肝总动脉瓣膜状闭塞

目的：正确认识肝总动脉瓣膜单方面闭塞并探讨其介入治疗肝癌的临床价值。材料与方法：肝总动脉闭塞伴胰动脉弓侧支供养肝脏的患者１７例，行肠系膜上动脉或胰十二指肠下动脉造影以了解有无肝总动脉瓣膜状闭塞。结果：１２例患者肝总动脉呈瓣膜状闭塞，即腹腔动脉造影时肝总动脉完全闭塞，肠系膜上动脉或胰十二指肠下动脉造影时，肝总动脉“闭塞段”血流通畅，类似静脉瓣状。结论：肝总动脉瓣膜状闭塞与多次介入治疗、肝癌切除＋术中     

肝动脉解剖变异及其对肝癌介入治疗的临床意义

目的：研究肝动脉解剖变异及其对肝癌介入治疗的临床价值。方法：采用Ｓｅｌｄｉｎｇｅｒ经股动脉插管法或超选择性动脉插管法对１７３例肝癌患者行肝动脉造影，分析动脉期图像。结果：肝动脉典型分布１５０例（８６．７％），肝动脉变异２３例（１３．３％）。肝动脉异位自肠系膜上动脉最多见，占８．０９％，其次为肝总动脉变异，占４．０５％。与文献报道尚有差异。另外有２例肝动脉异位自右膈下动脉，尚未见文献报道。结论：肝动脉造影的操作顺序是先行腹主动脉造影，再行腹腔动脉和肠系膜上动脉造影，如无异常，上行至肝动脉系统选择性造影插管至靶血管，才能保证肝动脉插管准确性及肝癌治疗中动脉血管阻断的彻底性。     

肝癌的的肝外动脉供血及其介入治疗

目的 探讨肝癌肝外动脉供血规律、插管技术及介入治疗。方法 总结７６例肝癌肝外动脉供血特征．７６例肝癌动脉栓塞术前常规腹腔动脉,肝总动脉,肠系膜上动脉造影,对位于膈顶部肿瘤还作膈动脉造影,发现肝外供血支进一步超选插管,并同时进行肝动脉、肝外动外动脉双动脉内化疗栓塞术。结果 ７６例肝人血支,由肝动脉闭塞引起侧支供血达２１例,其余５５例为肝脏本身固有的寄生性供血。肝外供敌国民肝块部位、大小密切相关。Ｇｏ     

肝癌的肝外动脉供血及其介入治疗

目的　探讨肝癌肝外动脉供血规律、插管技术及介入治疗。方法　总结７６ 例肝癌肝外动脉供血特征。７６ 例肝癌动脉栓塞术前常规腹腔动脉、肝总动脉、肠系膜上动脉造影,对位于膈顶部肿瘤还作膈动脉造影,发现肝外供血支进一步超选插管,并同时进行肝动脉、肝外动脉双动脉内化疗栓塞术。结果　７６ 例肝外供血支,由肝动脉闭塞引起侧支动脉供血达２１ 例,其余５５ 例为肝脏本身固有的寄生性供血。肝外供血与肿块部位、大小密切相关。Ｃｏｂｒａ、Ｙａｓｈｉｒｏ 导管配合ＳＰ 导管肝外动脉插管成功率为７２ ．４％ ,随访３６ 例,１、２ 年生存率分别为５２ ％ 和２１％ 。结论　１ ． 依据肿块部位积极寻找肝外供血支;２． 在介入治疗中,预防肝动脉闭塞,减少侧支供血形成至关重要;３． 对具有肝外动脉供血的肝癌采取双动脉内化疗栓塞是必要的、有效的     

肠系膜上动脉供血型肝癌的血管造影分析及介入治疗

目的：研究肠系膜上动脉供血型(即变异肝动脉起源于肠系膜上动脉)肝癌的血管造影表现及插管技术。方法：回顾分析41例肠系膜上动脉供血型肝癌的DSA及介入治疗资料，统计血管解剖变异的发生率，对其起源、走行、分支、分布等解剖学特征及其与血管插管的关系进行描述和分析。结果：350例肝癌中肠系膜上动脉供血型41例(11．9％)，其中副肝右动脉15例(36．5％)，替代肝右动脉16例(39．0％)，肝总动脉8例(19．5％)，腹腔动脉干起源于肠系膜上动脉2例(5％)。31例肠系膜上动脉发出替代或副肝右动脉者，29例(94．0％)腹腔动脉造影表现为肝右动脉细小或缺如，肝右叶出现无血管区。RH导管超选择性插管成功25例(61％)，未成功者改用Cobra、Simmon导管以及结合微导管技术后获得成功。结论：肠系膜上动脉供血型肝癌是一种比较常见的肝动脉变异性供血，熟忿其血管变异的特点对肝动脉化疗栓塞术具有重要的意义。     

