腔内微创治疗感染性动脉瘤

感染性动脉瘤并不多见 ,传统的外科手术 ,在切除瘤体后 ,因感染造成血管壁组织的严重破坏以及对血管再生的不良影响 ,血管重建困难 ,难于避免移植物感染 ,易导致手术失败。随着导管技术的进步和影像器材的发展 ,血管腔内微创治疗的应用范围不断扩展 ,技术手段不断提高 ,我们应用腔内微创治疗 14例感染性动脉瘤 ,报道如下。临床资料一、一般资料1997年 8月～ 2 0 0 2年 10月共收治 14例不同类型的感染性动脉瘤患者。男 9例 ,女 5例 ,年龄49～ 73岁 ,平均 6 3岁。有高血压病史者 9例 ,有高血脂者 8例。腹主动脉假性动脉瘤 7例 ,胸主动脉假性动…     

血管腔内治疗腹腔干动脉瘤16例效果分析

目的 探讨腹腔干动脉瘤(CAA)血管腔内治疗方法.方法 回顾性分析2011年6月至2015年12月共16例连续的CAA患者腔内介入治疗情况.11例单纯弹簧圈栓塞术,4例弹簧圈栓塞加覆膜支架植入术,1例多层裸支架植入术.术后第3、6、12个月及之后每年随访复查CTA,记录并评价围手术期和随访期临床结果指标.结果 手术技术成功率为100％.平均手术时间(91.56±39.30) min,平均住院时间(5.25±1.44)d.所有患者术后均经规律随访1～54个月,总生存率100％,CTA复查未发现弹簧圈异位、支架移位,瘤体增大、破裂或再通.结论 血管腔内治疗CAA技术成功率高,并发症发生率、死亡率低,是一种安全有效的治疗方法.     

腹主动脉复合动脉瘤的腔内隔绝术治疗

目的：讨论复合腹主动脉病变进行腔内隔绝术（EVE）的可行性。方法：1例腹主动脉并存真性、假性和夹层动脉瘤患者，经双侧股动脉切开、肱动脉切开引入贯穿导丝，利用导丝导向技术和牵张技术成功置入模块式支架-人造血管移植物，以隔绝瘤体。结果：腔内隔绝操作技术完全成功，3个瘤体同时被隔绝，未加用任何延伸移植，未出现内漏、移位等并发症，重建血流通畅。结论：本例为EVE扩大适应证提供了经验。     

主动脉夹层动脉瘤腔内修复术围手术期护理体会

目的：总结腔内修复术治疗主动脉夹层动脉瘤的护理经验。方法：根据主动脉瘤及腔内修复术的特点,对7例行此手术的患者进行基础护理、心理护理、心肺脑监护、血压控制、发热护理、器官供血状况及下肢动脉栓塞的观察和出院指导。结果：手术均获成功,无内漏,无手术死亡,未发生肾功能衰竭及截瘫。7例术后均有不同程度的发热,经及时治疗和护理恢复良好。结论：腔内修复术精心和专业的围手术期观察护理是提高手术疗效的有效保证。     

血管腔内隔绝术治疗降主动脉夹层动脉瘤6例

主动脉夹层动脉瘤为凶险的疾病。传统的治疗方法为主动脉人工血管置换，创伤大，死亡率、并发症都较高。应用人造血管覆膜支架进行血管腔内隔绝术治疗为一种较新的治疗手段。我院于2003—09～2006—03，行腔内隔绝术治疗主动脉夹层动脉瘤6例，报告如下。     

肾血管平滑肌脂肪瘤合并肾内动脉瘤一例

病例 女,47岁.因1周前健康体检时行B超检查发现左肾占位性病变而入院.平素健康,无腹胀、腹痛,无腰痛,无尿频、尿急、尿痛,无畏寒、发热,无肉眼血尿、脓尿.查体:T 36.2℃,P 72次/min,R 18次/min,BP 120/80 mmHg,双肾区无饱满,无叩击痛.双侧输尿管走行区无压痛.实验室检查:外周血WBC 12.2 × 109/L、中性粒细胞7.5 × 109/L;肝肾功能正常.     

