颈部动静脉瘘合并深静脉高压的影像特征分析

目的分析动静脉瘘(AVF)合并深静脉高压的影像特征旨在提高认识。方法回顾性分析1例颈部AVF致颅内深静脉高压病人的临床资料及影像表现,并复习相关文献。结果CT及MRI表现为深静脉高压征象:①双侧基底节丘脑区及脑室旁、左侧小脑肿胀伴血管源性水肿;②深静脉引流区多发细小迂曲血管影及含铁血黄素沉积。DSA显示左侧颈部AVF,动脉期见左侧颈内静脉-乙状窦-横窦-直窦反流。结论AVF临床及影像表现具有多样性,当颅内静脉引流区出现肿胀伴异常信号、多发迂曲血管影时,应及早行血管检查以明确诊断,DSA是确诊该病的金标准。     

广泛性动静脉畸形介入治疗的临床应用

广泛性动静脉畸形（ＡＶＭ）伴多发动静脉瘘（ＡＶＦ）的治疗文献报道甚少，３例此类患者我们采用经导管介入栓塞＋外科手术的方法：即采取先丝微粒后丝线段、先小后大和分段分期的介入栓塞，以达先栓小的病理血管，防止或减少侧支供血的建立，尔后以线段栓塞较大的病理血管。因ＡＶＭ的侧支供血甚多，丝微粒或丝线段有可能通过瘘口使ＡＶＦ再通，又施以栓后和／或栓塞同时＋手术，切除大的ＡＶＭ团块和切断、结扎ＡＶＦ交通，取得了     

Usefulness of dynamic renal scintigraphy in a patient with renal arteriovenous fistula treated by transcatheter embolization

Tc-99m-DTPA renal scintigraphy was performed before and after transcatheter coil embolization in a patient with renal arteriovenous fistula (AVF). Before embolization, scintigraphy showed a characteristic accumulation pattern compatible with the hemodynamics of an aneurysmal type of AVF in the vascular phase. After embolization, the effects of treatment, such as a change in the split renal function on the treated-side and the disappearance of the shunt flow through the fistula were evident. It was concluded that dynamic renal scintigraphy was very useful for patients with an aneurysmal type of renal AVF scheduled for transcatheter embolization.     

Transcatheter Embolization of a Renal Arteriovenous Fistula Complicated by an Aneurysm of the Feeding Renal Artery

Renal arteriovenous fistula (AVF) is rare. Renal AVF complicated by aneurysm of the feeding artery presents a technical challenge for endovascular treatment. We report a case managed by covered stenting of the renal artery aneurysm, coil embolization of the fistula, and bare stenting of the aorta.     

Transarterial and transvenous embolotherapy of arteriovenous fistulas in the transplanted pancreas

Arteriovenous fistula (AVF) is a rare but well-documented complication of pancreatic allotransplantation. Small, tortuous vessels in the head of the transplanted pancreas may complicate transarterial embolization. The authors recently encountered two women who developed clinical pancreatitis after right pelvic transplant placement with documented AVF in the head of the transplanted pancreas. In the first patient, embolization was successfully performed transarterially. In the second patient, transarterial embolization was not feasible due to the small caliber and extreme tortuosity of the pancreaticoduodenal arcade and transvenous embolic occlusion was successfully performed. Both patients recovered with normalization of enzyme levels and pain reduction.     

超声监测人工动静脉内瘘及其并发症的应用价值

目的探讨彩色多普勒超声监测血液透析动静脉内瘘及其并发症的应用价值。方法选取59例患者进行自体动静脉内瘘血管系统彩色多普勒超声检查,总结15例并发症患者声像图特征及相关临床处理情况。结果 (1)44例动静脉内瘘患者血流通畅,血流量正常,透析充分。(2)15例检测出并发症:5例血栓形成导致通路血管闭塞或重度狭窄;2例内瘘狭窄;1例瘘旁形成血肿导致通路外压性狭窄;2例形成假性动脉瘤;1例形成桡动脉真性动脉瘤;2例回流静脉形成瘤样扩张;2例出现盗血综合征。(3)将并发症分为3种类型。Ⅰ类:内瘘废用,须改建(建立新的血管通路);Ⅱ类:须处理,在原血管通路基础上进行手术修复;Ⅲ类:无需处理,仅需观察。结论彩色多普勒超声监测动静脉内瘘及其并发症有很大临床价值。     

Super-selective transcatheter arterial embolization of a traumatic splenic arteriovenous fistula

We report a 61-year-old woman with arteriovenous fistula (AVF) of a splenic artery caused by traumatic injury, which was successfully occluded by percutaneous transcatheter arterial embolization (TAE). We embolized the AVF with a coaxial system using six microcoils. This case suggests that super-selective TAE for traumatic AVF of a splenic artery is an effective and primary choice of first treatment. The use of a microcatheter and microcoils is an alternative to surgery.     

