创伤性颅内假性动脉瘤的血管内治疗

创伤性颅内假性动脉瘤发生率约占颅内动脉瘤的1%.由创伤导致颅内血管破裂,出血的血肿机化成瘤壁,从而形成与血管相通的动脉瘤.假性动脉瘤因为不具有完整的血管壁结构,容易破裂出血,因而在临床的治疗上与真性颅内动脉瘤有一定区别,无论是开颅手术还是介入栓塞治疗均伴有较高的风险.本文通过总结目前治疗动脉瘤的方法,结合假性动脉瘤的特...     

创伤性假性动脉瘤与动静脉瘘的介入治疗(附25例报告)

目的探讨介入放射血管内治疗在创伤性大血管损伤、破裂出血时紧急情况下的应用价值。方法对２５例血管外伤病例选择性血管造影明确诊断后，１７例用气囊导管经血管腔内阻断患侧的血流后再行手术切除假性动脉瘤，血管再植术。８例在假性动脉瘤的远侧端肢体血供不受影响的情况下，用可脱球囊闭塞了载瘤动脉。结果全组均获得了满意的效果。结论介入放射学的应用，使无法手术切除地巨大假性动脉瘤及大血管破裂的患者找到了一个简单、易行、安全可靠的治疗措施。     

创伤性假性动脉瘤与动静脉瘘血管内治疗

目的：探讨创伤性假性动脉瘤与动静脉瘘治疗效果．方法：本组共１１８例病人，其中颈内动脉海绵窦瘘８８例、动静脉瘘８例、假性动脉瘤２２例．采用可脱性球囊栓塞６４例；弹簧圈与钨丝螺旋圈栓塞３４例；肌瓣“放风筝”法治疗６例；眼上静脉穿刺注入栓塞材料２例；瘤腔直接穿刺注入栓塞材料２例；气囊导管暂时阻断动脉腔内血流与手术相结合治疗１０例．结果：除４例颈内动脉海绵窦瘘术后出现偏瘫、半年内恢复外，余皆治愈．结论：可脱性球囊栓塞颈动脉海绵窦瘘是目前国内外首选治疗方法．气囊导管暂时阻断动脉腔内血流，然后施行血管重建，可控制大出血并减少术中出血．本法是直接手术时安全有效的辅助措施，可提高邻近躯干部位大血管损伤救治成功率．     

头颈部肿瘤的血管内栓塞与化学治疗

目的 探讨头颈部肿瘤选择性动脉内治疗技术及价值。方法 对１９例颅内外肿瘤进行了２２次选择性动脉栓塞或化疗,其中区域性化疗１３例次,血管内栓塞１２例。结果 所有病人治疗后症状均有不同程度的好转,且栓后肿瘤染色部分或全部消失、供血动脉闭塞;未出现严重并发症。再行病变切除时发病变退缩、术中失血少,病理显示病灶及周边血管栓塞和血栓性脉管炎。结论 血管内介入治疗是头颈部肿瘤一种安全有效的辅助性疗法。     

创伤性假性动脉瘤与动静脉瘘的介入治疗

目的 探讨介入放射血管内治疗在创伤性大血管损伤，破裂出血时紧急情况下的应用价值。方法 对２５例血管外伤病例选择性血管造影明确诊断后，１７例用气囊导管经血管腔内阻断患侧的血流后再行手术切除假性动脉瘤，血管再植术。８例在假性动脉瘤的远侧端肢体血供不受的情况下，用可脱球囊闭塞了载瘤动脉。     

