影形态与出血的关系，结果表明下列因素与出血有关：（１）小的脑动静脉畸形；（２）仅有１支引流静脉的；（３）向深部静脉引流的及引流静脉狭窄和并发动脉瘤者。而供血动脉的数目和有颈外动脉参与供血者未见明显关系，笔者还分析了脑动静脉畸形的ＣＴ表现，认为ＣＴ与脑血管造影并用，可为临床提供更详细的资料。     

头颈部外伤所致颈内静脉血栓并肺动脉栓塞的CTA诊断

探讨螺旋CT血管成像(CTA)对颈内静脉血栓并肺动脉栓塞的临床诊断价值.对1例颈部外伤后颈部肿胀的患者行头颈、胸部CT平扫以及CTA和数字减影血管造影(DSA)检查.CTA显示右侧颈内静脉、头臂静脉被血栓充填不显影,上腔静脉、右肺动脉主干及肺段动脉内的充盈缺损,右侧颈外静脉、椎静脉丛、肋间、肩部等静脉侧支循环增多、增粗...     

实时MR成像引导下猪脑动脉导管插管的验研究

目的 探讨实时MR成像引导下在猪脑动脉内进行导管插管的可行性.方法 选用10只美国产的雌性小型猪作为实验对象.经皮穿刺股动脉,在实时MR成像引导下,将3 F主动追踪微导管分别插至双侧咽升动脉内.解剖其主动脉弓、头臂动脉、颈动脉和咽升动脉,用肉眼观察有无穿孔、夹层等损害.结果 MR血管成像证实,猪主要由双侧咽升动脉在颅底形成微血管网供应脑的血供.在实时MR(rtMR)成像引导下,对10只猪舣侧咽升动脉进行插管操作,均操作成功,单次操作费时为4～12 min.所有实验动物的主动脉弓、头臂动脉、颈动脉和咽升动脉的内壁均光滑完整,未发现血管壁损伤.结论 实时MR成像引导下,可以将导管迅速、准确地插至猪脑动脉.     

Head and neck hypervascular lesions: embolization with ethylene vinyl alcohol copolymer--laboratory evaluation in Swine and clinical evaluation in humans.

PURPOSE: (a) To assess in swine long-term (12-month) histopathologic changes, particularly, those related to recanalization and angiotoxicity after endovascular delivery of ethylene vinyl alcohol copolymer (EVAC), and (b) to evaluate initial clinical experience in 18 patients with head and neck tumors and arteriovenous malformations. MATERIALS AND METHODS: Embolization with EVAC was performed in one rete each in five swine. After 12 months, an angiogram was obtained, and the contralateral rete was also embolized (acute). Swine were sacrificed and the retia harvested for pathologic examination. In the clinical study, 18 patients with tumors (n = 14), facial arteriovenous malformations (n = 3), and vertebral arteriovenous fistula (n = 1) underwent therapeutic embolization. The technical aspects of EVAC embolization, percentage of occlusion, and clinical complications were evaluated. RESULTS: Angiographic 12-month follow-up in swine revealed persistent occlusion of the embolized rete or retia. Histologic examination of the same rete showed vascular occlusion and moderate intraluminal foreign body giant cell reaction; the acutely embolized rete showed no endothelial denudation or angionecrosis. Clinical evaluation in patients revealed satisfactory penetration of lesion vasculature with EVAC when the microcatheter was advanced within 2 cm of a lesion or when percutaneous puncture was performed. There were two transient complications: one increase in a preexisting fifth nerve palsy and one increase in preexisting hemiparesis. CONCLUSION: EVAC is a promising liquid embolic material providing long-term occlusion of blood vessels.     

An in vivo arteriovenous malformation model in swine: preliminary feasibility and natural history study.

