肾切除术前的肾动脉栓塞术：造影及栓塞方法

８例肾癌患者行旨在配合肾切除术的肾动脉栓塞术。其中５例取得了明显减少出血、操作容易、缩短手术时间的好效果。本文认为肾切除术前２￣７天行栓塞术较有利。无水乙醇比明胶海绵中断血运效果更佳。用无水乙醇只要栓塞至二极分支就足以中断肾血供。造影应显示供血动脉、肿瘤血管、引流静脉，为肾切除及栓塞术提供参考。栓塞前后应注意保护健肾，一般可以一次完成诊断造影及栓塞治疗。     

经导管动脉栓塞在脊柱肿瘤手术切除前的应用

对１２例脊柱肿瘤行经导管动脉栓塞治疗，栓后２～５ｄ行肿瘤根治切除，除１例因并发血栓使用了抗凝血药物而致术中失血量较多外，余１１例失血量５００～２０００ｍｌ，平均９３６ｍｌ；而对照组即手术切除前未行栓塞治疗的１５例病人术中失血量为２０００～４５００ｍｌ，平均３３４７ｍｌ，两组病例失血量经统计学处理有极显著性差异（Ｐ＜０．００１）．因此认为，脊柱肿瘤手术切除前经导管栓塞治疗可以明显减少术中失血。文中对栓塞后手术时机的选择、栓后并发症的预防和处理等问题作了简要讨论。     

左侧膈下动脉参与肝癌供血的介入治疗研究

目的 探讨左膈下动脉(LIPA)对肝癌的供血及其介入性栓塞在肝癌治疗中的价值.评价经导管行LIPA栓塞化疗的安全性和效果.资料与方法 对16例经DSA确认有LIPA 参与肝癌供血者进行肝动脉栓塞化疗术(TACE).其中,结节型15例,巨块型1例.术前行CT或MRI平扫及增强扫描,术中常规行腹腔动脉、肝动脉及膈下动脉造影,在确认供血范围后将导管超选择至供血支,先用碘油-抗癌乳剂栓塞肿瘤末梢血管,然后注入明胶海绵颗粒或聚乙烯醇(PVA)颗粒.观察术后临床经过、相关实验室检查和影像学表现,并与DSA进行对照分析.结果 病灶位于肝左叶13例(81.2%):5例位于S3, 5例位于S2,3例位于S4.病灶位于肝右叶(S5)3例 (18.8%).16例患者LIPA TACE全部成功.8例进行LIPA化疗栓塞时发现肝动脉完全阻塞.2例术后发生左下肺叶盘状肺不张和少量胸腔积液.结论 LIPA参与肝癌供血多见于多次行TACE的患者并且肿块位于肝左叶.栓塞LIPA的安全性很高,并发症少且多为自限性.     

Ovarian Artery: Angiographic Appearance,Embolization and Relevance to Uterine Fibroid Embolization

Purpose: To describe the angiographic appearance of the ovarian artery and its main variations that may be relevant to uterine fibroid embolization. Methods: The flush aortograms of 294 women who had been treated by uterine artery embolization for fibroids were reviewed. Significant arterial supply to the fibroid, and the origin and diameter of identified ovarian arteries were recorded. In patients with additional embolization of the ovarian artery, the follow-up evaluation also included hormonal levels and Doppler imaging of the ovaries. Results: A total of 75 ovarian arteries were identified in 59 women (bilaterally in 16 women and unilaterally in 43 women). All ovarian arteries originated from the aorta below the level of the renal arteries with a characteristic tortuous course. Fifteen women had at least one enlarged ovarian artery supplying the fibroids. Fourteen women (14/15, 93%) presented at least one of the following factors: prior pelvic surgery, tubo-ovarian pathology or large fundal fibroids. Conclusion: We advocate the use of flush aortography in women with prior tubo-ovarian pathology or surgery or in cases of large fundal fibroids. In the case of an ovarian artery supply to the fibroids, superselective catheterization and embolization of the ovarian artery should be considered.     

