血管内介入诊疗技术在脑动静脉畸形中的应用

目的　探讨血管内介入诊疗技术在脑动静脉畸形诊疗中的价值。方法　回顾性分析 98例脑动静脉畸形的血管内介入诊疗资料。结果　DSA能明确诊断 ,显示供血动脉、畸形血管团及引流静脉的情况。 5 2例栓塞治疗的技术成功率为 1 0 0 %,单纯真丝线段栓塞 36例 ,真丝线段和α-氰基丙烯酸正丁酯 (NBCA)联合栓塞 1 6例。栓塞程度 :畸形血管团完全消失者 1 2例 ,畸形血管团减少 75 %以上者 2 1例 ,畸形血管团减少在 5 0 %～ 75 %者 1 1例 ,畸形血管团缩小不足 5 0 %者 8例。结论　DSA检查是脑动静脉畸形合理而可靠的诊断方法 ,有利于估计其预后并制订治疗方案 ,血管内栓塞治疗是其安全有效的治疗手段。     

Arterial perfusion disorders of the hand in 9 patients with arteriovenous fistula for hemodialysis]

OBJECTIVE: To describe the treatment of hand ischaemia as a complication of arteriovenous fistulas, which have been used for haemodialysis vascular access. DESIGN: Retrospective. METHODS: In 1990-1998 there were in the University Hospital Maastricht, (AZM), the Netherlands, 9 patients with hand ischaemia as a complication of arteriovenous fistulas for haemodialysis. Five of these originated from the AZM, where in the same period 341 fistulas had been created. Data were collected from archives about the treatment in the 9 patients and its results. RESULTS: The patients were 7 women and 2 men, with a mean age of 61 years (range: 35-73). Four patients had diabetes mellitus. All patients had a high-flow AV fistula (mean flow: 1556 ml/min) at the level of the elbow. Surgical revision to diminish access flow volume was carried out in 2 patients, while fistula closure with creation of a new AV fistula was performed in 7 patients. Because of persistent ischaemia in 2 patients the access site was closed. Finger amputation was necessary in 3 patients. CONCLUSION: Of all patients with new vascular accesses 1.5% developed symptomatic ischaemic complications. Two out of 9 AV fistulas could be preserved after surgical correction and in 3 patients finger amputations were carried out because of irreversible necrosis.     

Superselective embolization of intrarenal arteriovenous shunt

A case of a successful catheter-embolization of an arteriovenosus fistula in the left kidney is reported. Following this procedure the massive hematuria requiring repeated transfusions previously is stopped.     

Role of neuronavigation in the resection of intracranial arteriovenous malformations

AIM: The aim of this study was to investigate the effect of neuronavigation on the following parameters: "skin incision", "craniotomy", "intraoperative anatomical orientation", "dissection guiding", "localization of the pathological formation", "assessment of the degree of resection" and "duration of surgical procedure" in the resection of intracranial arteriovenous malformations (AVMs) and to specify the indications for application of neuronavigation in the surgical treatment of AVMs. METHODS: Five neuronavigation-assisted resections of intracranial AVMs were performed between March 2003 and December 2005 at the Clinic of Neurosurgery of St. I. Rilsky University Hospital, Medical University, Sofia. The female/male ratio in the series was 2:3 (40%:60%). The patients' mean age was 28.2 +/- 18.27 (range 10 to 56) years. The study was prospective in design. Patients were examined and followed in a standardized manner. RESULTS: Arteriovenous malformations were totally removed in all 5 cases of neuronavigation-assisted resections. We did not observe any morbidity or mortality associated with the method. Neuronavigation allowed precise localization and individual design of the skin incision and craniotomy. Neuronavigation facilitated the surgeon during intraoperative anatomical orientation. Dissection guiding, localization of the formation and assessment of the degree of resection were assessed as markedly useful. This resulted in reduced duration of surgery compared to conventional neurosurgery. CONCLUSIONS: In AVMs resection neuronavigation optimizes surgical approach by visualizing the relationship ofAVMs to the skull and various critical anatomical structures. Deep vessel components and nidus margins, especially in the vicinity of the ventricles can be identified precisely. Neuronavigation can improve the early post-operative results in cerebral AVMs reducing operating time and blood loss.     

Clinical and physiological aspects of pulmonary arteriovenous malformations

In view of the high morbidity and mortality associated with unrecognized or untreated pulmonary arteriovenous malformations it is essential that a provisional diagnosis is followed by definitive investigation and prompt intervention. Careful physiological monitoring, including measurement of the right-to-left shunt, is required.     

