肾动脉瘤的血管腔内治疗

目的评价血管腔内治疗对于肾动脉瘤（RAA）的安全性及疗效。方法回顾性分析11例接受血管腔内治疗的RAA患者,治疗方法包括单纯以弹簧圈填塞动脉瘤腔（6例）、载瘤动脉栓塞术（3例）和覆膜支架隔绝术（2例）,并随访3～68个月。结果11例患者共发现13个RAA（右肾9个,左肾4个）,均为真性囊状动脉瘤,对其中11例（11个RAA）行血管腔内治疗。术后5例出现栓塞后综合征,其中4例发生部分肾梗死,肾功能无异常;未见其他严重并发症。随访未见动脉瘤内残腔及内瘘,未见动脉瘤破裂及复发。结论血管腔内治疗RAA安全、有效,成功率高。     

肾动脉瘤14例诊治报告

为探讨肾动脉瘤(RAA)的特点和诊治方法,回顾性分析2015年6月-2019年10月我院收治的14例RAA患者的临床资料.14例患者中,男8例,女6例;年龄40～77岁,平均59.1岁;左肾RAA 6例,右肾RAA 7例,双肾RAA 1例;体检发现8例,表现为腰腹部疼痛5例,表现为血压骤升1例;2例RAA破裂,1例表现...     

离体肾动脉瘤修补、肾动脉重建和自体肾移植治疗复杂性孤肾肾动脉瘤一例并文献复习

目的探讨离体肾动脉瘤修补、肾动脉重建和自体肾移植技术治疗复杂性孤肾肾动脉瘤的安全性和可行性。方法CT血管造影（CTA）确诊复杂性孤肾肾动脉瘤1例,病变位于肾动脉主干分叉部,累及节段分支动脉,深入肾门内。肾脏暂时性离体后,在低温和肾脏灌注液灌注保护肾脏的前提下,体外进行肾动脉瘤修补和自体大隐静脉肾动脉重建,然后将肾脏异位移植到右侧髂窝。结果手术成功,围手术期无严重并发症发生。术后血肌酐暂时性升高至约200μmol／L,半个月后逐渐恢复正常;术后2周复查CTA示右髂窝移植肾动脉及其分支血流通畅无狭窄,肾静脉回流通畅,输尿管无狭窄。结论该方法治疗复杂性孤肾肾动脉瘤安全可行,并为以后类似的复杂性肾脏疾病的处理提供了可行方法。     

动脉瘤性蛛网膜下腔出血的血管内治疗

颅内动脉瘤是一种常见而又危害极大的脑血管疾病，一旦破裂出血其死亡率和致残率较高，而80％-85％的自发性蛛网膜下腔出血（SAH）是由颅内动脉瘤破裂引起。20世纪90年代，一种可脱性铂金弹簧圈装置（GDC）进入临床应用领域，随着栓塞材料的改进和栓塞技术的革新，运用血管内栓塞技术治疗动脉瘤预防再出血越来越广泛的应用于治疗颅内动脉瘤患．一些研究机构甚至建议将血管内栓塞作为治疗的首选方法。本研究主要探讨这些问题．明确血管内治疗颅内动脉瘤的安全性和有效性。     

肾动脉假性动脉瘤的栓塞治疗

目的探讨经皮肾动脉造影及栓塞治疗肾动脉假性动脉瘤的临床价值。方法 2012年1月~2014年2月15例泌尿系结石术后尿道出血,经皮肾动脉造影诊断为肾动脉假性动脉瘤,导管超选择进入载瘤动脉近端,使用弹簧圈和明胶海绵栓塞载瘤动脉。结果 15例经肾动脉造影均能清晰显示假性动脉瘤,其中位于叶间动脉11例,弓状动脉3例和小叶间动脉1例,经导管弹簧圈栓塞后尿道出血停止。1例介入栓塞术后2 d再次出现尿道出血,再次栓塞后出血停止。栓塞术后2例出现一过性肾绞痛;7例体温37.8~39.3℃,持续3~8 d。15例随访3~24个月(平均15个月),无肾功能不全和尿道出血发生。结论经皮肾动脉造影和经导管栓塞治疗肾动脉假性动脉瘤安全、有效。     

