Endovascular repair of traumatic arteriovenous fistula between axillary artery and vein

Traumatic arteriovenous fistula between the axillary artery and vein may present a difficult problem in treatment. There are few reports demonstrating the endovascular repair of this challenge. Herein, we present such a case of endovascular repair of traumatic arteriovenous fistula between the axillary artery and vein with false aneurysm formation. The patient was discharged 11 days after successful operation. Oral clopidogrel and aspirin were administerted for 18 months. At one year follow-up, the patient was in good condition and showed no evidence of neurological deficit in the left upper limb.     

肝脏创伤性假性动脉瘤和动静脉瘘的诊治

目的 探讨肝脏创伤性假性动脉瘤(post-traumatic intrahepatic pseudoaneurysm，HPA)及动静瘘瘦(arteriovenous fistula,AVF)的临床特点及诊疗手段。方法 肝创伤性HPA／AVF病人13例，对其临床资料进行回顾性总结。结果 其主要病因为严重肝破裂伤和深部肝穿刺伤(10例)，病变部位肝右叶(8例)＞左叶(3例)＞肝门部(2例)，症状以迟发性出血伴腹痛为主(11例)，诊断率贴A＞CT＞B超。治疗包括肝动脉栓塞治疗(7例)，肝叶切除(3例)，瘤体切除、肝动脉结扎(2例)，1例未做特殊治疗。结论 创伤性HPA／AVF是肝外伤后迟发出血的重要原因，肝动脉造影及栓塞术是该类疾病的主要诊疗手段。     

Surgical treatment of post—traumatic pseudoaneurysms and arteriovenous fistulas

Objective:To report the experience in the diagnosis and treatment of post-traumatic pseudoaneurysms and arteriovenous fistulas.Methods:A series of 30 patients(11 women and 19 men) with posttraumatic pseudoaneurysms were reviewed retrospectively.Among them 7 patients (5 women and 2 men) were associated with arteriovenous fistula.Results:The causes included sharp penetration trauma(18 cases),blunt trauma (6 cases) and iatrogenic arterial injury (6 cases).The main clinical manifestations consisted of local pulsatile mass (26 cases),vascular bruits (19 cases),thrill (13 cases),ischemia of distal limb (9 cases),neuropathy (5 cases) and pseudoaneurysm rupture (2 cases).All patients underwent surgery.The operations included:ligation of the vessels (12 cases),surgical resection and primary suture repain of the vascular defect or anastomosis (11 cases),vascular reconstruction with autogenous saphenous vein (3 cases) and synthetic vascular graft (4 cases).Conclusions:Because of the imminent clinical course,early operation is usually indicated.The operative treatment is effective and safe for most of the patients with post-traumatic pseudoaneurysms and arteriovenous fistulas.     

外伤性三尖瓣关闭不全的外科治疗

目的　总结报告外伤性三尖瓣关闭不全外科治疗的时机、方法和近、远期效果。方法　1984年5月至2 0 0 4年9月,外科治疗8例外伤性三尖瓣关闭不全的病人,均为男性;年龄7～6 7岁,中位数38岁。7例胸部钝伤(其中车祸3例) ,1例刀戳伤。从外伤到手术治疗的间隔时间为1个月～2 0年,中位数19个月。术前心功能(NYHA) 2～4级,平均(2. 3±0. 7)级。均经超声心动图确定诊断。术中发现8例均有前叶腱索断裂,1例同时伴隔叶腱索断裂,且右室和瓣环均有不同程度扩大。3例行三尖瓣成形术,5例成形失败行三尖瓣置换术。结果　全组术后恢复良好,无并发症发生,3例三尖瓣成形术者出院时仅1例轻度三尖瓣反流。术后住院7～2 4d ,平均(16. 6±6. 5 )d。随访7～12 9个月,中位数39个月,心功能均为I级。结论　外伤性三尖瓣关闭不全的外科治疗效果良好,一经确诊为重度反流应尽早手术治疗,以增加三尖瓣成形的可能性。三尖瓣成形术和瓣膜置换术近、远期效果均较理想,但应首先考虑三尖瓣成形术     

