先天性肾动静脉畸形的栓塞治疗

目的评价经导管动脉栓塞治疗先天性肾动静脉畸形的价值。方法回顾性分析7例以肉眼血尿为主要症状的先天性肾动静脉畸形,选择性肾动脉造影确诊为肾动静脉畸形后,超选择性病变动脉插管,用明胶海绵、无水乙醇、弹簧钢圈等对病变血管进行栓塞治疗。结果所有7例先天性肾动静脉畸形都成功栓塞,栓塞24h内7例肉眼血尿消失,术后1周内可有栓塞侧腰部酸痛、低热、腹胀、恶心、呕吐等症状,但无严重并发症。随访36～98个月无血尿复发,肾功能正常。结论经导管肾动脉造影能明确诊断,动脉栓塞安全有效,对先天性肾动静脉畸形的治疗有重要意义。     

Transpleural ultrasound diagnosis of a pulmonary arteriovenous malformation

Pulmonary arteriovenous malformations (PAVMs) are rare. We discuss a case of an 81-year-old female who attended hospital with a haemothorax. Ultrasound not only demonstrated an echogenic effusion in the right pleural space, but also identified an associated tubular structure. Doppler was applied to this structure, which exhibited pulsatile flow. This raised the possibility of a PAVM, which was subsequently confirmed on CT and angiography. Although, PAVM is a rare cause of haemothorax, the diagnosis should still be considered and transpleural ultrasound can detect these malformations non-invasively by the bedside.     

Spontaneous occlusion of a massive arteriovenous malformation—Case report

Summary An unusual case of sudden subtotal occlusion of a massive AVM is reported and briefly discussed. It is the first angiographically demonstrated occurrence of this uncommon phenomena associated with middle cerebral artery thromboses.

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Spontanverschluß einer ausgedehnten arteriovenösen Mißbildung (Fall-Besprechung)

Zusammenfassung Fall-Besprechung einer arteriovenösen Mißbildung mit spontaner Rückbildung nach thrombotischem Verschluß der A. cerebri media.

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Occlusion spontanee d'une importante malformation arterio-veineuse. a propos d'un cas

Résumé Les auteurs rapportent et discutent brièvement un cas inhabituel d'occlusion brutale et sub-totale d'une importante malformation artério-vaineuse. Il s'agit de la première démonstration angiographique de ce phénomène peu commun associé á des thromboses de l'artère cérébrale moyenne.

     

Transcatheter embolization of an arteriovenous malformation of the scrotum

There are several vascular abnormalities that could affect the scrotum. The commonest is a varicocele, and differentiation between this and other lesions is possible using Doppler ultrasound and pelvic angiography. A patient with a scrotal arteriovenous malformation (AVM) is presented in whom transcatheter embolization was possible.     

肺动静脉畸形的影像学诊断

<正> 肺动静脉畸形(pulmonary arteriovenous malformation,PAVM)在临床较为罕见,但其可引起严重的临床症状,如脑梗死、致命性大咯血等,故及时、准确地诊断尤为重要。本文回顾性分析经手术及肺动脉造影确诊的PAVM 7例,旨在提高其诊断水平并评价各种影像学检查方法的优势。1 资料与方法1.1 一般资料搜集自2005～2010年经手术及肺动脉造影确诊的PAVM患者7例,其中男3例,女4例;年龄13～56岁。7例均否认有家族史。     

Generalized skull vault thickening in association with a large arteriovenous malformation

Generalized thickening of the skull is unusual but has a number of recognized associations such as chronic severe anaemia, Paget disease and phenytoin therapy. We report a case of generalized skull vault thickening seen in association with a large arteriovenous malformation of the brain.     

明胶海绵在介入治疗肾动静脉畸形中的应用

先天性肾动静脉畸形(renal arteriovenous malformation, RAVM)以突发性、顽固性血尿为主要症状, 超声检查、静脉肾盂造影(IVP)、CT 和MRI往往难以显示病变,而肾动脉DSA检查能明确诊断.超选择性肾动脉栓塞治疗RAVM,因其创伤小、恢复快、效果显著、费用低,已成为治疗先天性RAVM的首选方法[1-2].本院自2007-01-2010-07间利用数字减影血管造影(DSA)成功地诊断RAVM 11例,同时进行了超选择性肾动脉明胶海绵颗粒栓塞治疗,获得满意效果,报告如下.     

Secondary arteriovenous malformation due to subclavian vein occlusion

An 80-year-old man underwent rectal resection and insertion of a central venous catheter through the left subclavian vein 16 years earlier. Following surgery, he developed edema of his left upper limb that became exacerbated and infected. Computed tomography showed occlusion of the subclavian vein and multiple arteriovenous shunts from the branches of the axillary artery to the venous sac of the axillary vein. Angiography confirmed numerous shunts between the branches of the axillary artery and vein and dilated collateral veins. Embolization of the venous sac was performed using coils, alcohol, and glue. Postprocedural angiography showed complete eradication of the nidus.     

Contrast-enhanced MRA in pre-embolization assessment of a pulmonary arteriovenous malformation

We describe a case of a single pulmonary vascular malformation studied with a new contrast-enhanced three-dimensional MRA technique. Images provided the interventional radiologist with a pre-embolization road map from which information regarding the number and size of feeding and draining vessels was obtained accurately and noninvasively.     

Transcatheter occlusion of the arterial supply to arteriovenous fistulas with Gianturco coils.