Transcatheter embolization for huge pulmonary arteriovenous fistula using metallic "spider" and spring embolus--application of hand-made metallic "spider" using partial monorail technique]

We performed transcatheter embolization in two cases with huge pulmonary arteriovenous fistula (AVF) using a metallic "spider" and spring embolus. Conventional spring embolus or detachable balloon could not be used in these cases. Metallic spider was indicated for pulmonary AVF with a feeding artery diameter of more than 16 mm to prevent embolus passing through the AVF. In the first case, we used large handmade metallic spiders of 25 mm in diameter followed by embolization by numerous spring coils. At that time, a partial monorail technique was newly devised to carry the large metallic spider into the feeding artery, otherwise the spider could not pass into a 9F catheter. After embolization, symptoms and PaO2 in arterial blood improved remarkably in both cases. In the second case, a spring coil migrated into the normal pulmonary artery, but no infarction resulted. In conclusion, the metallic spider was very useful for embolization of hugee pulmonary AVF to avoid the embolus passing through and to tangle spring coils together with it. If commercially available "spiders" are too small, ones can be made easily.     

Treatment of slow-flow (type I) perimedullary spinal arteriovenous fistulas with special reference to embolization

Embolization of type I perimedullary spinal arteriovenous fistulas (AVFs) can be difficult, because of tortuosity and the small diameter of the feeder and distal location of the fistula site. The 1.5F flow-directed catheter in conjunction with a hydrophilic guidewire has been used in fistula embolization with cyanoacrylate glue for spinal vascular malformations at our institution. This combination has improved our success rate in achieving superselective catheterization of the fistula. Thus, 4 of 5 patients with type I perimedullary AVFs could be cured with this technique. Like type II and type III perimedullary AVFs, the endovascular approach may also be the first line of treatment in type I perimedullary spinal AVF.     

Percutaneous thrombin injection of a femoral artery pseudoaneurysm with simultaneous venous balloon occlusion of a communicating arteriovenous fistula

An 82-year-old woman developed acute occlusion of her right coronary artery. She underwent percutaneous coronary stent placement and aortic balloon pump installation. In the postprocedural period, she developed a common femoral artery pseudoaneurysm (PSA) that communicated with the common femoral vein via an arteriovenous fistula (AVF). After unsuccessful ultrasound-guided compression, ultrasound-guided thrombin injection of the PSA was performed, with simultaneous balloon occlusion of the common femoral vein at the level of the AVF. There was complete thrombosis of the PSA and AVF.     

超声对血液透析造瘘术前血管的观察和评价

目的:探讨血液透析动静脉造瘘术前应用超声评价相关血管的手术可行性的价值.材料和方法:采用Accuvix XQ彩色多普勒对34例拟行自体动静脉造瘘的患者行相关血管超声检查.结合30例患者的手术结果,总结其超声术前评价标准.结果:(1)4例放弃手术中,锁骨下动脉和腋动脉显著狭窄2例,桡动脉管壁钙化1例,头静脉内径过细(1.2mm)及位置过深1例.(2)30例行造瘘手术.其中,27例造瘘成功,3例失败;失败原因为血栓形成2例,血流量不足1例,无法满足透析.(3)超声术前评价标准:①供血动脉及回流静脉系统无显著狭窄或闭塞;②桡动脉内径＞1.6mm,反应性充血充分,管壁无明显形态学改变;③头静脉内径≥2.5mm(应用止血带),位置须表浅平直,无多条分支.结论:通过血管超声检查声像图表现及术前评价标准选择适合造瘘患者,特别对常规检查困难或不确定者,有很好的临床应用价值.     

Vascular complications in lumbar spinal surgery: Percutaneous endovascular treatment

Four patients underwent endovascular treatment of vascular injuries complicating lumbar spinal surgery. In two patients with massive retroperitoneal hemorrhage, the extravasating lumbar arteries were successfully embolized with microcoils. Two patients with large iliac arteriovenous fistula (AVF) were treated, one with embolization using a detachable balloon and coils, which failed, and the other with placement of a stent graft after embolization of distal runoff vessels, which occluded the fistula. We conclude that acute arterial laceration or delayed AVF complicating lumbar spinal surgery can be managed effectively with selective embolization or stent-graft placement, respectively.     

Dural arteriovenous fistula in children: endovascular treatment and outcomes in seven cases.

