输卵管不全闭塞的数字化造影和宫腹腔镜对照分析

目的探讨利用输卵管数字化造影和宫腹腔镜在诊断输卵管不全闭塞的价值。方法回顾性分析48例(96条)经宫腹腔镜联合通液术证实为输卵管不全闭塞的影像学资料,所有患者术前均经过输卵管数字化造影,评价子宫输卵管数字化造影诊断输卵管不全闭塞伴积水的敏感度、特异度及准确度。结果 48例(96条)患者中,宫腹腔镜联合通液术检查确诊56条输卵管不全闭塞,其中42条输卵管不全闭塞伴积水,14条不伴积水。数字化输卵管造影确诊输卵管不全闭塞伴积水41条,漏诊1条,误诊0条。输卵管数字化造影诊断输卵管不全闭塞伴积水敏感度97.6%(41/42)、特异度100%(14/14)、准确度98.2%(55/56)。结论数字化输卵管造影可准确显示输卵管不全闭塞的征象,为宫腹腔镜联合下微创治疗筛选患者。     

超声及磁共振血管造影诊断腹腔动脉硬化闭塞症的受试者操作特性分析

目的:使用受试者操作特性曲线(ROC)比较并评价超声与磁共振血管造影对腹腔动脉硬化闭塞症的诊断价值。方法:41例患者同日分别进行超声及磁共振血管造影检查,与数字减影血管造影检查(DSA)和/或手术相对照。结果:腹腔段超声诊断血管闭塞、狭窄(>50%)的Az值分别为0.979 6、0.938 6;磁共振血管造影诊断血管闭塞、狭窄(>50%)的Az值分别为0.965 4、0.995 5。结论:超声与磁共振血管造影诊断腹腔动脉硬化闭塞症均高度准确,可首选超声检查。     

64层螺旋CT在糖尿病下肢动脉硬化闭塞症中的诊断价值

目的评价64层螺旋CT下肢动脉成像在诊断糖尿病下肢动脉硬化闭塞症中的临床价值。方法对90例可疑下肢血管病变的Ⅱ型糖尿病患者进行64层螺旋CT血管造影检查,对所有扫描原始数据行容积再现(VR),最大密度投影(M IP),冠状、矢状面多平面重组(MPR)以及曲面重建(CPR)。结果64层螺旋CT下肢血管造影检查可以清晰显示自髂总至足背整个动脉系统病变的准确部位、范围及侧枝血管。90例患者中67例(77%)患者血管呈不同程度粥样硬化表现。其中轻或中度狭窄49例(56.3%),重度狭窄18例(20.7%),7例(8%)完全闭塞患者可见侧枝循环血管形成。结论64层螺旋CT下肢血管造影,对糖尿病下肢动脉硬化闭塞症的诊断和治疗具有重要价值。     

急性期脑梗死FLAIR序列血管高信号形成机制探讨

目的与血管造影对照探讨急性脑梗死磁共振快速液体衰减反转恢复(FLAIR)序列血管高信号(FLAIRvascular hyperintensities,FVH)的形成机制。资料与方法回顾性分析9例急性大脑中动脉闭塞6 h内患者的磁共振FLAIR序列及血管造影图像。评价急性脑梗死患者FVH的发生率、位置及形态学特征,并以血管造影分析其血流动力学特征。结果 9例患者FVH出现率为100%。FVH最常见于外侧裂(100%),颞叶或邻近颞叶为89%,顶叶为22%。FVH于颈内动脉血管造影上显示来自大脑前动脉软脑膜支不同程度侧支循环,微导管通过大脑中动脉闭塞段造影显示对比剂滞留,并无充盈缺损。结论急性脑梗死患者FVH形成的原因可能为近端血管闭塞,软脑膜侧支逆向缓慢血流代偿,而并非血管内血栓形成。     

弹簧圈再栓塞或覆膜支架治疗颅内动脉瘤复发

目的报道用弹簧圈再次栓塞或覆膜支架治疗颅内复发动脉瘤的经验。方法291例患者共305枚颅内动脉瘤行可脱卸弹簧圈治疗。随访期间,142例颅内动脉瘤中有41例(28.9%)动脉瘤复发。6个月内有脑血管造影随访的31例共31枚复发动脉瘤纳入本研究,其中20例行可脱卸弹簧圈再栓塞(A组),11例行覆膜支架置入术(B组)。将动脉瘤血管造影结果分为完全闭塞、不完全闭塞;临床评估分级为完全康复,改善,无变化,加重或进展。收集并分析技术成功率,即刻和末次血管造影结果等资料。结果所有复发动脉瘤弹簧圈栓塞和支架置入技术均获得成功。即刻脑血管造影示A组11例(55%)动脉瘤完全闭塞,B组8例(72.7%)完全闭塞;末次脑血管造影示A组10例(50%)动脉瘤完全闭塞,B组11例(100%)完全闭塞,两组间差异有统计学意义(P=0.005)。结论弹簧圈栓塞后动脉瘤复发,可以行弹簧圈再次栓塞术或覆膜支架置入术治疗和闭塞瘤腔。覆膜支架可能比弹簧圈栓塞能更有效地完全闭塞复发动脉瘤。     