双侧子宫动脉栓塞术治疗子宫肌瘤

本文介绍了经导管双侧子宫动脉栓塞术的临床病理基础、DSA造影和栓塞治疗的技术要点、临床处理以及介入操作经验，指出经导管动脉栓塞术治疗子宫肌瘤是一种有效、安全和较为成熟的治疗手段，具有操作简便、创伤很小、疗效较好、恢复快的优点，对一些不宜或不愿手术的患者特别有用。     

肝癌介入化疗栓塞前后的彩色多普勒显像观察

目的探讨CDFI对肝癌介入化疗栓塞(TAE)前后肝血供及肿瘤血供的表现特点,评价其治疗效果。材料和方法CDFI观察1995～1998年48例肝癌(TAE)前后肿瘤的血供情况、肝动脉血流动力学改变。结果肝癌主要由肝动脉供血,少部分由门静脉供血;TAE后肝动脉收缩期最大流速(Vmax)明显下降,肿瘤内部及周边动脉血流明显减少;TAE后肿瘤也明显减小。结论TAE前后,应用CDFI对肿瘤血供、肝动脉血流动力学改变进行观察分析,可以给TAE的预后提供重要指标,为下一步重复治疗提供依据。CDFI是目前肝癌化疗栓塞术治疗前后最好的影像检查方法。     

Ruptured Mycotic Pulmonary Artery Pseudoaneurysm in an Infant: Transcatheter Embolization and CT Assessment

Mycotic pseudoaneurysm of the pulmonary artery that ruptures during necrotizing pneumonia is a rare entity that is often fatal. Traditionally it has been treated with open thoracotomy and resection of both the aneurysm and the lobe in which the aneurysm is located. In this report, we describe the radiological findings and transcatheter coil embolization of a mycotic pulmonary pseudoaneurysm in a 6-month-old female infant. We also describe the subsequent morphologic changes observed on follow-up computed tomography after 9 months of embolization.     

子宫动脉栓塞治疗子宫肌瘤的临床应用研究

分析子宫动脉栓塞治疗子宫肌瘤的有效性和安全性。材料和方法：５１例子宫肌瘤行子宫通读动脉栓塞治疗,分别于栓塞后１、３、６、１２个月行Ｂ超随访肿瘤体积变化。结果：现例均无子宫坏死一严重并发症。栓塞后６个月,肿瘤体积缩小大于５０％、２０％￣５０％和小于２０％者分别为４１例（占８０．４％）、９例（１７．６％）和１例（占２％）,其中２例肿瘤全部消失。所有病例临床症状减轻或消失。４例自然受孕。结论：子宫动脉栓     

支气管动脉栓塞术治疗非肿瘤性大咯血

目的探讨支气管动脉栓塞术对非肿瘤性大咯血的治疗效果。方法46例患者术前均经影像检查明确诊断,术中先行胸主动脉造影,再选择支气管动脉或肋间动脉造影确认出血动脉,经导管送入真丝线段及明胶海绵(GS)栓塞。结果45例支气管动脉栓塞成功,1例栓塞失败。术中肺咯血即刻停止39例,6例肺咯血量明显减少,有5例术后复发。即刻止血率84.8%,有效率97.8%,复发率10.9%。结论支气管动脉栓塞术是治疗非肿瘤性大咯血的有效手段。     

肾脏穿刺活检术所致肾血管损伤的血管内栓塞治疗

目的 评价介入技术治疗肾脏穿刺活检术所致肾血管损伤的安全性和疗效。资料与方法 对7例因肾脏穿刺活检术所致肾血管损伤患者进行了超选择性肾动脉栓塞治疗。栓塞材料用微型钢丝圈6例,普通钢丝圈1例,同时用聚乙烯醇微球3例。结果 选择性肾动脉造影显示肾实质内动静脉瘘4例,对比剂外溢2例,肾内假性动脉瘤1例。栓塞成功率为100％。治疗结束时复查造影显示异常血管消失,正常分支保留。5例失血明显者,栓塞后经给予补充血容量,失血症状迅速改善;腰痛剧烈患者,术后2～5d腰痛消失;血尿7例,术后2～7d消失。术后原有肾功能不全加重2例,新出现肾功能不全1例,其中1例接受血液透析治疗。超声复查显示肾周围血肿于2～3个月逐渐吸收。随访10～68个月（平均36个月）,2例死于原发疾病（慢性肾功能衰竭和淋巴瘤各1例）,5例健在,未再针对肾脏损伤进行外科或介入治疗,未再发生出血,肾功能测定属正常范围。结论 经导管选择性肾动脉分支栓塞术是治疗肾脏穿刺活检术所致肾血管损伤的安全有效方法。     

Transcatheter Coil Embolization of an Aneurysm of the Pancreatico-duodenal Artery with Occluded Celiac Trunk

We report on a case of a wide-necked aneurysm of the pancreatico-duodenal artery with occlusion of the celiac trunk in an asymptomatic patient. The aneurysm was considered to be at high risk of rupture. Successful embolization after interdisciplinary consultation was followed with color-coded duplex ultrasound (CCDS) demonstrating significant flow reduction. Three weeks later CCDS and angiography demonstrated exclusion of the aneurysm and a patent arterial supply of the liver and spleen fed by superior mesenteric artery (SMA) collaterals. The patient has done well so far, without major adverse clinical events or evidence for tissue necrosis of the liver, pancreas or spleen. Discussion of the case and review of the literature indicate that transcatheter embolization is the therapy of choice even in complicated cases.     

