急性胰腺炎假性动脉瘤的CT诊断和栓塞治疗

目的评价急性胰腺炎伴假性动脉瘤的CT诊断和经导管栓塞治疗的价值。方法对18例急性胰腺炎伴假性动脉瘤患者进行腹部动脉造影和经导管栓塞治疗，回顾性分析其CT、血管造影和临床资料，观察假性动脉瘤的部位及止血效果。结果18例患者CT平扫显示腹腔局限或弥漫性高密度积液，增强扫描显示假性动脉瘤，破裂处可见造影剂外溢。血管造影显示假性动脉瘤22个，其中20个有活动性出血征象，均采用弹簧圈成功栓塞，18个假性动脉瘤一次成功止血。结论CT检查可发现急性胰腺炎伴假性动脉瘤，经导管栓塞治疗是有效和安全的方法。     

彩色多普勒超声对假性动脉瘤的诊治价值

总结29例假性动脉瘤的彩色多普勒超声资料,并与手术、造影及超声引导下压迫治疗后进行对比分析.结果 29例彩超诊断的假性动脉瘤均经手术、动脉造影及超声引导下压迫治疗证实,其定性符合率为100%,判断动脉来源正确率93%(27/29).经超声引导压迫治疗成功率88%(15/17).认为彩色多普勒超声对假性动脉瘤具有重要诊断价值,为临床选择手术或压迫治疗提供参考.     

结节性多动脉炎致腹腔血肿4例

回顾性分析4例结节性多动脉炎(PAN)导致腹腔血肿患者的临床资料, 所有4例患者均因为CT发现腹腔血肿, 并通过数字减影血管造影显示PAN特征表现:多发动脉瘤、动脉多发狭窄、串珠状改变、血管截断征等;并结合患者的乙型肝炎、高血压病史、肾功能受损、神经痛等;确诊为PAN致腹腔分支动脉瘤破裂导致腹腔血肿。患者经选择性动脉栓塞介入治疗, 配合内科治疗均取得良好临床效果。本研究认为PAN患者部分以腹腔血肿来诊;介入栓塞治疗是此类患者的首选治疗。栓塞术前CT判断靶血管, 介入选择性栓塞配合内科对症处理可以取得较好的临床疗效。     

超声引导下预注射生理盐水及注射凝血酶治疗上肢动脉假性动脉瘤

目的探讨超声引导下预注射生理盐水及注射凝血酶治疗上肢动脉假性动脉瘤的疗效。方法选择2006年2月～2007年5月住我院行冠状动脉介入诊疗后并发的5例上肢动脉假性动脉瘤患者进行瘤腔内凝血酶注射治疗,并对其疗效进行分析。结果 5例患者均即刻治疗成功,未见明显并发症。随访14～30天无复发。结论超声引导下预注射生理盐水及注射凝血酶能精确定位针头位置,避免远段动脉栓塞的严重并发症发生,是一种安全、有效、快速的治疗上肢动脉假性动脉瘤的首选方法。     

介入栓塞治疗肺动脉假性动脉瘤伴大咯血的临床疗效分析

目的 探讨体肺双途径栓塞治疗肺动脉假性动脉瘤(pulmonary artery pseudoaneurysms,PAPs)伴大咯血的临床疗效及安全性.方法 回顾性分析2016年1月至2018年2月海南医学院第二附属医院收治的经CT血管造影(CT angiography,CTA)/数字减影血管造影(digital subtractive angiography,DSA)证实为PAPs伴大咯血的15例肺结核患者的临床资料.记录相关影像学表现、介入治疗技术和临床止血成功情况,随访1年内咯血复发状况.结果 共发现15个PAPs,肺CTA发现14个,血管造影发现1个.术中仅支气管动脉造影发现6个,仅肺动脉造影发现4个,支气管动脉及肺动脉造影均发现4个,1个体肺动脉造影均未发现.介入栓塞术后咯血有效止血14例,1例患者术中因大咯血窒息导致死亡.患者随访12个月,其中1例患者术后2周复发大咯血行外科切除术;1例咯血术后3个月余复发,再次行介入栓塞后咯血停止.结论 经体肺双途径栓塞治疗肺结核患者PAPs伴大咯血的临床疗效确切,方法可行,但仍有一定风险.     