创伤性血管病变的腔内治疗

目的 探讨微创血管腔内技术治疗创伤性血管病变的可行性。方法 对已进行腔内治疗的6例创伤性血管病变进行回顾性分析。结果 6例创伤性血管病变包括颈总动脉假性动脉瘤、锁骨下动静脉瘘、胸主动脉假性动脉瘤、髂动静脉瘘、髂动脉假性动脉瘤、股浅动脉假性动脉瘤各1例。所有病变均在局部麻醉下进行，经腔内移植物治疗后均立刻重建血流通道。6例均得到随访，2个月至4年内所有移植物均通畅。无任何并发症。结论 腔内技术治疗创伤性血管病变具有成功率高、并发症少、损伤小等优点，可望成为创伤性血管病变的重要治疗手段。     

Balloon occlusion of traumatic vertebral arteriovenous fistula

A case of arteriovenous fistula of the vertebral artery following percutaneous angiography is reported. Successful obliteration of the fistula was achieved by an inflated Fogarty balloon that was placed during angiographic observation. The vascular dynamics of the fistula permitted a safe, one-stage procedure.     

肾动静脉瘘的腔内治疗

目的评估腔内治疗肾动静脉瘘(RAVF)的安全性及有效性。方法回顾性分析13例接受腔内治疗的RAVF患者资料。结果对13例RAVF患者行腔内治疗的技术成功率为100%(13/13),栓塞病变动脉共23条,治疗应用弹簧圈共78个。腔内治疗对RAVF患者血尿的有效率为100%(11/11),腰部疼痛有效率为85.71%(6/7),高血压有效率为100%(3/3)。RAVF患者术前血肌酐平均值[(94.50±29.82)μmol/L]与术后血肌酐平均值[(94.25±28.85)μmol/L]差异无统计学意义(P0.05)。术后无严重并发症,仅3例出现低热,2例患侧腰部不适。术后平均随访(37.23±16.78)个月。2例失访,余11例患者均无复发症状。结论腔内治疗对RAVF患者安全、有效且并发症较少。     

硬脊膜动静脉瘘的手术治疗

目的探讨硬脊膜动静脉瘘的手术方法及术后抗凝治疗。方法回顾性分析手术治疗的ＳＤＡＶＦ１９例,其中胸腰段１４例,骶部５例。手术方法包括：１４例胸腰段者于瘘口水平切断引流静脉。其中１１例可见硬膜外小供血动脉闭,同时电凝。骶部ＡＶＦ均于Ｌ５～Ｓ１水平切断引流静脉。９例行术后抗凝治疗。结果１６例术后脊髓功能改善,其中２例短暂好转后加重,经抗凝治疗后恢复。１例无改变,１例因过度抗凝出现术野血肿,１例残留ＡＶＦ。结论切断连接瘘口及冠状静脉丛的引流静脉是治疗ＳＤＡＶＦ的有效方法。术后抗凝可治疗及预防冠状静脉丛内血栓形成     

创伤性动静脉瘘20例的手术治疗

目的：探讨创伤性动静脉瘘(arteriovenous fistula,AVF)的手术方法。方法：回顾性分析了：1989年1月至2001年8月经手术治疗的创伤性AVF20例，共23个动静脉瘘。分别采用四头结扎术2例；经静脉切开修补瘘口3例；经动脉切开修补瘘口、重建动脉血流8例；瘘切断、动静脉壁瘘口侧面修补术1例；经瘤腔同时修补动静脉瘘口1例；经瘤腔修补静脉瘘口、动脉结扎或大隐静脉移植2例；瘘管结扎术3例。结果：死亡1例，随访16例，2例复发，2例肢端慢性溃疡者效果欠佳，余效果良好。结论：创伤性AVF应早期手术，根据分型采用不同手术方法，效果良好。     