PURPOSETo assess the feasibility, natural history, and preliminary physiologic validation of creating an in vivo arteriovenous malformation model in swine.METHODSA transorbital puncture technique into the cavernous sinus was used to create an arteriovenous communication between the rostral rete and the cavernous sinus in eight swine. Short-term patency and hemodynamic behavior were assessed clinically and by serial angiography. Acute phase physiologic characterization of four models was also performed, using intravascular pressure and Doppler blood flow velocity measurements.RESULTSLarge arteriovenous shunts between the rostral rete and cavernous sinus were consistently produced, which mimicked the angiographic features of cerebral arteriovenous malformations in humans. Classic changes in intraarterial and intravenous pressures and blood flow velocities were also observed. Early pathophysiologic evolution occurred in two animals, consisting of recruitment of previously unseen collateral vessels. Spontaneous occlusion of the arteriovenous shunt occurred in most animals within 7 days because of a rigorous fibroblastic response.CONCLUSIONSA simple technique for creating an arteriovenous malformation model in swine is now possible and is promising for future studies.     

Laboratory simulations and training in endovascular embolotherapy with a swine arteriovenous malformation model.

We assessed the suitability of a swine experimental arteriovenous malformation model for laboratory simulations and training in endovascular embolotherapy. Embolizations with liquid glue or particles were performed in 10 animals. The parameters of injection (microcatheter position, concentration and volume of embolic agent, injection rate) were deliberately varied to simulate results that may be observed in clinical practice. A range of successful and less desirable therapeutic outcomes or complications was simulated. In one model, intravascular mean blood pressure in the "terminal feeder" rose after "nidus" embolization, consistent with observations in feeders of cerebral arteriovenous malformations. Experience in the technical aspects of embolotherapy was gained by repeated performances using this model. Simplicity of creation, clear angiographic visibility of feeders, a nidus and a draining vein, and hemodynamic similarities with cerebral arteriovenous malformations make this an attractive in vivo experimental model for learning the principles of embolotherapy, testing new embolic agents, and training/gaining experience in embolization techniques.     

An experimental arteriovenous malformation model in swine: anatomic basis and construction technique.

We assessed the feasibility of creating an experimental arteriovenous malformation model in swine by diverting and increasing blood flow through bilateral retia mirabilia. This was achieved by surgical formation of a large right-sided carotid-jugular fistula, in combination with endovascular occlusion of several neck arteries ipsilateral to the fistula. Using this technique, 11 of 13 swine demonstrated an acute-phase angiographic simulation of an arteriovenous malformation. There was rapid circulatory diversion from the left ascending pharyngeal artery ("feeder"), across both retia ("nidus"), and fast retrograde flow into the right ascending pharyngeal and common carotid arteries ("draining vein") toward the fistula. The relevant vascular anatomy of the swine head and neck is outlined, and steps in the construction of this arteriovenous malformation model are detailed.     

Creation of a transrenal arteriovenous dialysis shunt: feasibility study in a swine model.

PURPOSE: To investigate the feasibility of percutaneous renal artery and vein access for the creation of a transrenal arteriovenous hemodialysis graft. MATERIALS AND METHODS: Renal-artery-to-ipsilateral-renal-vein conduits were constructed with use of entirely percutaneous techniques in seven swine. Renal artery and vein access was performed in six animals with use of a retrograde (inside-out) technique and in one animal with use of an antegrade (outside-in) technique. Modified 8-F sheaths were used in the first three animals and Wallgrafts were used in the final four animals to form the arterial and venous limbs of each shunt. The arterial and venous limbs were joined together by a subcutaneous segment of 6-mm reinforced polytetrafluoroethylene (PTFE) in five animals and by external conduits in two animals. Wallgrafts were deployed from the renal artery and vein into the segments of PTFE. The free ends of each conduit were tunneled and joined together to close the arteriovenous circuit. Post-shunt angiography was used in all animals to document successful shunt creation and demonstrate rapid arteriovenous shunting as a determinant of technical feasibility. Two of the seven animals received additional anticoagulation therapy and/or antiplatelet therapy to prevent shunt thrombosis during the follow-up period. The three initial animals were killed within 2 hours of shunt creation, and two of the remaining four animals returned for angiographic follow-up, one on day 2 and one on day 9. All animals underwent a complete necropsy to assess for potential complications including hemorrhage and vascular or bowel injury. RESULTS: Retrograde renal arterial and venous access was successful in all six animals in which it was attempted. Five of six arterial accesses and four of six venous accesses traversed the peritoneum with two arterial accesses and one venous access penetrating a loop of large bowel. Antegrade access was performed and successfully accomplished in the final animal. Brisk arteriovenous shunting was demonstrated on completion angiography in all animals. Graft occlusion was present in the two animals that returned for follow-up and two animals died before follow-up as a result of graft leakage and subsequent hemorrhage. Minimal perinephric and intrarenal hemorrhage was demonstrated at necropsy after shunt insertion in the remaining five animals. Renal infarction was present in all kidneys used for transrenal access. CONCLUSION: The transrenal approach for the creation of a percutaneous arteriovenous shunt is feasible after renal artery and vein access by either the retrograde or antegrade technique. Additional technical refinements of the procedure and the devices used will be necessary before follow-up studies are conducted.     