蛛网膜下腔出血早期病因诊断和治疗

目的对蛛网膜下腔出血患者进行早期病因诊断，并针对病因进行治疗。方法对138例经临床确诊的蛛网膜下腔出血患者，进行诊断性全脑血管造影，根据造影结果，分为开颅夹闭动脉瘤组(60例)、血管内治疗组(56例)和内科保守治疗组(22例)。结果138例患者中60例接受手术夹闭治疗。56例血管内介入治疗，22例内科保守治疗；4例死亡，134例痊愈。结论颅内动脉瘤是蛛网膜下腔出血最常见的病因，动脉瘤多位于前、后交通动脉，常为单发的中小动脉瘤。手术夹闭或介入栓塞治疗，疗效确切。     

胆囊十二指肠瘘继发胆囊假性动脉瘤致失血性休克:病例报告

背景胆囊十二指肠瘘(cholecystoduodenal fistula, CDF)继发胆囊假性动脉瘤致失血性休克病例罕见,而往往临床结果严重,致死率高.病例概述一例中年男性患者发生不可控制的上消化道大出血,后续通过相关诊疗手段诊断为CDF继发胆囊假性动脉瘤破裂导致失血性休克,经积极治疗后抢救成功.结论 CDF多继发于胆囊结石,早期诊断困难,联合应用B超、计算机体层摄影、磁共振胰胆管造影及胃镜、经内镜逆行胰胆管造影可提高早期诊断率,合并胆囊假性动脉瘤致出血时可行数字减影血管造影定位并栓塞止血.手术治疗原则是切除胆囊、取净结石、切断瘘管并修补瘘口.     

颅脑损伤性颅内假性动脉瘤的诊断及治疗(附17例报告)

目的 探讨颅脑损伤性颅内假性动脉瘤的诊断及治疗方法.方法 对17例颅脑损伤性颅内假性动脉瘤患者的临床资料作顾性分析.结果 颅脑损伤后一段时间突发头痛15例(其中11例CT检查提示自发性蛛网膜下腔出血5例、颅内血肿6例),反复癫痫大发作2例,反复大量鼻衄2例.均经全脑血管造影确诊为颅内假性动脉瘤.假性动脉瘤分别位于颈内动脉海绵窦段6例、颈内动脉床突上段4例、颈内动脉床突旁段3例、颈内动脉A2段4例.分别采用弹簧进行栓塞、支架辅助弹簧圈栓塞、覆膜支架、开颅切除载瘤动脉的方法治疗.术后随访6～12个月,1例死亡,2例偏瘫,余14痊愈无并发症.结论 全脑血管造影是确诊颅脑损伤性颅内假性动脉瘤的重要手段;血管内栓塞和(或)开颅手术,尤其前者,是治疗颅内假性动脉瘤安全有效的方法.     

内脏假性动脉瘤的血管内栓塞治疗42例

目的:分析内脏假性动脉瘤(visceral artery pseudoaneurysms,VAPA)的临床特征与介入栓塞的应用价值.方法:回顾性总结42例内脏假性动脉瘤患者的临床特征和介入栓塞治疗经验.术后均通过复查增强计算机断层扫描(computed tomography,CT)或CT血管造影(CT angiography,CTA)进行随访.结果:38例患者VAPA成功栓塞,介入手术成功率为90.4%(38/42);其中1例术后28 d死于多系统器官衰竭,术后30 d内死亡率是2.4%(1/42).4例再次出血患者需行二次介入手术,术后出血均停止.术后1-12 mo共17例肿瘤患者死亡,死亡率为40.5%,死因分别为原发病进展(n=8),多器官动能衰竭(n=7),心梗(n=1)和感染性休克(n=1).4例需脾栓塞的患者出现栓塞后综合征.在随访期间,所有患者均无肝功能的变化和肠缺血,VAPA均未复发.结论:介入栓塞VAPA创伤小、成功率高,尤其适用于外科手术禁忌的患者.     

根治性胃癌切除术后内脏假性动脉瘤破裂出血15例诊治研究

目的研究探讨根治性胃癌切除术后内脏假性动脉瘤破裂出血的临床表现和特征,总结相关治疗经验。方法本次研究选取本院2012年1月~2015年3月进行了根治性根治性胃癌切除术,且术后出现内脏假性动脉瘤破裂出血的患者15例为研究对象。对这15例患者的临床特征进行详细分析,回顾性分析临床治疗经验。结果所有患者中,经过手术治疗和经动脉导管栓塞治疗的成功止血的患者共计12例,治疗无效死亡3例。对治疗成功的患者随访2年,其中有10例患者随访期间无动脉瘤复发和再出血,另有2例患者在随访期间死亡。结论对于此类患者,要尽早采用造影进行确诊,然后积极的采取治疗措施。临床显示经动脉导管栓塞治疗此类患者具有较好的临床效果。     

Case of a bleeding pseudoaneurysm of the middle colic artery complicating acute pancreatitis

Massive bleeding from a pseudoaneurysm is rare, but it can be a life-threatening complication in patients with acute pancreatitis. We present a case in which massive bleeding from a pseudoneurysm in the middle colic artery complicating acute pancreatitis was successfully treated by transcatheter embolization and by continuous regional arterial infusion of a protease inhibitor and antibiotic. We also discuss the clinical features, diagnosis and treatment of such lesions in light of the literature. We emphasize the value of computed tomography in the early diagnosis of mesenteric hematoma in cases of acute pancreatitis and the value of angiography for control of bleeding from the complicating pseudoaneurysm.     