腔内治疗孤立性髂内动脉瘤21例

目的探讨孤立性髂内动脉瘤(ⅢAA)患者行腔内治疗的安全性和有效性。方法回顾性分析2011年7月至2017年7月本科收治的21例行腔内治疗ⅢAA患者的临床资料,包括基础疾病、手术时间、手术方式、围手术期并发症等情况。结果 21例患者均手术成功,平均手术时间(76.7±13.5)min,术后均恢复良好。术后平均住院时间(5.9±1.2)d,平均随访时间(24.3±6.7)个月,随访期间无患者死亡,除2例患者出现轻微臀肌跛行外,其余患者未有不适。结论腔内治疗术对ⅢAA患者治疗效果好,且相对于开放手术而言,其创伤小、恢复快,对患者的身体条件要求较低。     

血管内栓塞结合显微手术治疗颅内动脉瘤临床研究

目的应用显微手术夹闭、血管内栓塞和栓塞后手术夹闭3种治疗方法，探讨治疗颅内破裂动脉瘤的安全有效方案。方法显微手术瘤颈夹闭30个动脉瘤，栓塞34个动脉瘤，栓塞后夹闭15个动脉瘤。结果夹闭组30个完全夹闭，无复发，死亡率6％（2／30）。栓塞组完全闭塞率70．6％（24／34），复发率17．6％（6／34），死亡率11．8％（4／34）。栓塞后手术组15个完全夹闭，无复发，死亡率6．7％（1／15）。治疗结束用GOS评价，1个月后3组良好率分别为80．0％、79．4％和80．0％；半年后良好率分别为90．0％、88．2％和86．7％。结论显微手术瘤颈夹闭术仍然是治疗破裂动脉瘤的有效方法，具有1次治疗彻底和复发率低的优势，并可作为栓塞失败的补救手段。     

腔内修复术治疗孤立性髂动脉瘤14例

目的探讨腔内治疗孤立性髂动脉瘤的疗效。方法回顾性分析2004年10月至2006年5月腔内修复孤立性髂动脉瘤14例的临床资料。其中,右髂总动脉瘤8例,左髂总动脉瘤5例,左髂内动脉瘤破裂1例。髂动脉瘤腔内修复的标准是瘤体直径〉3．0cm。结果14例均取得技术成功。8例右髂总动脉瘤,钢圈栓塞右髂内动脉后选用分叉支架型人工血管行腔内修复术。其中1例右髂总动脉瘤累及腹主动脉下端,选用AUl支架型人工血管腔内修复加股．股动脉旁路术。5例左髂总动脉瘤栓塞同侧髂内动脉后选用直型支架型人工血管。1例左髂内动脉瘤破裂急诊行钢圈栓塞后选用直型支架覆盖左髂内动脉开口。术后即刻数字减影血管造影显示动脉瘤消失,远近端支架型人工血管与宿主动脉结合处均未见明显渗漏。1例术后出现急性左心功能不全和肺水肿,经抢救痊愈,其余13例无手术并发症。术后CTA随访10．2个月（3～19个月）,瘤体无增大,支架无移位,无内漏,旁路人工血管通畅。结论腔内修复术治疗孤立性髂动脉瘤具有可行、安全、微创等特点,近期疗效较好,远期效果需进一步随访。     

离体巨大肾动脉瘤切除、肾动脉成形和自体移植一例

肾动脉瘤是罕见的内脏动脉瘤，治疗巨大的肾动脉瘤的报道很少，我院采用肾切除后，在肾保护下行肾动脉瘤切除，肾动脉成形和自体肾移植的方法治疗右肾门处巨大肾动脉瘤1例，现报告如下。     