肝总动脉瓣膜性狭窄闭塞的初步研究

目的:探讨介入并发症肝总动脉瓣膜狭窄闭塞的原因以及CTA对其的预防价值。方法:回顾性分析DSA证实存在肝总动脉瓣膜狭窄闭塞的原发性肝癌患者8例。所有病例术前均行CTA检查,用VRT、MIP多方位显示感兴趣血管腔的形态、走行以及肝总动脉与上级血管之间的夹角。DSA造影排除解剖变异情况后,判断肝总动脉瓣膜性狭窄闭塞。结果:2例患者CTA示腹腔干及肝总动脉形态正常,而肝总动脉与腹腔干呈夹角狭小。3例术前CTA提示腹腔干起始端重度狭窄;另外3例腹腔动脉明显迂曲延长,肝总动脉起点距离增大,CTA与DSA所见一致。结论:肝总动脉瓣膜性狭窄闭塞是一种罕见的介入治疗并发症,多次介入操作以及解剖变异是可能的诱因,术前CTA能发现这些危险因素,术中选择合适器材轻柔操作是降低其发生率的关键。     

肝动脉解剖变异及多支供血在肝癌介入治疗中的临床意义

目的：研究肝动脉解剖变异和肝癌多支供血及临床意义。材料和方法：140例肝癌行介入治疗前常规腹腔动脉和肠系膜上动脉造影，邻近膈肌病灶加作选择性膈下动脉造影，分析造影图象。结果：肝动脉常见型113例（80．8％），变异27例（19．2％）。病灶单纯由肝动脉供血92例，48例存在除肝动脉外的多支血管供血。结论：熟悉肝癌的血供特点可指导术者方便快捷插入导管，发现除肝动脉外的供血动脉，并给予化疗栓塞以确保疗效。     

内脏动脉狭窄闭塞侧支循环的多层螺旋CT血管成像

目的:探讨腹腔动脉(CA)、肠系膜上动脉(SMA)、肠系膜下动脉(IMA)狭窄闭塞侧支循环在多层螺旋CT血管造影(MSCTA)中的表现.方法:搜集CA、SMA、IMA慢性狭窄闭塞行MSCTA检查的患者80例,采用容积再现(VR)血管添加技术(AV)对侧支血管进行选择性重建.结果:80例慢性期内脏动脉狭窄闭塞患者中SMA...     

原发性肝癌肝外血供的血管造影分析及介入治疗

目的 探讨原发性肝癌的肝外血供的血管造影表现及其对肝癌介入治疗的意义.方法 本组32例原发性肝癌患者行常规腹腔动脉造影及肝外血供探查,并对其行超选择性插管及化疗栓塞治疗(TACE).结果 32例患者共见37支肝外营养血管,分别为肠系膜上动脉12支,右膈下动脉9支,左膈下动脉1支,胃左动脉6支,胰十二指肠动脉弓2支,胃网膜动脉2条,胃十二指肠动脉2支,右胸廓内动脉1支,右肋间动脉1支,脾动脉1支.大多数肝外血供为肠系膜上动脉和右膈下动脉;4支肝外营养血管因未能成功行超选择性插管而只予化疗药灌注治疗,其余33支肝外血供均行超选择性插管和化疗栓塞治疗.结论 原发性肝癌的肝外血供较为常见和多变,对肝外血供的化疗栓塞在肝癌的介入治疗中具有重要的意义.     

肝癌介入治疗中肝动脉狭窄闭塞及肝外侧支血管对肝癌供血的分析

目的 探讨在肝癌介入治疗中肝动脉狭窄闭塞后肝外侧支血管的形成对肝癌介入治疗的意义。材料与方法 观察和统计787例肝癌血管造影中见到的37例肝动脉狭窄闭塞者肝外侧支血管的部位及其发生率。结果 右膈下动脉和胃左动脉是形成肝外侧支的主要血管,分别占40．5％、29．7％,而胰十二指肠下动脉、胃十二指肠动脉、肠系膜上动脉分别占8％、5．4％8％。肝右叶7、8段肿瘤侧支血供主要来自右隔下动脉,5、6段肿瘤主要来自胆总管周围动脉,肝左叶肿瘤侧支血供主要来自胃动脉。经 肝动脉狭窄闭塞的主要原因为重复导管化疗和操作不当。结论 肝左叶肿瘤侧支血供主要来自胃左动脉。引起肝动脉狭窄闭塞的主要原因为重复导管化疗和操作不当。结论 肝动脉狭窄闭塞后肝外侧支血管成为肝肿瘤的主要供血动脉。了解侧支血管发生的部位及其发生率对肝癌患者的进一步治疗有重要意义。     