Transcatheter occlusive therapy is finding widespread clinical application. Numerous types of occlusive devices have been described. This report details the first three cases of occlusion of the arterial supply to arteriovenous fistulas with Gianturco stainless steel coils. Patients benefiting from this approach include those who refuse or cannot tolerate surgery, those in whom previous surgery failed, and those with chronic fistulas in whom surgery is likely to fail. The angiographer should make sure the coil is completely within the desired vessel, the feeding vessel is smaller than the coil to prevent passage through the fistula, and there is adequate collateral flow to distal organs to prevent infarction after occlusion of a major artery. This technique is useful as a nonsurgical treatment for a variety of arteriovenous fistulas and is within the capability of any experienced angiographer.     

肺动静脉畸形经导管封堵术的疗效评价

目的对肺动静脉畸形(AVM)经导管封堵术进行疗效评估。方法16例肺AVM患者接受经导管弹簧圈栓塞术治疗,其中5例同时辅以经导管可脱式球囊栓塞术或国产自制双伞形血管封堵器置入术治疗。对所有患者的家族史,术前和术后的临床表现,动脉血气分析以及其影像学表现等作了回顾性分析。16例患者术后平均随访(21±1)个月,根据其胸部CTA检查结果及动脉血气分析结果评估疗效,并对其术前和术后血氧饱和度(SaO2)、动脉血氧分压(PaO2)进行统计学分析。结果16例首次经导管封堵治疗技术成功率75%(12/16),再次经导管封堵治疗技术成功率100%。16例患者术前SaO2平均值为(76±5)%,PaO2平均值为(46±3)mmHg;术后SaO2平均值上升为(94±5)%,PaO2平均值上升为(62±3)mmHg,与术前相比差异均有统计学意义(P<0.01和P<0.05)。术后随访,所有患者无症状复发,胸部CTA检查未发现明显血管再通。结论采用经导管弹簧圈栓塞术,或同时辅以经导管可脱式球囊栓塞术或国产自制双伞形血管封堵器置入术等治疗肺AVM,可获得满意的临床疗效。     

Transcatheter occlusion of inferior mesenteric arteriovenous fistula: A case report

Transcatheter embolization of the inferior mesenteric artery with steel coils was performed for the control of massive lower gastrointestinal bleeding and sepsis. The bleeding and sepsis was caused by a very large arteriovenous fistula of the inferior mesenteric vessels. This iatrogenic lesion developed and became symptomatic just 5 weeks after an anterior resection of the rectum was performed. Following embolization, the patient made a speedy recovery from the sepsis and no recurrent bleeding was noted.     

Three-dimensional gadolinium-enhanced magnetic resonance angiography of pulmonary arteriovenous malformation

Pulmonary arteriovenous malformations (AVMs) are rare vascular malformations of the lung. Although most patients are asymptomatic, AVMs can bleed and result in haemoptysis and haemothorax. We describes a case of pulmonary AVMs in a patient with Osler-Weber-Rendu syndrome with 3-D contrast-enhanced MR angiography. Magnetic resonance angiography provided accurately and non-invasively the number and size of the feeding arteries and draining veins.     

A small pulmonary arteriovenous malformation as a cause of recurrent brain embolism

We report a case of recurrent paradoxical brain embolism mediated through a small pulmonary arteriovenous malformation (PAVM) with a 1.8-mm-diameter feeding artery. In this case, the further recurrent stroke was prevented successfully by PAVM embolization. Although embolization therapy is currently recommended only for PAVMs with feeding arteries greater than 3 mm in diameter, the therapy may be needed also in the smaller PAVMs.     

Iatrogenic pulmonary artery perforation associated with 5-Fr catheter manipulation during pulmonary arteriovenous malformation embolization with a vascular plug

Vascular plugs have been increasingly used because they have lower recanalization rates than coil embolization in pulmonary arteriovenous malformation (PAVM) embolization. To deliver the vascular plug close to the PAVM, a large-diameter catheter should be advanced into the feeding pulmonary artery, which carries a risk of vascular damage. Fifty-three-year-old women was admitted to our hospital for embolization of a single PAVM. Pulmonary angiography revealed a simple PAVM with a tortuous, small feeding artery in the right middle lobe, and feeding artery negotiation was attempted using a 5-Fr headhunter-type catheter to deliver the vascular plug. However, unintentional arterial perforation occurred suddenly when the guide wire was withdrawn after the catheter was advanced to the feeding artery adjacent to the sac. Immediate embolization using a vascular plug and microcoils at the proximal site of the perforation was performed to stop both PAVM shunt flow and bleeding. To prevent such a catheter-induced complication, it is necessary to select a diagnostic catheter with appropriate stiffness and angle and to switch to a small-diameter delivery system depending on the situation.     

Dual use of an amplatzer device in the transcatheter embolization of a large high-flow renal arteriovenous fistula

Embolization procedures are now considered the first-line therapy in the treatment of renal arteriovenous fistulas (AVFs). However, a risk posed by the use of these minimally invasive techniques is the migration of occluding agents into the venous and pulmonary circulations. The risk is of particular importance for larger, high-flow fistulas. The authors describe a case in which an Amplatzer Vascular Plug (AVP) was opened upstream of a renal AVF in the dilated feeding artery and used as a filter and a buttress during coil embolization to prevent coil migration during the treatment of the large, high-flow renal AVF. It was then removed and used again as the final embolic device in the renal artery, performing a dual role in the closure of the renal AVF.