主动脉夹层动脉瘤腔内修复术围手术期护理

目的：总结腔内修复术治疗主动脉夹层动脉瘤的护理经验。方法：根据主动脉瘤及腔内修复术的特点,对7例行此手术的患者进行基础护理、心理护理、心肺脑监护、血压控制、发热护理、器官供血状况及下肢动脉栓塞的观察和出院指导。结果：手术均获成功,无内漏,无手术死亡,未发生肾功能衰竭及截瘫。7例术后均有不同程度的发热,经及时治疗和护理恢复良好。结论：腔内修复术精心和专业的围手术期观察护理是提高手术疗效的有效保证。     

烟雾病合并颅内血流相关性动脉瘤的血管内治疗

目的探讨烟雾病合并颅内血流相关性动脉瘤的血管内治疗。方法 2010年1月—2012年3月收治8例烟雾病合并颅内动脉瘤患者,经CT检查证实6例为蛛网膜下腔出血,1例为脑室内出血,1例为缺血症状。对患者行血管内栓塞治疗,其中采用单纯弹簧圈栓塞5例,支架辅助栓塞1例(基底动脉顶宽颈动脉瘤),氰基丙烯酸正丁酯液态胶栓塞1例,1例失败。结果 7个动脉瘤位于Willis环周围,1个动脉瘤位于胼周动脉远段分支动脉。8例中,7例经血管内栓塞治疗成功,动脉瘤栓塞术后5 min复查造影,完全栓塞4例,几乎完全栓塞2例,不完全栓塞1例,术后随访结果良好。结论血管腔内栓塞治疗烟雾病合并颅内动脉瘤安全、有效,对外周动脉型动脉瘤也可予栓塞治疗。     

经皮肾动脉腔内成形术治疗肾血管性高血压

目的：评价经皮穿刺肾动脉腔内成形术（PTRA）对肾血管性高血压的治疗效果。方法：1983年3月至1996年12月，对21例肾血管性高血压的24支狭窄肾动脉（双侧者3例）施行了PTPA治疗。根据术中狭窄部位动脉压差改变及临床血压变化对其疗效进行了评价。结果：从21例进行了PTRA的24支狭窄肾动脉中，18支（75%）立刻获得技术成功。后经随访的12例病人中，3年疗效；治愈9例（75%），改善2例（16.7%），无效1例（8.3%）；5年疗效：治愈7例（58.3%），改善2例（16.7%），无效3例（25%）。结论：PTRA对肾血管性高血压的治疗是一种简便，安全，且有较好远期疗效的方法。     

介入治疗基底动脉夹层动脉瘤效果分析

目的 评价血管内介入治疗基底动脉夹层动脉瘤的安全性、有效性.方法 回顾性分析2009年1月至2015年4月在我院接受血管内介入治疗的26例基底动脉夹层动脉瘤患者.按瘤体大小分为大型-巨大型组和中小型组,比较两组患者治疗效果.记录并发症和随访情况.结果 26例基底动脉夹层动脉瘤患者均获得成功治疗,其中接受单纯支架植入9例,支架植入结合弹簧圈栓塞17例.围手术期共发生5例并发症,其中3例为后循环梗死(单纯支架组1例,支架结合弹簧圈组2例),2例为小脑出血(均发生于支架结合弹簧罔组),随后4例恢复良好出院,1例支架内急性血栓形成死亡.22例患者获得DSA随访,结果显示12例改善,7例稳定,3例复发(2例有新发症状).亚组分析显示单纯支架组并发症发生率低于支架结合弹簧罔组,两组远期疗效相当;大型-巨大型组并发症发生率和严重残死率均高于中小型组,差异均有统计学意义(P=0.020,Z=3.247).结论 血管内介入治疗基底动脉夹层动脉瘤有较好的安全性和有效性.多重支架技术仍然是目前优先推荐的术式,需依据不同病变特点确定是否使用弹簧罔辅助.大型和巨大型夹层动脉瘤治疗仍然棘手,需要进一步研究.     