Embolization of Isolated Lumbar Artery Injuries in Trauma Patients

Purpose The purpose of the study was to evaluate the angiographic findings and results of embolotherapy in the management of lumbar artery trauma. Methods All patients with lumbar artery injury who underwent angiography and percutaneous embolization in a state trauma center within a 10-year period were retrospectively reviewed. Radiological information and procedural reports were reviewed to assess immediate angiographic findings and embolization results. Long-term clinical outcome was obtained by communication with the trauma physicians as well as with chart review. Results In a 10-year period, 255 trauma patients underwent abdominal aortography. Eleven of these patients (three women and eight men) suffered a lumbar artery injury. Angiography demonstrated active extravasation (in nine) and/or pseudoaneurysm (in four). Successful selective embolization of abnormal vessel(s) was performed in all patients. Coils were used in six patients, particles in one and gelfoam in five patients. Complications included one retroperitoneal abscess, which was treated successfully. One patient returned for embolization of an adjacent lumbar artery due to late pseudoaneurysm formation. Conclusions In hemodynamically stable patients, selective embolization is a safe and effective method for immediate control of active extravasation, as well as to prevent future hemorrhage from an injured lumbar artery.     

Treatment of Uterine Artery Vasospasm with Transdermal Nitroglycerin Ointment During Uterine Artery Embolization

Uterine artery vasospasm can complicate uterine artery embolization (UAE) by prolonging procedure times or even causing treatment failure. Embolization must be delayed until the spasm improves and adequate antegrade flow in the vessel is restored. Vasospasm can also produce a “false endpoint” to the procedure, where stasis of flow in the vessel is falsely attributed to successful embolization but is actually the result of vasospasm, leading to undertreatment or treatment failure. Traditional treatments for uterine artery vasospasm have included transcatheter intra-arterial vasodilators and catheter withdrawal from the vessel, both of which can yield mixed results. We report a case of uterine artery vasospasm during UAE successfully treated with transdermal nitroglycerine ointment. Case Report     

支气管动脉栓塞治疗肺大咯血

目的　探讨支气管动脉栓塞治疗大咯血的方法及疗效。方法　对 36例大咯血或长期反复咯血的病人用明胶海绵颗粒栓塞支气管动脉。 36例病人中 ,单侧 31例 ,双侧 5例。肺癌 1 7例 ,支气管扩张 8例 ,肺结核 1 1例。先行支气管动脉造影 ,确定出血血管后 ,用明胶海绵颗粒栓塞 ,直到支气管动脉闭塞为止。结果　即刻止血 31例 ,出血完全控制。 5例咯血明显减少 ,内科治疗后咯血完全停止。随访 3月～ 5年 ,再出血 2例。结论　支气管动脉栓塞是治疗大咯血的有效方法 ,效果确切 ,止血迅速     

Rupture of True Aneurysms of the Pancreaticoduodenal Arcade: Treatment with Transcatheter Arterial Embolization

We present 2 cases of ruptured true aneurysms of the pancreaticoduodenal arcade, underscoring the role of transcatheter arterial embolization (TAE) as the initial treatment of choice in pancreaticoduodenal arcade aneurysm. Ruptured true aneurysms of the pancreaticoduodenal artery (PDA) are uncommon and few cases have been reported, whereas false aneurysms are seen more often. The first patient we describe is a 63-year-old woman with an aneurysm of the PDA initially treated by TAE. The second case is a 67-year-old woman with an aneurysm of the inferior PDA postoperatively treated by TAE. In both patients TAE via a combined superior mesenteric artery and celiac axis approach was successful. Follow-up contrast-enhanced computed tomography showed prolonged occlusion of both aneurysms. A review of the literature concerning TAE supports our experience that TAE of ruptured aneurysms of the pancreaticoduodenal arcade, when feasible, is at least as effective as conventional surgery, but with lower morbidity and mortality. Therefore, TAE should be the initial treatment of choice in this group of patients.     