创伤性颈内动脉假性动脉瘤的血管内治疗

目的 探讨载瘤动脉闭塞、弹簧圈栓塞以及支架技术治疗颅内创伤性颈内动脉假性动脉瘤(pseudoaneurysm,PSA)的适应证及其疗效.方法 本组6例患者,3例海绵窦段PSA合并颈内动脉海绵窦痿(carotid-cavernous fistula,CCF),2例单纯颈内动脉PSA,1例CCF球囊栓塞后复查显示PSA.球囊闭塞CCF及创伤性颈内动脉PSA 1例,弹簧圈栓塞3例,颈内动脉球囊闭塞2例.根据6例患者的临床表现、影像学资料、治疗方法选择、临床疗效、随访资料以及文献,分析三种治疗方式的适应证.结果 本组患者无手术相关并发症发生,无脑缺血并发症.术后无鼻出血发生,3例眼球突出回复,1例随访半年视力改善,3例颅内杂音消失,3例瞳孔缩小,复查数字减影血管造影(DSA)未见PSA复发.结论 血管内治疗是治疗颈内动脉PSA的首选,合并CCF时可行球囊闭塞或载瘤动脉闭塞.对单纯窄颈者予以弹簧圈栓塞,对宽颈的采用支架技术结合弹簧圈栓塞,而位于颈内动脉岩段可选择带膜支架.

Abstract：

Objective To investigate the indication and result of parental artery occlusion, embolization with coils, stents in treatment of the traumatic carotid artery pseudoaneurysm. Methods There were six patients with traumatic carotid artery pseudoaneurysm including three patients of cavernous pseudoaneurysm combined with carotid-cavernous fistula (CCF), two with simple traumatic carotid artery pseudoaneurysm and one with traumatic carotid artery pseudoaneurysm that was found after CCF embolization with detachable balloon. The treatment included balloon occlusion for CCF and traumatic carotid pseudoaneurysm in one patient, coil embolization in three and intenal carotid artery balloon occlusion in two. The Clinical manifestations, imaging data, choice of treatment, clinical efficacy, follow-up data and literatures were analyzed to discuss the indications for three treatments. Results There was no cerebral ischemia or surgically-related complication. No epistaxis occurred. The eyeball protrusion restoration was found in three patients and intracranial bruit vanishing in three. Vision was improved one patient after half a year follow-up. The pupils shrank in three patients during follow - up. Digital subtraction angiography (DSA) showed no recurrence of pseudoaneurysm. Conclusions Endovascular treatment is the preferred choice of treatment for traumatic carotid artery pseudoaneurysm. The occlusion or parent artery balloon occlusion can be used when the pseudoaneurysm is combined with CCF. Coil embolization can be used for shoes with narrow neck, stent technology combined with coil embolization for those with wide neck and the covered stent for the rock section of the internal carotid artery.     

创伤性假性动脉瘤的介入治疗

目的　介绍不同类型创伤性假性动脉瘤 (假瘤 )的几种不同治疗方法。方法　 8例不同部位、不同创伤原因引起的的假瘤 ,采用不同的方法进行治疗。 3例终末型动脉的假瘤采用明胶海绵栓塞 ,2例主干性外周动脉的假瘤采用覆膜支架置入术将其隔绝 ,1例支干型假瘤采用两端弹簧圈栓塞 ,1例股动脉穿孔型假瘤采用压迫法 ,另 1例巨大血肿伴假瘤经栓塞后作手术血肿清除加动脉结扎术进行治疗。结果　所有假瘤均完全闭合 ,置入覆膜支架者其远端动脉搏动正常。 1例患者因其他原因 ,致穿刺部位又出现假瘤。其他患者无并发症。结论　采用不同的介入技术能治疗各种假瘤 ,多数情况下可以代替外科治疗     

创伤性假性动脉瘤的介入治疗及临床观察

目的探讨创伤性假性动脉瘤介入治疗的方法及疗效。方法对18例假性动脉瘤患者(肝动脉瘤2例,肾动脉瘤4例,脾动脉瘤1例,胸主动脉2例,周围血管9例),采用不同方法治疗。6例置入带膜支架,10例采用明胶海绵栓塞或弹簧圈栓塞,1例采用部分动脉瘤内填塞加供血动脉栓塞治疗,1例股动脉穿孔型假瘤采用压迫法。结果技术成功率100%。17例动脉瘤闭塞,症状体征消失;1例胸主动脉假瘤出现内瘘;未出现其他并发症。结论介入方法治疗假性动脉瘤安全有效。     