Transrenal arteriovenous dialysis graft creation: survival and patency in a swine model

PURPOSE: To investigate transrenal arteriovenous graft creation in an animal model and to report survival and patency. MATERIALS AND METHODS: Arteriovenous grafts were created from the renal artery to the renal vein in 10 swine. Renal access was accomplished with a combined percutaneous and transvascular approach. A reinforced 6-mm polytetrafluoroethylene conduit was tunneled between both flank access points, and stent-grafts were deployed from each of the renal origins into the conduit. Clopidogrel (10 mg per kilogram of body weight) was administered intravenously during the procedure, followed by a daily oral dose (75 mg) for up to 2 weeks. Animals were monitored with auscultation and angiography for up to 1 month; necropsy was performed in all animals. RESULTS: Rapid arteriovenous flow at completion angiography was achieved in eight of 10 animals. Shunts were patent in five of six animals that were followed for 1 month. Diffuse pseudointimal hyperplasia was mild in three of six shunts and moderate in two (focal stenoses). Immediate thrombosis occurred in the first two animals when the clopidogrel bolus was administered after stent-graft deployment. These shunts were recanalized mechanically. Shunts were immediately patent in five of the six remaining shunts when the clopidogrel bolus was administered prior to stent-graft deployment. Complications occurred in four of 10 animals, three of which were euthanized within 1 week. The bowel was traversed in two animals, and renal vein laceration occurred during two procedures because of failure of the stent-graft delivery system. CONCLUSION: Transrenal arteriovenous graft creation in swine is technically feasible, and long-term patency is possible with antiplatelet therapy.     

Endovascular treatment of arteriovenous malformations with selective intranidal occlusion by detachable platinum electrodes: technical feasibility in a swine model.

The technical feasibility of selective intranidal endovascular occlusion of experimental arteriovenous malformations with detachable superfine platinum electrodes was assessed in a swine model. The delivery and release of electrodes were performed within normal carotid retia mirabilia, the faster-flowing nidus (bilateral retia) of a carotid-jugular fistula-type model of an arteriovenous malformation, and a small-caliber H-type direct arteriovenous fistula. Controllable atraumatic placement of the electrodes was possible deep within each rete and in the middle of the fistula. The devices were soft and flexible, allowing them to conform to the tight turns and branches of rete vessels. Marked diminution of flow was achieved by release of multiple devices within each rete. Migration of the electrode occurred when detached within the larger-caliber arteriovenous fistula. The main advantages of this technique appear to be the controlled delivery and assured release of an occlusive radiopaque embolic agent within the nidus.     

Liquid 2-poly-hydroxyethyl-methacrylate embolization of experimental arteriovenous malformations: feasibility study

