超选择载瘤动脉栓塞术治疗腹腔非主干动脉假性动脉瘤破裂出血

目的探讨超选择载瘤动脉栓塞术治疗腹腔非主干动脉假性动脉瘤破裂出血的临床疗效及安全性。 方法回顾性分析2017年2月至2020年6月采用超选择栓塞治疗的腹腔内非主干动脉假性动脉瘤破裂出血患者临床资料，分析止血效果及并发症，总结治疗经验。 结果21例患者均使用微导管超选择至假性动脉瘤的载瘤动脉以微弹簧圈行栓塞治疗，其中10例联合明胶海绵颗粒进行巩固栓塞。21例患者中18例患者栓塞假性动脉瘤的载瘤动脉近端血管，3例患者于假性动脉瘤载瘤动脉的远端和近端行"三明治"栓塞，技术成功率100%（21/21），初次栓塞的临床成功率81.0%（17/21），二次栓塞后总体临床成功率为85.7%（18/21）。4例患者术后有一过性轻度腹痛，1例患者发生脾脏部分梗死，予对症抗炎治疗后好转。 结论超选择载瘤动脉栓塞术治疗腹腔非主干动脉假性动脉瘤破裂出血成功率高、可重复性强，是一种可供选择的治疗方法。合理选择栓塞材料可达到较好的止血效果并降低并发症的发生。     

Embolization for acute small-bowel bleeding from the collateral artery of the superior mesenteric left deep circumflex iliac artery associated with narrowing of the bilateral common external iliac arteries

We present a case of acute small-bowel bleeding from the collateral artery of the superior mesenteric-left deep circumflex iliac artery that was successfully managed by transarterial coil embolization.     

Delayed hemorrhage following transcatheter arterial embolization for blunt hepatic injury

This is the first report of delayed hemorrhage (21 days after the injury) following transcatheter arterial embolization (TAE) for severe hepatic injury. The first TAE was performed about 2 h after admission on a 21-year-old man with severe blunt hepatic injury. Three bilomas were detected by cholescintigraphy 19 days later. The patient's status had been eventless until the occurrence of a delayed hemorrhage with hypotension. Angiography was repeated and three pseudoaneurysms were detected TAE, pseudoaneourysms disappeared and hemorrhage could be controlled. Intrahepatic biloma may be related to pseudoaneurysms and delayed hemorrhage in severe hepatic injury.     

Hepatic artery embolization of experimental hepatic tumors with absolute ethanol

Hepatic artery embolization with absolute ethanol (HAEE) was done in rats and rabbits with experimentally induced liver tumors, and its effects on liver parenchyma and tumors were analyzed microscopically in comparison with those of controls. HAEE with 0.1 ml in rats brought massive tumor necrosis and minimal damage to liver parenchyma. But HAEE with 0.15 ml in rabbits induced moderate to massive necrosis of liver parenchyma with minimal to moderate tumor necrosis. Damage to the intrahepatic bile ductules was also seen in both animals. Many problems should be resolved before clinical use.     

Percutaneous thrombin embolization of a pancreatico-duodenal artery pseudoaneurysm after failing of the endovascular treatment

Pancreatico-duodenal artery (PDA) pseudoaneurysms are rare vascular conditions with high mortality rates after rupture and they are frequently secondary to pancreatitis, surgery, trauma or infection. Due to the high risk of rupture and bleeding, it is mandatory to treat all pseudoaneurysms, regardless of their size or symptomatology. First option of treatment is open surgical repair, but it has high mortality rate, especially in hemodynamically unstable patients. In the recent years, percutaneous ultrasonography (US)- or computed tomography-guided thrombin injection was proposed as an alternative method for treating visceral aneurysms and pseudoaneurysms, but few reports described this therapy in case of peri-pancreatic pseudoaneurysms. We present a rare case of pseudoaneurysm of the PDA in a patient with no previous history of pancreatitis nor major surgery but with an occlusive lesion of the celiac axis. To the best of our knowledge this is the first reported case of PDA pseudoaneurysm successfully treated in emergency by single transabdominal US-guided injection of thrombin after failed attempts of percutaneous catheterization of the feeding vessel of the pseudoaneurysm.     

肝海绵状血管瘤动脉栓塞术后胆管损伤原因分析与对策

目的：探讨肝动脉栓塞术治疗肝血管瘤后胆管损伤的原因与对策。方法：46例肝海绵状血管瘤患者,用5F导管超选择插管至肝血管瘤的供血支,经导管注入平阳霉素-碘油乳剂（PLE）进行栓塞。结果：超选择性插管成功率100%,术后共有2例出现胆管损伤并发症,总发生率4.4%,经对症等处理后分别于3、8个月后肝功能恢复正常。结论：明确CHL血供类型、控制碘油乳剂用量及高水平的操作技术可以减少和避免胆管损伤并发症的发生。     

Embolization of the hepatic falciform artery to prevent supraumbilical skin rash during transcatheter arterial chemoembolization for hepatocellular carcinoma

A dilated hepatic falciform artery (HFA) arising from the left hepatic artery was demonstrated on arteriography prior to chemoembolization of an unresectable hepatocellular carcinoma (HCC) located predominantly in the left lobe of the liver. The HFA was occluded by microcoils to prevent a possible toxic supraumbilical skin rash following chemoembolization of the HCC via the left hepatic artery. There were no postprocedure complications. We consider this procedure useful for improving the safety of chemoembolization.     