脑分水岭梗死血管造影分析

目的:分析脑分水岭梗死(CWI)血管造影的表现,探讨脑分水岭梗死与脑血管狭窄的相关性。方法:回顾性分析32例经CT或MR证实的CWI患者的脑血管造影表现。结果:32例CWI患者中发现28例(87.5%)有脑血管狭窄或者闭塞,4例(12.5%)血管造影正常。前循环大脑中动脉和颈内动脉受累最为常见。后循环受累的血管中以椎动脉最为常见。结论:脑分水岭梗死血管造影显示大部分患者有肯定的脑血管狭窄或者闭塞,及时行脑血管造影检查有利于指导治疗,判断预后。     

64层螺旋CT在冠状动脉搭桥术后的应用价值

目的:探讨64层螺旋CT在冠状动脉搭桥术后的临床应用价值。方法:采用西门子Somatom Sensation Cardiac64螺旋CT对22例冠脉搭桥术后的患者(共计44根桥血管)进行了扫描,其中11例患者同时进行了冠状动脉造影检查。结果:64层螺旋CT显示22例患者发现44支桥血管,显示率100%。44支桥血管中,33支(75%)通畅、5支(11.4%)闭塞、3支(6.8%)中重度狭窄、3支(6.8%)轻度狭窄。与冠脉造影对照,诊断桥血管明显狭窄及闭塞的敏感性100%,特异性92.9%,阳性预测值87.5%,阴性预测值100%,准确率95.2%。结论:64层螺旋CT是评价桥血管闭塞及狭窄的可靠方法。     

颅内巨大或大型动脉瘤的血管内治疗:三种技术的比较

目的评价可脱卸球囊、可脱卸弹簧圈和颅内覆膜支架治疗颅内巨大动脉瘤的疗效。方法收集资料完整的经血管内治疗的颅内巨大动脉瘤20例,其中球囊/弹簧圈闭塞载瘤动脉9例,可脱卸弹簧圈动脉瘤腔填塞8例,覆膜支架治疗3例,另有2例为经弹簧圈瘤腔栓塞治疗后复发,行覆膜支架治疗。随访9～83个月,平均(41.1±25.3)个月。术后即刻血管造影结果评价标准为：动脉瘤完全闭塞(100%),大部闭塞(95%～99%)和部分闭塞(＜95%)。随访血管造影结果评价标准为：不变、血栓形成和再开放。结果所有动脉瘤血管内治疗均获得成功,无并发症。术后即刻血管造影显示动脉瘤完全闭塞11例,大部闭塞7例,部分闭塞2例,其中1例部分闭塞患者术后7 d再出血死亡。19例健在患者最终血管造影显示：动脉瘤完全闭塞15例,大部闭塞3例,部分闭塞1例。19例中,10例载瘤动脉保持通畅。长期临床随访结果显示11例患者的临床症状消失,8例改善。结论动脉瘤腔可脱卸弹簧圈栓塞治疗颅内动脉巨大动脉瘤的完全闭塞率低且再通率高;可脱卸球囊或弹簧圈闭塞载瘤动脉治疗动脉瘤完全闭塞率高但牺牲载瘤动脉,有潜在或短暂的脑缺血事件发生;覆膜支架治疗操作简单、安全,且可保持载瘤动脉通畅。     

急性心源性栓塞卒中颈动脉系统闭塞部位的超声评价

作者应用多普勒超声测定46例急性心源性栓塞卒中患者的颈总动脉(CCA)的血流速度,以评价其是否能反映颈内动脉(ICA)或大脑中动脉(MCA)闭塞部位,同期行脑血管造影。男25例,女21例,将患者分为三组:IC组:20例,单侧颅内ICA闭塞;M_1组:16例,MCA水平段闭塞;MBr组:10例,MCA分支闭塞。血管造影显示40例颈动脉分叉处正常,6例有较小病变(<25%的狭窄),另设双侧颈动脉血管造影正常的30例为对照组。首先测定双侧CCA舒张末期血流速度,然后计算舒张末期速度比率(ED比率:卒中患者为闭     

冠状动脉CTA对冠状动脉慢性闭塞病变闭塞段长度评价的准确性研究

目的评价冠状动脉CTA测量冠状动脉慢性闭塞病变(chronic total occlusion,CTO)的准确性。方法回顾性分析2013年5月～2016年9月73例就诊于首都医科大学附属北京安贞医院心内科血管完全闭塞患者。均行冠状动脉CTA及冠状动脉造影检查,分别测量闭塞血管段长度。结果造影示闭塞段血管平均长度(22.4±18.7)mm,CTA测量闭塞段血管平均长度(21.3±14.0)mm,两者无统计学差异(P=0.630)。CCTA检查时间、并发症发生率均显著低于冠状动脉造影(P0.05)。结论冠状动脉CTA与冠状动脉造影在CTO病变长度测量上无差异,可准确测量闭塞段长度。     

Duplex and color Doppler flow sonography of occlusion and near occlusion of the carotid artery.