表现为蛛网膜下腔出血的海绵窦区硬脑膜动静脉瘘1例

<正>患者女,66岁,因"反复头痛1月余,发热9天"入院。患者于1个月前出现剧烈头痛,主要位于右侧头顶及颞部,呈针刺样疼痛,伴右眼胀痛,最高体温达39℃,且头痛症状持续存在。既往有高血压、糖尿病病史。神经系统查体未见阳性定位体征。实验室检查:C-反应蛋白21.30mg/L;脑脊液检查:脑脊液为均匀淡红色,脑脊液白细胞计数50×106/L、红细胞计数10×106/L;脑脊液葡萄糖7.41 mmol/L、氯116.5 mmol/L、蛋白51.4mg/dl;脑脊液压力、腺苷脱氨酶、乳胶凝集试验、抗酸染色、改良抗酸染色、墨汁染色、脑脊液找癌细胞等均为正常。CT     

肾动静脉瘘的诊断与治疗

目的 探讨肾动静脉瘘的诊断和治疗方法。方法 回顾性分析8例肾动静脉瘘患者的临床资料。其中原发性动静脉瘘5例，继发于肾肿瘤2例、外伤1例。结果 2例肾肿瘤者1例行肾切除术，1例因肿瘤转移仅行化疗。6例行经皮超选择性肾动脉栓塞治疗。随访6-60个月，1例栓塞失败者行肾切除术，1例瘘管再通者行二次栓塞治疗。一次栓塞成功者4例。结论 影像学检查是诊断肾动静脉瘘的主要手段，除恶性肿瘤外经皮超选择性肾动脉栓塞是治疗肾动静脉瘘的首选方法。     

介入治疗复杂右颈外动脉动静脉瘘1例

患者男,24岁,右侧颞部搏动性包块伴右侧耳鸣及听力下降2年。自出生发现右颞部搏动性包块,伴间断性头痛,以右侧额颞部为重,考虑右颞部血管畸形,于2年前行外科手术切除,术中见右颞浅动脉增粗,直径约6mm,结扎后分离周围畸形血管团并予以切除。术后3个月再次出现搏动性包块,逐渐增大,伴明显右侧耳鸣及听力下降。     

Surgical treatment for an idiopathic renal arteriovenous fistula with a large aneurysm

Interventional embolization is currently the first line treatment for arteriovenous fistulas; however, the efficacy of repeated embolization remains controversial. A case is reported of an idiopathic renal arteriovenous fistula with large aneurysmal dilatation treated by surgery following the failure of interventional embolization. A 42-year-old woman was admitted to Ichikawa General Hospital, Japan, with gross hematuria containing many clots. Right renal arteriogram showed an aberrant vessel arising from the main trunk of the renal artery, which was followed by the formation of an aneurysm and rapidly ended in arteriovenous shunting. The aneurysm was approximately 35 mm in size. As interventional embolization had failed, surgical treatment including extracorporeal renal surgery was performed. Postoperative renal angiography revealed excellent renal function and beautiful vascular architecture. Although the indication for surgical treatment of renal vascular disease has decreased owing to the advancement of interventional techniques, there are still some risky cases for which surgical repair should be recommended.     

Surgical management of aneurismal dilation of vein and pseudoaneurysm complicating hemodialysis arteriovenuos fistula

Background  

Pseudoaneurysm (PS) and aneurismal dilation of vein (ADV) are recognized complications of arteriovenous fistulas (AVF) in patients on hemodialysis. We present our experience about surgical management of these complications, which resulted in AVF preservation for continuing hemodialysis.     