外周血管假性动脉瘤的介入治疗

目的 介绍不同类型外周血管假性动脉瘤的不同治疗方法。方法 13例假性动脉瘤，3例终末型动脉的假性动脉瘤采用明胶海绵进行栓塞，其中1例巨大血肿伴假性动脉瘤经栓塞后作手术血肿清除加动脉结扎术进行治疗；1例支干型假性动脉瘤采用两端弹簧圈栓塞；9例主干性外周动脉假性动脉瘤采用覆膜支架隔绝术。结果 所有假瘤均完全闭合，置人覆膜支架者其远端动脉搏动均正常。1例患者由于其他特殊原因，致穿刺部位又出现假性动脉瘤。其他患者无明显并发症。结论 采用介入技术可使各种外周血管假性动脉瘤得到有效治疗，多数情况下可以代替外科治疗。     

Endovascular Treatment of Lower Limb Penetrating Arterial Traumas

Purpose: The purpose of this study was to evaluate the effectiveness of percutaneous arterial embolization in patients with penetrating peripheral arterial trauma. Materials and Methods: Twelve patients with penetrating peripheral arterial trauma were treated with percutaneous arterial embolization between 2002 and 2007. All injuries were secondary to penetrating stab wounds. Active bleeding (eight patients), recurrent bleeding episodes (one patient), persistent pain and mass (one patient), leg edema, claudication, swelling (one patient), local hyperemia, and pain (one patient) were the presenting symptoms. Microcatheter systems were used for catheterization. We used n-butyl cyanoacrylate mixture as the embolizing agent in all patients. Results: On angiograms the inferior gluteal artery (one patient), internal pudendal artery (one patient), perforating branch of the profundal femoral artery (six patients), superficial femoral artery (one patient), peroneal artery (two patients), and anterior tibial artery (one patient) were found to be injured. In all patients, the source of arterial bleeding could be reached, and a safe embolization was achieved. Nontarget embolization due to backflow of n-butyl cyanoacrylate mixture was detected in two patients and inguinal hematoma at the puncture site occurred in one patient. Conclusions: We conclude that embolization—particularly n-butyl cyanoacrylate embolization—is technically feasible in patients with penetrating peripheral arterial trauma.     

Endovascular repair of a traumatic axillary pseudoaneurysm following anterior shoulder dislocation

Pseudoaneurysms due to musculoskeletal trauma are rare and comprise less than 2% of all pseudoaneurysms. We report a case of axillary pseudoaneurysm following anterior dislocation of the shoulder. The patient was successfully treated by endovascular intervention.     

局部穿刺栓塞治疗头颈部高血流病变

目的 总结局部穿刺栓塞治疗头颈部高血流病变的经验。方法 11例头颈部高血流病变(8例颌骨中心性血管瘤，3例鼻咽纤维血管瘤)进行了局部穿刺栓塞治疗。数字减影颈动脉造影在Philips V3000下完成。颌骨中心性血管瘤采用的栓塞材料为附纤毛的螺形圈，鼻咽纤维血管瘤采用的栓塞材料为组织胶(N-butyl-2-cyanoacrylate，NBCA)。穿刺针为14G和长7号注射针。结果 颌骨中心性血管瘤急性出血的患者经局部穿刺栓塞圈栓塞，有效控制了出血。随访9～24个月后，未发现有口腔内渗血或出血，随访X线平片可见螺形圈周围成骨。3例鼻咽纤维血管瘤局部穿刺栓塞后行手术治疗，手术中未行输血，完整摘除肿瘤。结论 局部穿刺栓塞治疗头颈部高血流病变是1种有效、安全的治疗方法。     

外伤性动脉破裂的血管内治疗

目的 探讨介入治疗在外伤性动脉破裂出血紧急情况下的使用价值。方法 全组76例均行股动脉穿刺插管选择性血管造影,明确诊断后,13例用气囊导管经血管腔内阻断血流后再行血管修补术;63例用固体栓塞材料闭塞材料闭塞受损伤的动脉,结果 全组经血管内治疗出血立即停止,无并发症,无致残,无死亡,结论气囊导管阻断血流为血管修补手术提供了一条简单易行,安全可靠的术前措施,用血管内栓塞可达到一次性治愈的效果。     

Endovascular treatment of high-risk tentorial dural arteriovenous fistulas: clinical outcomes