Rupture of a saccular renal artery aneurysm: report of a case

This paper reports a patient who was successfully treated for a ruptured renal artery aneurysm. A 64-year-old man presented with sudden onset of strong abdominal and lumbar pain, and a 2-week history of abdominal discomfort. Abdominal computed tomography and visceral arteriography revealed a retroperitoneal hematoma and a 7.5-cm saccular renal aneurysm with active bleeding. A laparotomy was indicated, and a nephrectomy was performed due to the persistent bleeding and refractory hypotension presented during surgery. The postoperative course was uneventful, and the patient was discharged with a normal renal function on the tenth day. This paper presents the successful management of a ruptured renal aneurysm with a review of the literature, and the management possibilities of such patients is also discussed. Received: August 7, 2001 / Accepted: January 8, 2002     

肾动脉瘤介入治疗的方法及疗效

目的 探讨肾动脉瘤(renal artery aneurysm,RAA)腔内介入治疗的方法及疗效.方法 回顾性分析2009年1月至2014年4月17例确诊为RAA并行介入治疗患者的临床资料.男7例,女10例.年龄20 ～ 67岁,平均(46.4±10.3)岁.体检发现5例,表现为腹痛和腰痛各4例,表现为间断性肉眼血尿2例,表现为乳糜尿和少尿各1例.多发9例,单发8例.17例共31个动脉瘤,其中真性动脉瘤26个,假性动脉瘤5个;囊状动脉瘤17个,纺锤形或梭形、不规则形、实质内动脉瘤各4个,夹层动脉瘤2个.8个动脉瘤位于肾动脉主干,19个位于肾动脉二级、三级分支,4个位于肾实质内.6例行瘤腔栓塞+载瘤动脉栓塞术,4例行瘤腔栓塞术,3例行载瘤动脉栓塞术,2例行裸支架辅助瘤腔栓塞术,1例行覆膜支架置入术,1例双侧RAA行右侧裸支架辅助瘤腔栓塞术+左侧瘤腔栓塞术. 结果 本组17例中16例一次手术成功.随访3～53个月,平均23个月,无严重并发症或死亡病例.术后1周3例尿潜血阳性者转为阴性.术后1个月12例的肉眼血尿、腹痛、腰背痛、发热等首发症状消失或明显减轻.术后3～12个月,实验室检查示SCr、BUN、尿常规等未见明显异常.复查超声或CT动脉造影示16例支架及弹簧圈无移位,8例载瘤动脉通畅,未见动脉瘤复发或瘤腔扩大.结论 RAA的腔内介入治疗创伤小、安全、有效.应根据RAA的具体情况制定手术方案.     

Selective embolization of splenic artery aneurysm – case report

Summary BACKGROUND: Embolization of visceral artery aneurysms has been increasingly accepted as a beneficial alternative to surgery. METHODS: The aim of this case report was to evaluate the feasibility of the endovascular therapy of a saccular aneurysm of the splenic artery at its first bifurcation. We approached the aneurysm with a supraselective catheter embolization using coils. RESULTS: After an interval of 4 weeks, we found a residual perfusion (0.3 by 0.6 mm) within the former neck in the control angiography. A repeat supraselective embolization was not favored because of catheter-induced vascular spasms of the splenic artery. A further 8 weeks later, control angiography revealed thrombosis of the previously diagnosed aneurysmatic sac, confirmed only minor residual flow through the thrombosed neck of the former aneurysm, and indicated sustained spleen blood supply as further revealed in later duplex ultrasonography follow-up. CONCLUSIONS: Selective coil embolization as first-line therapy to treat saccular splenic artery aneurysm is feasible.     