PURPOSETo determine whether color Doppler flow imaging with the use of slow-flow sensitivity improves sensitivity and specificity in the differentiation of occlusion and near occlusion of the internal carotid artery.METHODSColor Doppler and duplex sonography were performed in symptomatic patients who had angiographically confirmed occlusion and/or near occlusion of the internal carotid artery. The study consisted of two phases: in the first, we assessed the usefulness of color Doppler flow imaging by retrospectively reviewing the records of 35 patients with 36 angiographically confirmed occlusions or near occlusions of the internal carotid artery who were examined with color Doppler flow imaging at our institution during a period of 4 years; in the second phase, we incorporated color Doppler sonography into the routine scanning protocols of 39 patients with 41 occluded or nearly occluded internal carotid arteries seen over a period of 2 1/2 years.RESULTSOverall, color Doppler imaging correctly showed all 34 of the near occlusions (sensitivity, 100%) and 36 of the 43 occlusions (specificity, 84%). Seven patients with angiographically confirmed occlusion had sonographic findings that suggested near occlusion. In the first phase, eight near occlusions were misinterpreted as occlusions with conventional duplex sonography, but were correctly shown with color Doppler flow imaging. In the second phase, sensitivity increased from 50% to 100% (18 or 18) because of better detection of the nearly occluded lumen. This was at the expense of a decrease in specificity (from 100% to 78%). owing to identification of apparent flow in the internal carotid artery on color Doppler flow images in five of 23 occlusions.CONCLUSIONBecause of its ability to depict slow flow, color Doppler imaging with slow-flow sensitivity is superior to conventional duplex sonography for the noninvasive discrimination of occlusion from near occlusion of the internal carotid artery.     

Gallbladder varices: A potential collateral pathway in portal hypertension and portal vein occlusion

Varices of the gallbladder were demonstrated angiographically in four patients. One patient who had had a mesocaval shunt developed gallbladder varices as a result of hepatoportal shunting. Three patients had gallbladder varices owing to collateral circulation from portal vein occlusion.     

Artery of Percheron thrombolysis

SUMMARY: A patient with acute top of the basilar syndrome clinically was found to have only a small basilar artery filling defect but complete occlusion of the artery of Percheron. Intra-arterial thrombolysis resulted in favorable neurologic outcome. To our knowledge, this is the only case of angiographically proved and treated artery of Percheron occlusion. The value of this report is that reperfusion of ischemic areas was only achieved when persistent investigation disclosed artery of Percheron occlusion.     

Fogarty catheter complication treated with angiographic techniques: New use for balloon occlusion catheter

Fogarty catheter embolectomy is occasionally associated with complications, including intimal dissection and thrombosis. We report a case of this complication in the iliac artery treated angiographically by thrombectomy with a balloon occlusion catheter.     

Routine MR imaging of the internal carotid artery siphone: angiographic correlation with cervical carotid lesions

This study correlates the appearance of the cavernous segment of the carotid artery on MR images with the presence of significant stenosis or occlusion of the cervical carotid artery as seen on angiograms in 100 patients who had brain MR imaging and arteriography within a 1-week period. Four patients demonstrated isointense signal within the carotid artery's cavernous segment; two of these findings correlated with complete carotid occlusion as seen angiographically, while partial compromise was seen angiographically in the other two. Four other patients had variable signal intensity and irregularity of the luminal outline in the carotid siphone, correlating with angiographic evidence of atheromatous disease in three patients and of dissection in one patient. The demonstration of normal signal void within a normal-appearing cavernous segment of the internal carotid artery in the remaining 92 patients correlated with absence of significant stenosis within the cervical segment in 86 patients. In the remaining six, significant disease of the internal carotid artery was found. Isointensity within the intracranial carotid artery can indicate either complete occlusion or very slow flow. Therefore, angiography is still necessary to completely exclude potentially treatable disease that produces very slow flow leading to isointensity. The presence of normal flow void in the intracranial segment does not exclude significant compromise of the cervical segment of the carotid artery.     