Tumor tissue characterization evaluating the luciferase activity under the control of a hsp70 promoter and MR imaging in three tumor cell lines

Severe stenosis/occlusion of the proximal celiac trunk due to median arcuate ligament compression (MALC), arteriosclerosis, pancreatitis, tumor invasion, and celiac axis agenesis has been reported. However, clinically significant ischemic bowel disease attributable to celiac axis stenosis/occlusion appears to be rare because the superior mesenteric artery (SMA) provides for rich collateral circulation. In patients with celiac axis stenosis/occlusion, the most important and frequently encountered collateral vessels from the SMA are the pancreaticoduodenal arcades. Patients with celiac artery stenosis/occlusion are treated by interventional radiology (IR) via dilation of the pancreaticoduodenal arcade. In patients with dilation of the pancreaticoduodenal arcade on SMA angiograms, IR through this artery may be successful. Here we provide several tips on surmounting these difficulties in IR including transcatheter arterial chemoembolization for hepatocellular carcinoma, an implantable port system for hepatic arterial infusion chemotherapy to treat metastatic liver tumors, coil embolization of pancreaticoduodenal artery aneurysms, and arterial stimulation test with venous sampling for insulinomas.     

Transcatheter arterial chemoembolization for hepatocellular carcinomas in patients with celiac axis occlusion

PURPOSE: To verify the hypothesis that most instances of celiac axis occlusion in patients with hepatocellular carcinoma (HCC) are caused by diaphragmatic compression and, therefore, transcatheter arterial chemoembolization (TACE) can be performed through the compressed lumen of the celiac axis. MATERIALS AND METHODS: The authors attempted to perform TACE in 36 consecutive patients with HCC and celiac axis occlusion. Spiral computed tomographic (CT) images were available in 26 patients. Initially, catheterization of the hepatic arteries was attempted through the occluded celiac axis. If it failed, catheterization was performed through the pancreaticoduodenal arcades. The causes of celiac axis occlusion were evaluated based on spiral CT and angiographic findings, access routes, technical success rates, and related complications in superselective catheterization of hepatic arteries. RESULTS: Among the 26 patients who underwent spiral CT, diaphragmatic compression of the celiac axis was demonstrated in 23. Selective catheterization of hepatic arteries was possible through the occluded celiac axis in 23 patients (64%). In nine (25%) of the remaining 13 patients, TACE was performed through the dilated pancreaticoduodenal arcades from the superior mesenteric artery. As a procedure-related complication, celiac axis dissection occurred in one patient (3%). CONCLUSION: Most patients with celiac axis occlusion had arcuate ligament compression. In TACE, the celiac artery occlusion could be traversed directly and this should be the initial approach.     

Analysis of the origin of the right inferior phrenic artery in 178 patients with hepatocellular carcinoma treated by chemoembolization via the right inferior phrenic artery

BACKGROUND: No previous report has described the level of the origin of the right inferior phrenic artery (RIPA) based on an analysis of the relationships between the level of the RIPA, the celiac artery (CA), the superior mesenteric artery (SMA), and the right renal artery (RRA) in a series of cases. PURPOSE: To evaluate the origin of the RIPA by retrospectively analyzing angiographic findings in 178 patients with hepatocellular carcinoma (HCC) who underwent transcatheter arterial chemoembolization (TACE) via the RIPA. MATERIAL AND METHODS: In patients treated with intraarterial chemoembolization for HCC, additional superselective chemoembolization of the RIPA branches was necessary in 178 cases. We analyzed the level of the origin of the RIPA in these patients according to the relationships between the level of the origin of the RIPA, the CA, the SMA, and the RRA on angiography. RESULTS: Among the 178 cases, the RIPA arose from 1) the aorta directly in 102 cases (57%), 2) the CA in 53 (30%), 3) the left gastric artery (LGA) in three (2%), 4) the dorsal pancreatic artery (DPA) in one (1%), and 5) the RRA in 19 (11%). The level of the origin of the RIPA that originated directly from the aorta was supraceliac in 56 cases (32%), between the CA and the SMA in 31 (17%), and between the SMA and the RRA in 15 (8%). CONCLUSION: In our study, the RIPA originated from the aorta between the CA and the SMA directly in 17% of cases. When it is difficult to identify the origin of the RIPA, we must keep in mind that the RIPA may originate from the right part of the aorta within the small distance between the SMA and the CA.     