硬脑膜动静脉瘘介入治疗的临床分析

目的：总结硬脑膜动静脉瘘（DAVF）患者的介入治疗特点,以提高疗效。方法：回顾性分析135例DAVF患者的临床资料。结果：治愈74例,好转53例,8例无效,其中1例死于颅内出血。结论：DAVF的临床表现和预后与其静脉引流类型密切相关,颈动脉压迫法及选择性血管内栓塞是安全有效的治疗方法。     

创伤性浮肩的手术治疗与重建

目的 :探讨浮肩损伤的外科治疗策略及临床效果。方法 :自2010年3月至2013年12月,采用切开复位钢板螺钉内固定治疗12例浮肩患者,其中男10例,女2例;年龄22~45岁,平均31.7岁。术前X线及二三维CT提示11例为同侧锁骨骨折并肩胛颈骨折,1例为肩胛颈骨折合并同侧肩锁关节脱位。观察其术后并发症,并采用Herscvici功能评价标准进行疗效评价。结果:12例患者均获得随访,时间8~26个月,平均15个月。患者均获得骨性愈合,术后无感染、钢板及螺钉松动和断裂发生。根据Herscvici等功能评价标准,肩关节功能恢复优9例,良2例,可1例。结论:外科治疗重建浮肩患者肩关节及周边的解剖结构和稳定性,可以缩短肩关节制动及固定时间,取得满意疗效。     

髂腰内固定治疗创伤性脊柱骨盆分离

 目的 探讨创伤性脊柱骨盆分离的临床特点及后路髂腰内固定治疗该损伤的临床效果。方法 回顾性分析2008年7月至2012年12月收治12例创伤性脊柱骨盆分离患者资料,男8例,女4例;年龄18~50岁,平均（34.6±9.2）岁。致伤原因：坠落伤11例,车祸伤1例。所有骨折均为闭合性损伤,均有不同程度的合并伤。骶骨骨折按形态学分型：U型4例,H型6例,Y型2例。Roy-Camille分型：Ⅱ型6例,Ⅲ型6例。采用髂腰固定对12例患者进行手术治疗,并对6例有明显神经损害表现且有明确手术指征的患者同时行神经减压术。临床疗效评价采用Majeed标准,神经损伤按照Gibbons评价方法进行评定。结果 12例患者均获得随访,随访时间12~36个月,平均（15.5±6.3）个月。9例患者在受伤早期存在误诊或漏诊,12例患者均有不同程度的神经损害表现。术后所有骨折均获得愈合,骨折愈合时间4~8个月,平均（4.8±2.8）个月。根据Majeed标准,优4例、良4例、可2例、差2例,优良率66.7%（8/12）。12例患者术后患肢感觉、运动功能恢复率为91.7%（11/12）。6例行神经减压术的患者术后感觉、运动功能恢复率为83.3%（5/6）。末次随访时,Gibbons神经评分由术前平均（3.25±0.75）分降至术后平均（1.67±0.99）分,差异有统计学意义。结论 创伤性脊柱骨盆分离是一种少见的高能量损伤,其合并伤及神经损害的发生率很高;后路髂腰内固定是一种值得推荐的治疗方式,对有指征的患者早期行神经减压有利于神经功能的恢复。     

经桡动脉行自体动静脉内瘘功能不良的介入治疗

目的探讨经桡动脉行自体动静脉瘘(AVF)腔内成形和(或)溶栓治疗的可行性。方法于因AVF狭窄或血栓闭塞而需行介入治疗的患者中,选取经桡动脉入路介入治疗的8例患者进行回顾性分析。结果首次造影证实6例患者为AVF重度狭窄,即刻行腔内球囊成形术,术后狭窄程度改善;对2例急性血栓形成患者行动脉内溶栓治疗,次日复查造影示血栓溶解,其中1例溶栓后造影显示吻合口附近静脉狭窄严重,行PTA治疗,另1例狭窄程度较轻者未进一步PTA治疗。对8例患者随访2~13个月,其中7例可正常行AVF透析,1例单纯PTA治疗患者2个月后再次行PTA治疗,4个月后因AVF功能不良而改行颈内静脉插管透析。结论经桡动脉行AVF功能不良的介入治疗有一定的可行性。