Bronchial Artery and Systemic Artery Embolization in the Management of Primary Lung Cancer Patients with Hemoptysis

Purpose To assess the safety and effectiveness of arterial embolization in lung cancer patients with hemoptysis. Methods Nineteen primary lung cancer patients with hemoptysis underwent bronchial artery and systemic artery embolization from April 2002 to March 2005. There were 17 men and 2 women, with a mean age of 59 years. Histologic analysis revealed squamous cell carcinoma in 10 patients and poorly differentiated adenocarcinoma in 9 patients. The amount of hemoptysis was bleeding of 25–50 ml within 24 hr in 8 patients, recurrent blood-tinged sputum in 6, and bleeding of 100 ml or more per 24 hr in 5. Embolization was done with a superselective technique using a microcatheter and polyvinyl alcohol particles to occlude the affected vessels. Results Arterial embolization was technically successful in all patients and clinically successful in 15 patients (79%). The average number of arteries embolized was 1.2. Bronchial arteriography revealed staining (all patients), dilatation of the artery or hypervascularity (10 patients), and bronchopulmonary shunt (6 patients). The recurrence rate was 33% (5/15) and 11 patients were alive with a mean follow-up time of 148 days (30–349 days). Conclusion Arterial embolotherapy for hemoptysis in patients with primary lung cancer is an effective, safe therapeutic modality despite the fact the vascular changes are subtle on angiography.     

肝动脉栓塞治疗外伤性肝破裂出血

目的探讨肝动脉栓塞术治疗外伤性肝破裂出血的临床疗效、关键技术及其并发症。资料与方法回顾性分析经B超及CT证实的外伤性肝破裂出血患者50例,采用超选择插管至病变血管,用明胶海绵和(或)弹簧圈栓塞,术后观察止血效果。结果 9例单纯用明胶海绵颗粒栓塞,41例用明胶海绵颗粒+钢圈联合栓塞。47例一次肝动脉栓塞后即成功止血;3例于首次栓塞后12～72 h复发出血,行第二次肝动脉栓塞后有2例完全止血康复,1例于第二次栓塞后2周并发肝脓肿和腹腔感染而死亡。49例随访3个月～3年无复发出血。结论肝动脉导管栓塞治疗外伤性肝破裂出血安全、有效。     

Intractable Postpartum Hemorrhage Resulting from Uterine Artery Pseudoaneurysm: Superselective Arteriographic Embolization via the Collateral Route

We present a patient with intractable postpartum hemorrhage resulting from uterine artery pseudoaneurysm despite bilateral hypogastric artery ligation who was successfully treated by an endovascular approach via the collateral route. Although there is a good argument for postponing surgery until transcatheter embolization has been attempted, this case shows that embolization can still be successful even if the iliac vessels have been ligated.     

Renal Artery Embolization of Perirenal Hematoma in Hemorrhagic Fever with Renal Syndrome: A Case Report

Hemorrhagic fever with renal syndrome (HFRS) is an acute viral disease characterized by fever, hemorrhage and renal failure. Among the various hemorrhagic complications of HFRS, spontaneous rupture of the kidney and perirenal hematoma are very rare findings. We report here on a case of HFRS complicated by massive perirenal hematoma, and this was treated with transcatheter arterial embolization.     

Percutaneous Glue Embolization of a Visceral Artery Pseudoaneurysm in a Case of Sickle Cell Anemia

Although aneurysmal complications of sickle cell anemia have been described in the intracranial circulation, visceral artery pseudoaneurysms in this disease entity have not previously been reported in the literature. Conventional treatment of visceral pseudoaneurysms has been surgical ligation or resection of the aneurysm. Transcatheter embolization has emerged as an attractive, minimally invasive alternative to surgery in the treatment of these lesions. In certain situations, however, due to the unfavorable angiographic anatomy precluding safe transcatheter embolization, direct percutaneous glue injection of the pseudoaneurysm sac may be considered to achieve successful occlusion of the sac. The procedure may be rendered safer by simultaneous balloon protection of the parent artery. We describe this novel treatment modality in a case of inferior pancreaticoduodenal artery pseudoaneurysm in a patient with sickle cell anemia. Although a complication in the form of glue reflux into the parent vessel occurred that necessitated surgery, this treatment modality may be used in very selected cases (where conventional endovascular embolization techniques are not applicable) after careful selection of the balloon diameter and appropriate concentration of the glue–lipiodol mixture.