Hemorrhagic pseudocyst and pseudocyst with pseudoaneurysm successfully treated by pancreatectomy: report of three cases

Hemorrhagic pseudoaneurysm of pancreatic pseudocyst is one of the serious complications of acute pancreatitis. We successfully treated three patients who had hemorrhagic pseudocyst and pseudocyst with pseudoaneurysm by pancreatectomy. Case 1 was 43-year-old Japanese man who had had several episodes of acute pancreatitis and was diagnosed with hemorrhagic pseudoaneurysm of the splenic artery in a pseudocyst in the pancreatic tail, shown on computed tomography (CT) and angiography. Transarterial embolization (TAE) yielded hemostasis of the pseudoaneurysm, but rebleeding occurred 2 weeks after the TAE. Distal pancreatectomy and splenectomy was successfully performed. Case 2 was a 64-year-old Japanese man who presented to us with several attacks of acute pancreatitis. Imagings showed bleeding pseudoaneurysm of the transverse pancreatic artery in a pseudocyst in the pancreatic body. Because of marked stenosis in the proximal portion of the transverse pancreatic artery, TAE was unsuccessful. Distal pancreatectomy and splenectomy was performed successfully. Case 3 was a 40-year-old Japanese woman who had a history of abdominal trauma. Imagings showed bleeding pseudoaneurysm of the splenic artery in a posttraumatic pseudocyst in the pancreas. TAE of the pseudoaneurysm was unsuccessful because of the proximity of the pseudoaneurysm and the splenic artery. Distal pancreatectomy and splenectomy was successfully performed and her postoperative outcome was satisfactory. Whenever interventional radiology (IVR) is not indicated or has failed, aggressive and immediate surgical intervention should be considered for early and definitive recovery in these patients.     

Transcatheter embolization as primary treatment for visceral pseudoaneurysms in pancreatitis: clinical outcome and imaging follow up.

BACKGROUND: Pseudoaneurysm formation is an uncommon but fatal complication of pancreatitis. The morbidity and mortality associated with surgical management is high. Transcatheter embolization is a definitive minimally invasive form of treatment. AIM: To review our experience with transcatheter embolization as a therapeutic modality for pseudoaneurysms complicating pancreatitis. METHODS: This retrospective analysis included data of 30 patients (mean age 37 years, range 25 to 65; 24 men) with visceral pseudoaneurysms secondary to pancreatitis, who underwent diagnostic angiography and transcatheter embolization, during the period March 1993 to February 2003. RESULTS: In 29 patients the pseudoaneurysms were successfully isolated from the circulation, and hemostasis was achieved. Re-bleeding occurred in one patient, for which re-embolization was done. Twenty-nine patients improved clinically. One patient in whom the pseudoaneurysm was successfully embolized died due to septicemic shock. CONCLUSION: Endovascular embolization is a safe and effective non-surgical modality of treatment for visceral pseudoaneurysms complicating pancreatitis.     

Percutaneous thrombin embolization of a ruptured peripancreatic pseudoaneurysm

Peripancreatic pseudoaneurysm formation is a recognized complication of pancreatitis. When associated with an acute episode of pancreatitis, surgical treatment is often difficult due to the inflammatory process that surrounds the pseudoaneurysm. In the stable patient, transcatheter embolization is the treatment of choice of this complication. However, this is not always technically feasible, as the aneurysm may be supplied by small inaccessible branch vessels. Recently, percutaneous thrombin injection has been described as a possible alternative for pseudoaneurysms. This is generally performed under computed tomography guidance in stable patients with non-ruptured pseudoaneurysms. We describe an acutely ruptured peripancreatic pseudoaneurysm in a critically ill patient, in whom percutaneous thrombin injection under computed tomography guidance resulted in immediate stabilization and cure of the pseudoaneurysm.     