Introduction  An increasing number of intracranial dural arteriovenous fistulas (DAVFs) are amenable to endovascular treatment with Onyx-18. We reviewed our experience with the endovascular management of tentorial dural arteriovenous fistulas (TDAVFs) treated transarterially and transvenously. Materials and methods  Clinical records for 19 consecutive patients (three women, 16 men) with TDAVFs treated endovascularly between 2005 and 2008 were reviewed to determine their presenting symptoms, angiographic features, endovascular treatments, and clinical outcomes. Most patients (78.9%) presented with intracranial hemorrhage (ICH). All patients had high-risk angiographic features such as leptomeningeal venous varix. Results  Transarterial embolization was performed in 19 patients. Transvenous embolization was additionally performed in two patients and caused one death. At the time of the last follow-up evaluation, 16 (84.2%) patients had good or excellent outcomes (modified Rankin score, 0 or 1) and one (5.3%) was deceased. Six patients had a residual fistula and were treated with gamma knife radiosurgery. The overall morbidity and mortality rate was 10.5%. Conclusion  High-risk TDAVFs can be successfully managed with good outcomes. When anatomic features can be accessed endovascularly, endovascular treatment is indicated. Patients with residual filling of the DAVF should be considered for adjuvant therapy, including further radiosurgery.     

Endovascular Management of Superior Mesenteric Artery Pseudoaneurysm and Fistula

The uncommon presentation of an arterioportal fistula (APF) involving the superior mesenteric artery (SMA) associated with a pseudoaneurysm represents a therapeutic challenge. We present the case of a 24-year-old female admitted to the hospital after multiple gunshot wounds to the abdomen; the patient underwent multiple surgeries and, in the process, developed a SMA pseudoaneurysm and fistula. The vascular interventional radiology team was consulted for treatment of the pseudoaneurysm and fistula. A covered stent was inserted percutaneously to exclude the APF and the pseudoaneurysm in a single procedure. The patient returned to our service after 21 months for a follow-up CT scan, which demonstrated the stent and the distal vasculature to be patent.     

Imaging appearance of granulomatous lesions of head and neck

We aim to review the imaging appearance of granulomatous lesions of the head and neck. Granulomatous lesions are seen in different regions of the head and neck and a difficult diagnostic challenge for the radiologist. Infective granulomas may be due to bacterial or fungal agents. Non-infective granulomas are Wegener's granulomatosis, sarcoidosis, amyloidosis, chemical granuloma and reparative giant cell granuloma. Familiarity with the clinical presentation and imaging features of these lesions can suggest diagnosis in some cases. CT and MR imaging demonstrate the exact location, extension and effect on surrounding structures. A thorough knowledge of age, gender, common location, clinical features and imaging appearance of granulomatous lesions are important for diagnosis.     

Characterization of head and neck lesions with diffusion-weighted MR imaging and the apparent diffusion coefficient values

Purpose

The aim of this study was to determine the role of diffusion-weighted MR imaging (DWI) and the apparent diffusion coefficient (ADC) in characterization of head and neck lesions.

Patients and methods

MR imaging including diffusion-weighted sequences was performed on 43 patients presented with head and neck lesions. Images were obtained with a diffusion-weighted factor (b factor) of 100, 500, and 1000 s/mm². ADC maps were reconstructed, and the ADC value of the lesions was calculated.

Results

The mean ADC value of malignant tumors was (1.02 ± 0.22) × 10⁻³ mm²/s (n = 31). The mean ADC value of benign tumors was (1.62 ± 0.27) × 10⁻³ mm²/s (n = 12). The mean ADC of lymphomas was significantly lower than that of carcinomas. The difference in the ADC value between the malignant tumors and benign lesions was statistically significant (p < 0.001). Selection of (1.2) × 10⁻³ mm²/s as a threshold value of ADC for differentiating benign from malignant tumors yielded the best result, with an accuracy of 94%, sensitivity of 95%, specificity of 92%, positive predictive value of 92% and negative predictive value of 94%.

Conclusion

DWI and the ADC measurement are promising, non-invasive imaging approach that can be used for characterization of head and neck lesions. It can help differentiate malignant tumors from benign lesions.