子宫动静脉畸形的诊断和治疗进展

<正>动静脉畸形(arteriovenous malformations,AVMs)是由于血管连接异常引起大量的或者不规则出血而危及生命,可发生在全身各脏器。而子宫AVMs是指子宫的动脉与静脉之间形成的异常交通,可导致反复顽固的阴道出血,严重时可危及生命。子宫AVMs比较罕见,患病率目前未知,国外文献中目前只有约100例的报道~([1])。由于多普勒超声、计算机断层扫描(computed tomography,CT)及核磁共振成像(magnetic resonance imaging,MRI)等影像学手段的日益普及,报告的病例呈上升趋势。宫腔操作一般用于处理异常出血,可能会导     

Percutaneous embolization of hemorrhaging renal arteriovenous fistula]

A 67 year old male patient with macroscopic hematuria was treated by percutaneous intraarterial embolization with Gianturco-coil (Cook). The patient had a percutaneous stone removal from the left kidney two weeks before the bleeding. The emergency angiography showed an arteriovenous shunt in the left kidney. A superselective embolization was performed. There was no bleeding on the control angiography. The embolization was performed without complication.     

Liquid embolization for arteriovenous malformation with temporary balloon occlusion of another feeders

A case of frontal arteriovenous malformation, embolized using a new balloon catheter technique, was reported. During liquid embolization of the main feeder from anterior cerebral artery, middle cerebral artery was temporary occluded with another balloon catheter, to decrease blood flow from branches of middle cerebral artery. About 90% of the AVM could be obliterated by this technique.     

Eight cases of intracranial arteriovenous malformations treated by conventional radiation therapy

We conducted radiotherapy in 8 cases of intracranial arteriovenous malformation that had difficult embolectomy and other surgery from 1983 to October, 1988. The results in 6 cases of dural arteriovenous malformation at the cavernous sinus were "marked effect" in 4 cases, "relapse" in 1 case, and "no effect" in 1 case. One case of dural arteriovenous malformation at the sigmoid venous sinus demonstrated only slight irradiation effect. No irradiation effect was observed in 1 case of cerebral arteriovenous malformation.     

栓塞后早期显微手术切除治疗脑动静脉畸形的体会

目的 探讨脑动静脉畸形的治疗方法和疗效.方法 回顾性分析13例脑动静脉畸形患者栓塞后早期显微手术切除治疗的临床资料.S-M分级：Ⅲ级3例,Ⅳ级6例,Ⅴ级4例.畸形血管团最长径2.6～ 11.8（6.8± 1.6） cm.均接受栓塞后早期（≤3 d）显微外科手术治疗,以格拉斯哥预后评分（GOS）评价疗效.结果 4例术后无症状加重;2例症状改善;7例出现相应部位的定位神经功能障碍,其中感觉障碍1例,单肢轻偏瘫2例,偏盲1例,失语1例,四肢瘫痪1例,癫痫1例,无死亡.术后GOS 5分6例,4分4例,3分2例,2分1例.术后血管造影示全切除8例,近全切除4例,部分切除1例.结论 栓塞后早期显微手术切除是脑动静脉畸形有效的治疗方法.     

Stereotactic radiosurgery with adjusted linear accelerator for cerebral arteriovenous malformations: preliminary results in the Netherlands]

OBJECTIVE: To assess the effects of stereotactic radiosurgery of a cerebral arteriovenous malformation (AVM). DESIGN: Prospective. METHOD: In November 1991-December 1995 linear acceleration radiosurgery was performed on 29 patients for their 30 cerebral AVMs in the University Hospital Vrije Universiteit, Amsterdam, the Netherlands. There were 15 females and 14 males with a mean age of 37.1 years (range: 13-58). Generally one isocentre was used and 15 Gy was given to the margins of the AVM at the 80% isodose. The mean target volume was 2.4 ml (range; 0.5-8.2). After 6 months, one year and thereafter every year, neurological and MRI-controls took place, in the outpatient ward. Angiography was performed after an average of 35 months (range: 24-70) to check if the AVM had obliterated. RESULTS: Angiographic post-treatment results were available in 27 patients and MRI information in one. Angiographic obliteration occurred in 20 patients (71%). No permanent radiation-induced neurological deficit was seen, nor did any hemorrhage occur during the interval between irradiation and obliteration.