Successful transcatheter arterial embolization for pseudoaneurysm of the deep femoral artery in a patient with presumptive ACTA2-related vasculopathy

ACTA2-related vasculopathy is an autosomal dominant genetic disorder characterized by aortic aneurysms and dissection, and limb artery lesions are rare. We report a case of transcatheter arterial embolization for a pseudoaneurysm of a deep femoral artery in a patient with presumptive ACTA2-related vasculopathy. A 58-year-old woman was presumed to have an ACTA2 mutation based on her history of aortic diseases and family history of ACTA2 mutations. During follow-up, contrast-enhanced computed tomography for aortic diseases revealed occlusion and vessel wall abnormalities of the bilateral deep femoral arteries. Two weeks later, she complained of acute right inguinal pain without any triggering factors, and contrast-enhanced computed tomography revealed a pseudoaneurysm of the right deep femoral artery. Vascular fragility due to ACTA2 mutation was believed to be the cause of the pseudoaneurysm. Transcatheter arterial embolization was successfully performed and no rebleeding occurred during 1.5 years after the transcatheter arterial embolization.     

金属内支架胆管引流与放射治疗结合治疗肝外胆管癌

目的回顾性分析局部晚期肝外胆管癌金属内支架胆管引流结合放射治疗的疗效。方法1996年1月至2002年9月收治17例不能手术切除肝外胆管癌患者,先接受金属支架行胆管引流,3例治疗1周内失访,其余14例单纯近距离放疗(近距离照射组,n=5)或外照射(外照射组,n=9,其中包括2例近距离 外照射)。Ir192高剂量率近距离放疗在金属内支架置入当天或隔天治疗。外照射的中位剂量48Gy(14～66Gy),2Gy/次。结果经金属内支架置入结合放疗后,10例黄疸患者中8例黄疸消褪,近距离和外照射对缓解黄疸症状无显著差别。全组中位生存期12个月(5～35个月),1、2年生存率分别为40.8%和8.2%。近距离治疗组与体外照射组的中位生存期、1、2年生存率分别为8个月、40.0%、20.2%和12个月、40.0%、13.3%(χ2=1.10,P=0.29)。结论金属内支架胆管引流结合放射治疗可以显著缓解黄疸症状,高剂量放射治疗可以进一步提高长期生存。     

Successful embolization of a renal artery pseudoaneurysm with arteriovenous fistula and extravasations using Onyx after partial nephrectomy for renal cell carcinoma

Partial nephrectomy can be associated with vascular complications. Computed tomography (CT) with CT angiography is ideal for noninvasive imaging of this process. The treatment of choice is selective embolization. Successful transcatheter embolization of right renal subsegmental artery pseudoaneurysm with arteriovenous fistula and extravasations using Onyx was performed in a 66-year-old woman with macrohematuria 12 days after partial nephrectomy for renal cell carcinoma.     

CT引导下弯针穿刺乙醇消融术治疗肝动脉化疗栓塞后残存肝癌

原发性肝癌起病隐匿,临床发现时多已为中晚期,失去了手术切除的机会,非手术治疗肝癌成为研究热点。肝动脉化疗栓塞（transarterial chemoembolization,TACE）和无水乙醇瘤内注射（percutaneous ethanol injection,PEI）是目前临床最为广泛应用的非手术疗法,疗效明显。然而,实践表明单独应用均有一定的局限性,联合应用可提高疗效,因而肝癌综合治疗成为趋势。我们针对TACE治疗后残存活性肝癌病灶,采用CT引导下弯针穿刺无水乙醇消融治疗,取得了满意疗效,现将结果报道如下。     

Extended intraarterial cisplatin infusion for treatment of gynecologic cancer after alteration of intrapelvic blood flow and implantation of a vascular access device

Purpose: Twenty-two patients with advanced gynecologic cancer underwent extended intraarterial cisplatin infusion after alteration of the intrapelvic blood flow and implantation of a vascular access device (VAD). Methods: To maximize concentrations of cisplatin at the target lesion, the superior and inferior gluteal arteries were embolized with steel coils. The tip of the catheter was inserted into the internal iliac artery; the opposite end of the catheter was connected to the VAD. Results: Intensive radioisotope accumulation was demonstrated in the anterior division of the pelvis, seen by scintigraphy performed with technetium 99m macroaggregated albumin via the VAD. Local perfusion in the tumor was well seen by ultrasonographic angiography with CO₂ microbubbles via the VAD. Continuous consecutive infusion of cisplatin at a rate of 12.5 mg/day via the VAD minimized the toxicity. The overall response rate was 73%. Radical surgery was possible in 16 of the 22 patients after this intraarterial infusion. Conclusion: This method was useful for treating advanced gynecologic cancer without significant toxicity. Received: 0/00/000 Accepted: 0/00/00