BACKGROUND AND PURPOSE: We investigated the use of 2-poly-hydroxyethyl-methacrylate (2-P-HEMA) as an embolic agent in swine arteriovenous malformations (AVMs). METHODS: In seven mini swine, experimental AVMs were created surgically. The aim of treatment was complete embolization of the nidus compartment filled by the feeding artery, without brain embolization. Six animals received pure liquid 2-P-HEMA, and one, 50% 2-P-HEMA. For radiopacity, liquid 2-P-HEMA was mixed with tungsten powder. Six animals underwent angiographic follow-up within 5-8 mo (mean, 6.5 mo). Evaluation criteria were controllability, procedural reproducibility, and duration of the nidus occlusion. To detect complications, brain MR imaging and CT were performed. Histopathologic studies were performed to prove occlusion and assess histopathologic responses. RESULTS: 2-P-HEMA was easily injected through microcatheters, with a reproducible technique. Because of the radiopacity of the mixture, deep nidus penetration was controlled with fluoroscopy and confirmed with CT and histopathologic examination. In five AVMs embolized with pure 2-P-HEMA, feeder obliteration was long term. One animal had vasospasm during embolization, and complete obliteration of the main feeder was maintained for 3 mo, but partial recanalization developed 2 mo later. One animal receiving pure 2-P-HEMA had an infarction. In the animal embolized with 50% 2-P-HEMA, angiography and CT revealed embolic material in the circle of Willis; the animal died after embolization. No marked inflammatory reaction in the vessel wall or perivascular tissue was observed in the embolized AVMs. CONCLUSION: Experimental AVM embolization with pure 2-P-HEMA, made radiopaque with tungsten, is technically feasible in swine. Because of its properties, 2-P-HEMA has great potential as a therapeutic embolic agent.     

非肿瘤性肾动静脉畸形或瘘节段性肾动脉栓塞治疗

目的　分析非肿瘤性肾动静脉畸形或瘘引起肾出血节段性肾动脉栓塞治疗的方法及疗效 ,探讨栓塞后肾脏再出血的原因及处理措施。方法　 4例肾出血患者 ,其中 2例先天性肾动静脉畸形 (AVM) ,2例肾穿刺后并发肾动静脉瘘 (AVF)。经股动脉插管行肾动脉及其分支造影 ,用明胶海绵、钢丝圈或无水酒精超选择性栓塞病变血管。结果　 4例畸形血管均闭塞 ,出血停止 ,全部病例在栓塞后无严重并发症发生 ;1例先天性AVM病人用钢丝圈及明胶海绵栓塞 8个月后再出血 ,经无水酒精再次栓塞后出血停止 ,随访 9个月无再出血。结论　肾动脉造影是诊断肾脏AVM和AVF的可靠方法 ;节段性肾动脉栓塞术是治疗肾脏AVM和AVF有效、安全的微创性手术 ;少数病例再发出血 ,可能与栓塞剂类型的选择和病变的特点有关 ,需应用永久性栓塞剂或多种栓塞剂联合治疗 ,甚至外科手术处理。     

Simplified technique for percutaneous transrenal arteriovenous dialysis graft creation in a swine model

PURPOSE: To investigate the experimental creation of a percutaneous arteriovenous graft via the renal vessels using a simplified technique and to report on its safety, complications, and 1-month follow-up. MATERIALS AND METHODS: Transrenal arteriovenous grafts were created from the renal artery to the renal vein in six swine. Using a combined transfemoral and percutaneous approach, a 7 mm x 150 mm stent graft was deployed to create a renal vein limb, and a 6 mm x 150 mm stent graft was deployed to form the renal artery limb. The external portion of the arterial limb was telescoped into the venous limb to form one continuous loop and was placed into a subcutaneous pocket. The duration and technical success of the procedure were recorded. Shunt patency was assessed by auscultation and angiography, as well as by necropsy and histopathology. RESULTS: Arteriovenous graft creation was technically successful in all six animals with rapid arteriovenous shunting documented with angiography at completion. The mean procedure duration was 84 minutes (range, 70-130 minutes). Auscultation and angiography revealed that four of the six shunts were occluded at 4 weeks. Moderate (50% to 75%) diffuse in-stent angiographic stenosis was present in the two remaining animals. No technical complications occurred. Midterm complications of localized and gradual concentric stenosis due to mural thrombosis occurred in three animals. Graft infection resulting in late abrupt thrombosis occurred in four animals. CONCLUSIONS: Transrenal arteriovenous graft creation using the simplified technique can be performed safely in swine. Delayed complications including graft infection and in-stent stenosis must be addressed prior to use of the technique in clinical settings.