血管内栓塞治疗大脑前动脉A1段近端动脉瘤破裂十例

目的 探讨血管内栓塞治疗大脑前动脉(ACA)A1段近端动脉瘤的可行性和有效性.方法 2008年3月-2013年10月采用血管内栓塞治疗破裂的ACA A1段近端动脉瘤10例,回顾性分析其临床资料和疗效.结果 所有的患者血管内治疗均获得了成功,6例单纯采用弹簧圈栓塞术,1例单纯采用支架植入术,3例采用支架辅助弹簧圈栓塞术.术后即刻血管造影显示9例动脉瘤腔完全闭塞,1例单纯支架植入术见瘤腔内对比剂滞留,无手术相关的并发症发生.临床随访6～ 60个月未发生颅内再出血和缺血并发症.7例术后6～ 12个月行DSA随访,动脉瘤瘤腔完全性阻塞,未见载瘤动脉狭窄及闭塞.结论 采用血管内栓塞治疗破裂A1段近端动脉瘤是可行的、有效的.为保证成功栓塞,恰当的微导管塑形是必须的,必要时还需结合辅助技术.     

支架治疗颈内动脉分叉部宽颈动脉瘤

目的初步评价支架治疗颈内动脉分叉部宽颈动脉瘤的可行性、安全性和有效性。方法收集2004年1月至2010年12月11例颅内动脉瘤患者,共检出16枚颅内动脉瘤。其中位于颈内动脉分叉部的11枚动脉瘤均为宽颈动脉瘤,动脉瘤直径2.5～18 mm。所有患者采用不同类型支架及支架技术治疗,并于术后1、3、6、12个月进行随访。结果治疗中采用不同类型支架11枚,其中球扩支架1枚,自膨胀支架10枚。动脉瘤即刻栓塞结果按Raymond分级.Ⅰ级4枚,Ⅱ级2枚,Ⅲ级5枚。未发生手术相关并发症,出院时改良Rankin评分0～1分11例。11例患者随访1～108个月,均病情稳定,无新发的神经功能障碍。影像学随访7例,随访时间1～48个月,动脉瘤不显影4例,改善2例,稳定1例。结论对于颈内动脉分叉部宽颈动脉瘤,支架治疗技术可行,且安全有效,长期疗效有待于进一步研究。     

Emergent endovascular treatment of ruptured vertebral artery dissecting aneurysms

The goal of this study was to evaluate the results of endovascular and surgical treatments for ruptured vertebral artery dissecting aneurysms (VADAs) to determine which treatment is preferable. We evaluated the cases of 25 consecutive patients with ruptured VADAs treated in our institution. From 1992 to 1997, five patients were treated surgically. Since 1998, 20 patients with VADAs have been treated with endovascular therapy. The goal of the treatment was to exclude the aneurysm from the circulation. Among the five patients undergoing surgery, three aneurysms were treated with proximal clipping, one with trapping, and one with dome clipping. None of the patients were treated during the acute stage of rupture. Transient complications occurred in two patients. Of the 20 patients treated through the endovascular approach, 15 were treated within 24 h of rupture, but 12 had rebleeding before treatment. Eighteen aneurysms were occluded, along with the affected vertebral artery (VA), by using detachable coils (internal trapping), and one was occluded with the VA preserved. A stent-assisted occlusion of one aneurysm was done in a patient who had a contralateral hypoplastic VA. In both groups, the outcome of each patient depended greatly on the patients condition before treatment and whether there was rebleeding. No posttreatment bleeding occurred. All procedures were effective, but endovascular treatment was less invasive and easier to use during the acute stage of subarachnoid hemorrhage. Although this report does not describe a controlled study, we found that endovascular treatment is preferable for treating ruptured VADAs in the acute stage.     

小脑后下动脉瘤血管内栓塞治疗的初步临床研究

目的 探讨小脑后下动脉(PICA)瘤栓塞治疗的方法及效果.方法 回顾性分析21例PICA瘤经血管内栓塞治疗的临床资料,根据DSA资料估计动脉瘤的解削分段.采取单纯弹簧圈栓塞8例、单纯液体胶栓塞5例、弹簧圈联合液体胶栓塞2例、支架辅助弹簧圈栓塞2例、球囊辅助弹簧圈PICA闭塞4例,用格拉斯哥预后(GOS)评分评估疗效.结果 单纯弹簧圈致密栓塞5例,90%以上栓塞2例,85%栓寒1例;单纯液体胶栓塞的5例及弹簧圈联合液体胶栓塞的2例均达到致密栓塞;支架辅助弹簧圈栓塞的2例90%以上栓塞;球囊辅助弹簧圈完全闭塞载瘤动脉3例,90%以上栓塞1例.术后脑干穿支动脉闭塞导致死亡1例,术后1周新发神经功能障碍1例,其余未见再出血及小脑损害症状.术后随访6～60个月,平均(22±8)个月.COS评分Ⅰ级1例,Ⅱ级1例,Ⅲ级2例,Ⅳ级5例,Ⅴ级12例.结论 根据PICA瘤的解剖分段选择不同的栓塞方法,可取得良好的治疗效果.     