BACKGROUND AND PURPOSE: Dural AVF is a vascular anomaly that rarely occurs in children and is best treated by endovascular embolization. We report our experience using various endovascular embolization techniques in the treatment of dural AVF in a pediatric population. METHODS: Seven children with angiographically proven dural AVF were treated with endovascular embolization using microcoils, N-butylcyanoacrylate, detachable balloons, and/or silk suture. All imaging studies, embolization procedures, and patient charts were retrospectively reviewed. RESULTS: Seven children had been treated for dural AVF at our institution since 1987. Three newborns presented with congestive heart failure. Four older children (10 months-10 years) presented with signs referable to venous hypertension, including seizures, hydrocephalus, and proptosis. Embolization approaches included transarterial, transvenous, and direct puncture after neurosurgical exposure of a dural sinus. The number of embolizations ranged from 1 to 13 sessions per patient. All patients experienced symptomatic improvement after each embolization session. The three newborns showed marked improvement in cardiac function that allowed discharge to home. Clinical follow-up ranged from 3 weeks to 9 years (mean, 4.1 years). Two children with partially embolized dural AVF died, and one was lost to follow-up. Four children are alive after complete embolization of their dural AVF; two are developmentally normal, and two have mild developmental delay. CONCLUSION: Endovascular embolotherapy is the current treatment of choice for dural AVF. Embolization therapy may be life saving in the setting of cardiac failure and curative in cases of small or simple fistulae. Multiple, complex dural AVF are usually not curable, and treatment is aimed at symptomatic relief. Treatment strategies focus on the location and/or complexity of the fistula, the patient's clinical status, and the neurologic prognosis.     

An unusual dural arterio venous fistula in an infant

Dural arteriovenous fistula, (AVF), a rare entity, presents most commonly in adults. An 11-month-old boy presented with symptoms of congenital toxoplasmosis associated with an extensive dural AVF of the torcular Herophili and bilateral occulusion of the transverse and sigmoid sinuses. His intracranial venous drainage had become rerouted via the cavernous sinuses to the ophthalmic veins. The relationship of toxoplasmosis and sinus thrombosis to the pathogenesis of dural AVF and their clinical and radiological features are discussed.     

Assisted Maturation of Native Fistula in Two Patients with a Continuous Flow Left Ventricular Assist Device

Patients who receive a left ventricular assist device (LVAD) are prone to develop end-stage renal disease. Primary arteriovenous fistula (AVF) maturation in these patients may be unsuccessful secondary to the nonpulsatile flow with an LVAD. Two patients with LVADs are described in whom assisted maturation aided long-term AVF patency.     

Endovascular treatment of AVF after hair transplantation

Arteriovenous fistula (AVF) of the scalp is a very rare complication of hair transplantation. Only 9 cases have been reported in nearly half a century. The diagnosis is clinical but angiography is necessary for defining the angioarchitecture of the lesion. Due to technical developments, endovascular embolization has become the primary treatment for AVF of the scalp.     

Coil embolization of cavernous sinus in patients with direct and dural arteriovenous fistula

To determine technical success and acute complication rates after endovascular coil packing of the cavernous sinus. Nineteen patients presented with either direct (13) or dural (6) arteriovenous fistula (AVF) and were treated by means of coil embolization of the cavernous sinus. The aim of treatment was complete obliteration of the fistula. In a retrospective study, the degree of obliteration, regression of symptoms as well as complication rates were evaluated. Initial complete obliteration was achieved in 12 patients, subtotal occlusion of the sinus in 6 and incomplete packing with major residual fistula in 1 of the patients. Retreatment was successfully performed in two patients with early recurrence of AVF. Follow-up showed complete occlusion rates in 16 and subtotal obliteration in 3 patients. Chemosis and exophthalmus regressed rapidly in all affected patients. Persistence of cranial nerve deficits was observed in 11 cases. Postinterventional thrombosis of the ophthalmic vein was the only major acute complication (n = 2). Coil embolization of the cavernous sinus in cases with AVF is a complex procedure that is technically feasible and safe in the majority of cases. Adequate anticoagulation is recommended to avoid thrombembolic complications. Long-term outcome has to be determined by further studies.     

Spinal dural arteriovenous fistula localization with a technique of first-pass gadolinium-enhanced MR angiography: initial experience

Nine patients with initial magnetic resonance (MR) imaging and clinical findings suggestive of spinal dural arteriovenous fistula (AVF) underwent spinal MR angiography with an autotriggered elliptic centric ordered three-dimensional gadolinium-enhanced technique (hereafter, this MR angiographic technique) before conventional intraarterial angiography. In all nine patients, findings with this MR angiographic technique correctly and precisely localized the spinal dural AVF. Observer error resulted in one case in which the site of the fistula was not prospectively reported but was easily identified retrospectively on the spinal MR angiogram.     

Arteriovenous fistula as a complication of lumbar disc surgery: case report

Arteriovenous fistula (AVF) is a rare, late complication of lumbar disc surgery. It is often not suspected and the symptoms are diagnosed as heart failure or deep venous thrombosis. We report a case in which the patient developed leg swelling and high-output congestive heart failure due to a left ilioiliac AVF after lumbar laminectomy. Received: 3 September 1997 Accepted: 27 October 1997     

Surgical Repair of a Post-traumatic Arteriovenous Fistula Complicated by Stent-Graft Misplacement

An arteriovenous fistula (AVF) is an abnormal connection between an artery and a vein which may result from a traumatic injury or occur as a congenital abnormality. It may be asymptomatic or may present with a variety of symptoms. Surgical or endovascular treatment can be preferred. We present a case of unsuccessful percutaneous treatment of a femoral AVF due to misplacement of the stent-grafts, necessitating surgical correction.