肝动脉瘤破裂影像学表现1例

患者女,46岁,主因无明显诱因突然剧烈腹痛就诊。查体：体温37．7℃,脉搏120次／分,呼吸20次／分,血压80／50mmHg。血常规：WBC23．30×10^9／L、HB73．2g／L。患者10年前曾因小肠动脉血管畸形接受小肠部分切除术。超声：肝脏大小正常,周边不规则,实质回声不均质,右叶可见多个局限性液性暗区,较大者大小约4．0cm×1．8cm,边界欠清,     

Ruptured distal middle cerebral artery aneurysm: Case report

INTRODUCTIONThis report describes a rare case of a distal middle cerebral artery (dMCA) aneurysm.PRESENTATION OF CASEThat developed a right intracerebral haematoma and subarachnoid haemorrhage. It was treated by surgical exploration and clipping via pterional approach.DISCUSSIONClinical findings and surgical approaches of dMCA aneurysm are different from proximal middle cerebral artery (MCA) aneurysms. Microneurosurgical clipping is the most effective treatment of dMCA aneurysm.CONCLUSIONWe comprehensively review the literature related to these rare aneurysms within the temporal lobe, surgical anatomy of the dMCA aneurysm.     

Endovascular treatment of ruptured pancreaticoduodenal artery aneurysm: The importance of collateral vessels. A case report

IntroductionTrue pancreaticoduodenal artery aneurysm occurrence is infrequent, but it is a fatal disease and accounts for accounts for <2% of all visceral aneurysms.Presentation of caseA 62-year-old man with a two-day history of epigastric pain was admitted at emergency department. CT showed a retroperitoneal haematoma due to a 1.5 cm posterior inferior PDA ruptured aneurysm. Angiography had been conducted immediately: both inflow and outflow of the aneurysm were embolized. Another CT scan had been conducted, which revealed residual flow inside the aneurysm sac fed by small collateral vessels. Sub-selective catheterization was repeated and definitive haemostasis was obtained by embolizing the collateral vessels. Postoperative course was uneventful. CT scan follow-up at 36 months showed no abnormalities.DiscussionThe incidence rate of pancreaticoduodenal artery aneurysm rupture has been estimated to be less than or equal to 65%. In the case of rupture the treatment is challenging and mortality had been reported up to 50%. Endovascular treatment showed superior results as compared to surgical treatment of aneurysms, especially in emergency settings.ConclusionThe authors elucidate the importance of occlusion of inflow and outflow of the aneurysm in conjunction with the occlusion of collateral vessels to avert reperfusion of the sac. Simultaneous handling of celiac axis stenosis is still prone to controversy: no relapse of aneurysm have been reported in patients with celiac axis stenosis at long-term follow-up, simultaneous treatment should be reserved when angiography is alarming for likely hepatic or duodenal ischemia.     

肾动脉狭窄的腔内治疗经验

目的探讨腔内治疗肾动脉狭窄的临床疗效及影响因素。方法2003年2月至2005年6月共收治19例肾动脉狭窄患者,分析其中行腔内治疗12例的临床资料。其中动脉硬化9例,多发性大动脉炎1例,纤维肌性发育不良2例。结果本组12例,均有严重高血压,1例肾功能异常。支架置入10例,技术成功率91．7％(11／12)。随访12例,随访时间3—15个月,随访平均6．5个月,患者血压从(172±26／98±15)降至(156±22／88±14)mmHg。高血压治愈2例,改善6例,未愈4例,高血压控制率为66．7％。术后肾功能无明显变化。无并发症和死亡病例。再狭窄1例,再狭窄率为8．3％。结论严格掌握手术适应证,腔内治疗肾动脉狭窄是安全、有效的。     

小肾癌误诊为肾动脉瘤1例

患者男,57岁。5年前无明显诱因出现双侧腰背部钝痛,伴尿频、尿急,无恶心、呕吐,无血尿,无发热。近半年体质量下降约15 kg。查体：右肾区压痛,双肾区叩击痛。1个月前肾脏CT检查见右肾肾窦内等密度结节灶,