Emergency endovascular treatment with stent graft of a gastric artery aneurysms (GAA)

The purpose of this paper is to present a case of emergency endovascular treatment of a symptomatic gastric artery aneurysm (GAA) with stent graft. A symptomatic aneurysm of a “gastro-hepatic” trunk in a 63-year-old patient was excluded with stent graft. Treatment was successful and without complications. Follow-up computed tomography-angiography confirmed the exclusion of the aneurysm after 6 months. Endovascular therapy with stent graft can be considered a feasible and effective approach for the treatment of GAAs in patients with suitable anatomy.     

Giant aneurysms of the internal carotid artery: endovascular treatment and long-term follow-up

We report the long-term follow-up of 18 patients with giant aneurysms of the internal carotid artery (ICA) referred for endovascular occlusion of the parent vessel. There were 10 aneurysms involving the infra- and/or supraclinoid cavernous segment, six the ophthalmic segment, one the petrous segment and one the bifurcation. One patient who did not tolerate test occlusion was treated medically. Clinical and imaging follow-up were obtained in 16 patients for a mean of 30 months, range 6–80 months. Endovascular treatment led to excellent clinical outcome in 16 patients. One 34-year-old woman, who presented with subarachnoid haemorrhage (SAH), died from bilateral middle cerebral artery infarcts due to severe vasospasm 4 days after treatment. The patient treated medically died from SAH. Long-term imaging follow-up in 16 patients revealed a markedly smaller aneurysm sac in all cases.     

Idiopathic aneurysms of distal cerebellar arteries: endovascular treatment after rupture

Introduction Idiopathic ruptured aneurysms of distal cerebellar arteries (DCAAs) are rare, and their endovascular therapy (EVT) has as yet not been extensively reported. They are usually assumed to result from local arterial wall disruption rather than infection, unlike distal supratentorial artery aneurysms. This study was performed to audit their frequency, potential aetiology and results of EVT. Patients and methods Using strict inclusion criteria and a database of 1715 EVT patients, we identified ten idiopathic ruptured DCAAs (0.6%) over a 13-year period (1993–2006). The series comprised six males and four females with mean age of 64 years and solitary aneurysms located on posterior inferior cerebellar artery (five patients), anterior inferior cerebellar artery (three patients) and superior cerebellar artery (two patients). Nine aneurysms were fusiform and were treated by endovascular parent artery occlusion, and one was saccular and treated by endosaccular packing. Endovascular therapy was performed with coils in seven cases, n-butyl-2-cyanoacrylate (NBCA) in two cases and with both in one case. Results Primary EVT was successful in eight patients. One patient died following a procedure-related re-bleeding and one patient required re-treatment after failed endosaccular packing. Nine patients made good or excellent clinical recoveries (modified Rankin Scale 2 or less). Focal cerebellar infarctions were seen on computed tomography images after EVT in three patients, only one of whom was symptomatic with transient dysmetria, which resolved completely during follow up. No aneurysm recanalisation was detected on late follow-up imaging up to 24 months. Conclusion Ruptured DCAAs are rare. The majority are fusiform in shape and their aetiology remains uncertain. Endovascular treatment is feasible and effective. It usually requires parent artery occlusion.     

颅内夹层动脉瘤血管内治疗进展

夹层动脉瘤是颅内血管病变少见疾病之一.它是指病理性夹层发生在动脉中膜层内或中膜和外膜之间造成动脉壁膨出,发生的动脉瘤样扩张.其动脉瘤壁破裂引起的蛛网膜下腔出血是导致患者致残、致死的主要原因.由于颅内夹层动脉瘤各自不同的临床特点,尚无统一的治疗方案.目前国内外对颅内夹层动脉瘤的治疗方式主要有闭塞载瘤动脉、支架辅助弹簧圈栓塞等,两者长期随访研究结果显示缺血及出血事件无明显差异.目前国内外更为关注的是载瘤动脉的重建.一些新的治疗理念如多支架重叠重建载瘤动脉等越来越得到多数学者的推崇.本文就其血管内治疗进展予以综述,为临床治疗提供理论参考.