Percutaneous Retrograde Recanalization of the Celiac Artery by Way of the Superior Mesenteric Artery for Chronic Mesenteric Ischemia

A 52-year-old man presented with recurrent postprandial abdominal pain, sitophobia, and progressive weight loss. Chronic mesenteric ischemia (CMI) due to subtotal occlusion of the superior mesenteric artery (SMA) and flush occlusion of the celiac artery (CA) was diagnosed. Retrograde recanalization of the CA by way of a collateral channel from the SMA was performed using contemporary recanalization equipment. The CA and SMA were then stented, resulting in sustained resolution of CMI-related symptoms.     

Preoperative Embolization of the Celiac Axis or Common Hepatic Artery before Distal Pancreatectomy with Resection of the Celiac Axis

Patients with locally advanced pancreatic cancer who undergo distal pancreatectomy with resection of the celiac axis (CA) are at risk for postoperative hepatic or gastric ischemia if collateral blood flow from the superior mesenteric artery (SMA) via the gastroduodenal artery is insufficient. This study presents a technique for preoperative angiographic evaluation of these collateral vessels by using an AMPLATZER Vascular Plug to temporarily occlude the CA or common hepatic artery while simultaneously performing digital subtraction angiography of the SMA. If collateral vessels are deemed sufficient, the plug can subsequently be released for permanent occlusion with the intent to enhance the blood flow in these collateral vessels.     

肠系膜上动脉病变 MSCTA 诊断价值

目的：探讨多层螺旋 CT 血管成像(MSCTA)诊断肠系膜上动脉(SMA)病变临床价值。方法回顾性分析40例 SMA病变患者 MSCTA 图像特点,运用容积再现(VR)、多平面重组(MPR)、曲面重组(CPR)及最大密度投影(MIP)等多种后处理重建技术。结果SMA 缺血16例,包括 SMA 急性闭塞8例,其中并发小肠缺血性坏死1例并行坏死小肠切除术。SMA 慢性闭塞8例;孤立性 SMA 夹层10例;SMA 真性动脉瘤7例,感染性心内膜炎相关假性动脉瘤1例;SMA 溃疡3例,其中1例合并肠系膜下动脉(IMA)重度狭窄;腹腔干重度狭窄2例;IMA 闭塞1例。本组40例患者可见 SMA 疾病相关侧支循环13例,4例见于 SMA 慢性闭塞,3例见于 SMA 急性闭塞,1例见于孤立性 SMA 夹层,1例见于 SMA 假性动脉瘤,2例分别见于 IMA 狭窄和闭塞。2例见于腹腔干重度狭窄。其中包括胰十二指肠前、后动脉弓3例,胰背动脉侧支2例、Riolan 弓10例。结论MSCTA 可以清晰观察SMA 各类病变、侧支循环开通情况以及评估肠腔缺血状态。     

Gadolinium-enhanced MR angiography of visceral arteries in patients with suspected chronic mesenteric ischemia

The purpose of this study was to evaluate accuracy of dynamic gadolinium-enhanced MR angiography (MRA) of the celiac, superior, and inferior mesenteric arteries in patients with suspected mesenteric ischemia compared with catheter angiography or surgery. Sixty-five patients with suspected mesenteric ischemia underwent three-dimensional spoiled gradient-recalled acquisition in the steady state (GRASS) gadolinium-enhanced MRA. Correlative studies were performed on 14 patients, catheter angiography alone was performed on 12 patients, and surgery alone was performed on two patients. Six patients had mesenteric ischemia. In all patients, the celiac artery (CA) and superior mesenteric artery (SMA) were seen well enough to evaluate; however, the inferior mesenteric artery (IMA) could be evaluated in only 9 of the 14 patients. MRA showed severe stenosis (>75%) or occlusion of the celiac axis in seven patients, of the SMA in six patients, and of the IMA in four patients. The overall sensitivity and specificity were 100% and 95%, respectively, compared with catheter angiography and surgery. The two errors were caused by overgrading the severity of IMA disease. Three-dimensional gadolinium-enhanced MRA can accurately demonstrate the origins of the CA and SMA and is useful in evaluation of patients with suspected mesenteric ischemia.