Routine MR imaging of the internal carotid artery siphon: angiographic correlation with cervical carotid lesions

This study correlates the appearance of the cavernous segment of the carotid artery on MR images with the presence of significant stenosis or occlusion of the cervical carotid artery as seen on angiograms in 100 patients who had brain MR imaging and arteriography within a 1-week period. Four patients demonstrated isointense signal within the carotid artery's cavernous segment; two of these findings correlated with complete carotid occlusion as seen angiographically, while partial compromise was seen angiographically in the other two. Four other patients had variable signal intensity and irregularity of the luminal outline in the carotid siphon, correlating with angiographic evidence of atheromatous disease in three patients and of dissection in one patient. The demonstration of normal signal void within a normal-appearing cavernous segment of the internal carotid artery in the remaining 92 patients correlated with absence of significant stenosis within the cervical segment in 86 patients. In the remaining six, significant disease of the internal carotid artery was found. Isointensity within the intracranial carotid artery can indicate either complete occlusion or very slow flow. Therefore, angiography is still necessary to completely exclude potentially treatable disease that produces very slow flow leading to isointensity. The presence of normal flow void in the intracranial segment does not exclude significant compromise of the cervical segment of the carotid artery.     

Trauma angiography of the extremity: The impact of injury mechanism on triage decisions

A review of angiographic studies of 227 consecutive injured patients suspected of having sustained extremity arterial trauma was done to determine whether knowledge of the mechanisms of injury was of use in the establishment of priority in multiply injured patients. Stab wounds and other lacerations occurred in 32 patients. Major arterial injury occurred in only 3 (12%) cases; in no case was arterial occlusion present or limb viability threatened. These injuries may be angiographically evaluated on a nonurgent basis. Alternatively, patients with gunshot wounds (130 patients) and blunt injuries (63 patients) had a high incidence of major arterial injury (18 and 38%, respectively), especially arterial occlusion (15 and 24%, respectively) as well as a significant incidence of threatened limb viability (5 and 21%, respectively). Disproportionately increased risk of arterial injury occurred in patients with high-energy gunshot wounds (75%), motorcycle accidents (62%), and crush injuries (63%). Patients who sustain gunshot wounds or blunt injuries and have an abnormal vascular physical examination should be evaluated angiographically on an urgent basis.     

Acute peripheral arterial and graft occlusion: treatment with selective infusion of urokinase and lysyl plasminogen

Thirty-five patients hospitalized for recent angiographically documented arterial occlusion in the legs (27 femoropopliteal arteries and eight grafts) benefited from local fibrinolytic therapy delivered at the site of the occlusion with a 4- or 5-F catheter. This therapy combined a continuous urokinase (UK) infusion of 1,000 U/kg/hour and a lysyl plasminogen (LYS-PLG) infusion of 15 microkatals every 30 minutes. Angiographically confirmed lysis was obtained in 85% of the cases. Only 3% of the patients had major and 6% had minor groin hematomas. Only two patients had concentrations of fibrinogen as low as 100 mg/dl. Intravascular infusion of UK-LYS-PLG is as effective as streptokinase. Its excellent tolerance makes it a good alternative in the treatment of acute ischemia in the lower limbs.     

Complete recovery after early intraarterial recombinant tissue plasminogen activator thrombolysis of carotid T occlusion

Carotid T occlusion (intracranial carotid bifurcation occlusion with involvement of A1 and M1 segments) is associated with poor outcome. In most cases, treatment with intraarterial thrombolysis within a 6-hour window has been unsuccessful. We describe the case of a 26-year-old woman who presented with severe neurologic deficits (National Institutes of Health Stroke Scale score of 23) secondary to angiographically proved right carotid T occlusion. She was treated with intraarterial infusion of recombinant tissue plasminogen activator that was started less than 3 hours after symptom onset (26 mg administered during 2 hours 15 minutes). Thrombolysis resulted in recanalization of all major intracranial vessels and complete neurologic recovery. Early intraarterial thrombolysis may be effective in the treatment of patients with carotid T occlusion and should be considered for appropriate candidates.     

Intravenous digital subtraction angiography in diagnosis of vascular graft occlusion

Differentiation is often difficult between vascular graft occlusion and progression of underlying disease in patients after vascular surgery. We have studied 57 patients after surgery for traumatic and atherosclerotic arterial occlusion and other vascular anomalies using a commercial digital subtraction angiography (DSA) unit; no complications occurred. Indications for examination included pain, diminished pulse, and failure of catheter angiography. Graft patency was established if proximal and distal anastomoses were visualized; occlusion was diagnosed if no graft was imaged or vascular stump found—noted in 31 grafts. Our diagnosis was proved surgically in 24 patients (two refused operation); three others were confirmed angiographically and one by Doppler ultrasonic examination. In our experience DSA is a safe, specific means of following postoperative grafts and diagnosing their occlusion. This work was supported in part by U.S. Public Health Service Grant No. HL07334