Clinical features of pseudoaneurysms complicating pancreatitis: single center experience and review of Korean literature]

BACKGROUND/AIMS: Pseudoaneurysm is a life-threatening complication of chronic or acute pancreatitis. This study was undertaken to evaluate the clinical features of pseudoaneurysm complicating pancreatitis. METHODS: We reviewed the medical records of 7 patients diagnosed as pseudoaneurysms with chronic pancreatitis in Korea University Guro and Anam Hospital from January 1995 to March 2006 and analyzed their demographics, clinical courses and outcomes. RESULTS: All patients were men and mean age was 54.6 years (range, 43-67 years). All the cases occurred in the setting of chronic alcoholic pancreatitis complicated by pseudocyst. Abdominal pain was the unique initial clinical symptom in 5 cases, hematemesis in 1 case, and simultaneous abdominal pain with hematemesis in 1 case. Bleeding into pseudocyst developed in 5 cases, flowing into duodenum through pancreatic duct in 1 case and rupture into the descending colon in 1 case. Mean duration between onset of symptom and diagnosis of pseudoaneurysm was 7.8 days (range, 1-23 days). Six cases were diagnosed by abdominal computed tomography disclosing characteristic finding of focal high density area in the pseudocyst. Pulsed doppler abdominal sonography was performed before computed tomography in 3 cases and results were negative in 2 cases. Transcatheter arterial embolizations were initially performed in 6 cases, and there was no recurrent bleeding except one case of splenic infarction. Distal pancreatectomy was initially performed in 1 case. CONCLUSIONS: Pseudoaneurysms complicating chronic pancreatitis shows various clinical features. Transcatheter arterial embolization can be recommended as a primary therapeutic modality.     

Diagnosis and endoscopic endonasal management of nontraumatic pseudoaneurysms of the cranial base

Background

Nontraumatic pseudoaneurysms of the cranial base are rare and present unique diagnostic and treatment dilemmas compared with both true aneurysms and pseudoaneurysms outside of the cranial base. There is a dearth of knowledge regarding the management of these complicated lesions.

Methods

Nontraumatic pseudoaneurysms of the cranial base internal carotid artery (ICA) were retrospectively identified at the University of Pittsburgh Medical Center through a key word search of cranial base cases from 2010 to 2017.

Results

Three cases were identified, demonstrating pseudoaneurysms of the cavernous and petrous ICA. Each patient underwent diagnostic work‐up with computed tomography, magnetic resonance imaging, and angiography, followed by endovascular occlusion and endoscopic endonasal surgery, which resulted in relief of presenting complaints and ablation of the pseudoaneurysm.

Conclusion

Symptomatic cranial base pseudoaneurysms should undergo treatment to obliterate the aneurysm and relieve the mass effect. First, formal angiography is necessary for accurate diagnosis and treatment planning. Next, endovascular occlusion is performed, with a preference for coiling or endoluminal reconstruction with a flow diverter. Last, endoscopic intervention follows in cases where: (1) decompression of vital structures is indicated; (2) diagnosis of the pseudoaneurysm cannot be definitively confirmed with angiography; or (3) the etiology of the confirmed pseudoaneurysm requires further investigation.

     

Endovascular treatment of gastroduodenal artery aneurysm

Gastroduodenal artery aneurysms are rare. Common causes include blunt trauma, pancreatitis, infection, autoimmune disorders, vascular intervention and surgery. We report 2 patients with gastroduodenal artery aneurysms, the first being an idiopathic true aneurysm and the next, a pseudoaneurysm resulting from pancreatitis. Diagnoses were made by computed tomography scans with successful embolization of both patients. Treatment of gastroduodenal artery aneurysms includes surgery, endovascular techniques or observation. Embolization is a feasible option for gastroduodenal artery aneurysms and pseudoaneurysms.     

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.     

Thrombosis of splenic artery pseudoaneurysm complicating pancreatitis.

The natural history of pseudoaneurysms complicating pancreatitis is unknown. A patient with chronic pancreatitis is described in whom thrombosis of a splenic artery pseudoaneurysm occurred. Early diagnosis and radical treatment of a bleeding pseudoaneurysm are mandatory. When elective treatment is considered, however, contrast enhanced computed tomography may be useful just before surgery as thrombosis may occur.     

The treatment of a simple pancreatic pseudoaneurysm or one associated with hemosuccus pancreaticus]

When a permanent communication occurs between an artery and a pancreatic pseudocyst, the pseudocyst becomes a pseudoaneurysm. Pancreatic pseudoaneurysms are primarily found in patients with alcoholic chronic pancreatitis. Fistulization of a pseudoaneurysm into the main pancreatic duct results in ductal hemorrhage. From 1980 to 1990, 43 cases of pancreatic pseudoaneurysm and 24 cases of ductal hemorrhage (15 of these secondary to pancreatic pseudoaneurysm) have been published. Pancreatectomy, ligation of the affected vessel (alone or in combination with a drainage procedure), or intraarterial embolization have all been used to treat pancreatic pseudoaneurysms. We herein describe two patients with alcoholic chronic pancreatitis and pancreatic pseudoaneurysm; one patient presented with ductal hemorrhage. The inferior pancreatico-duodenal artery was the affected vessel. Both patients were treated with suture-ligation; an internal drainage was added to the patient presenting with ductal hemorrhage.