覆膜血管内支架在外周动脉瘤和动静脉瘘中的应用

目的探讨覆膜血管内支架在外周动脉瘤及动静脉瘘中的临床应用疗效及安全性。方法回顾性分析我院2000年5月至2006年11月14例接受覆膜血管内支架治疗患者的临床资料。14例患者主要的血管病变为真性或假性动脉瘤、动静脉瘘。结果覆膜血管内支架的置放技术成功率为100%,无严重并发症和围手术期死亡,术后临床症状明显改善。1例患者出现I型内漏,但临床症状仍有改善。平均随访时间10个月。随访期内除1例患者仍有内漏外余无内漏。未发现支架移位和狭窄等并发症。结论覆膜血管内支架治疗外周动脉瘤及动静脉瘘具有创伤小、疗效确切、安全等优点,短期随访效果满意。     

创伤性动脉瘤和动静脉瘘

目的：为了进一步探讨创伤性动脉瘤和动静脉瘘的手术方法，我院血管外科分析了１９６３年６月～１９９５年１２月，经手术治疗的创伤性动脉瘤和动静脉瘘９６例。其中创伤性动脉瘤５５例，含６３个动脉瘤，动静脉瘘４１例，含４３个动静脉瘘。方法：根据血管造影和手术发现，将创伤性动脉瘤和动静脉瘘各分为四个类型。手术方法包括直接修补、单纯或四头结扎、瘤或瘘切除然后行对端吻合或大隐静脉或人造血管移植。结果：除１例左颈总动脉根部动脉瘤伴左颈总动脉—无名静脉瘘术后１９小时死于弥漫性血管内凝血外，其余无死亡。动脉瘤和动静脉瘘得到随访的分别为７９．６％和７８．０％。远期随访效果较佳。结论：不同类型的创伤性动脉瘤和动静脉瘘，应采用不同的手术方法。     

An Arteriovenous Fistula Between the Internal Mammary Artery and the Pulmonary Vein Following Blunt Chest Trauma

A 67-year-old man suffered a traffic accident and was transferred to an emergency hospital close to the scene. He was diagnosed to have bilateral pneumohemothorax with a lung contusion, an anterior fracture dislocation of the C6-vertebra and a cervical cord injury at the level of C7. On the 48th day, massive hemoptysis was suddenly recognized. He was transferred in a state of shock to our hospital to undergo hemostasis for the bleeding. On the day of admission, a selective arteriogram showed extravasation from the left bronchial artery, for which embolization was carried out using Gelfoam. In spite of this treatment, his hemoptysis continued. On the next day, a selective left internal mammary arteriogram showed an arteriovenous fistula between the left internal mammary artery and the left pulmonary vein without any apparent extravasation. The arteriovenous fistula was successfully embolized using platinum fiber coils. The patient no longer demonstrated any hemoptysis after embolization.     

Color doppler sonography as a primary diagnostic tool in the diagnosis of vein of galen aneurysm in a critically ill neonate

We describe the use of transcranial color Doppler ultrasound in the diagnosis of arteriovenous fistula with vein of Galen aneurysm. This technique allows early, rapid, bedside diagnosis of the condition so that appropriate therapy can be instituted.     

Balloon-assisted,ultrasound-guided percutaneous real-time thrombin injection,for the arteriovenous fistula pseudoaneurysm treatment

A pseudoaneurysm or false aneurysm is the consequence of a persistent blood leak caused generally by iatrogenic rupture of a vessel wall. The blood leak creates a new cavity delimited by surrounding tissues and allows blood flow to remain in continuity between this cavity and the vessel. In hemodialysis fistula, pseudoaneurysm generally results from repeated puncturing of the vein at the same site, leading to a bulging anatomical defect in the vein. Over the past few years, interventional radiological treatment has evolved and taken the place of surgery, with different kinds of percutaneous and endovascular treatment methods in pseudoaneurysm management. We reported a case report of successful treatment of arteriovenous fistula pseudoaneurysm with no-measurable neck. We performed ultrasound-guided percutaneous direct thrombin injection while an inflated balloon transiently obstructed flow out of the pseudoaneurysm, in order prevent non-target embolization.     

Arteriovenous aneurysm of the occipital artery

We report an unique case of a giant aneurysm of the occipital artery, with a venous connection to the transverse sinus via an emissary vein. Because of this connection, the term arteriovenous aneurysm is used.     

Stab wounds of the renal artery branches: angiographic diagnosis and treatment by embolization

Renal artery branch injury resulting from stab wounds of iatrogenic origin or street violence is an important cause of renal hemorrhage. Over a period of 10 years we accurately diagnosed the injury and successfully managed the associated hemorrhage in 15 patients by using angiography and percutaneous embolization techniques. Nine branch injuries in eight patients were due to street knifings and seven injuries were complications of invasive medical procedures (four from renal biopsy, two from nephrostolithotomy, and one from nephrostomy). All patients had gross hematuria at the time of angiographic evaluation. False aneurysms were present in six patients (one with associated frank extravasation), false aneurysm/arteriovenous fistula in three, false aneurysm/arteriocaliceal fistula in one, and isolated arteriovenous fistula in two. Frank extravasation without associated false aneurysm/arteriovenous fistula was present in two. One patient had two injuries, an upper-pole false aneurysm and a lower-pole false aneurysm/arteriovenous fistula. In the eight patients injured in street knifings, hematuria recurred after surgical exploration and treatment. None of the 16 injuries involved the main renal artery. Gelfoam was used for embolization of nine lesions and steel coils for four. Three others were treated with Gelfoam plus coils. Hemostasis was achieved in all and none required subsequent surgery. Renal tissue loss was small to moderate (less than 30%) in 12 patients and large (30-50%) in three patients. Transient postembolization hypertension occurred in one of the latter. We consider selective angiography/embolization to be an effective and safe means for diagnosing and treating wounds of the renal artery branches.     

A proposed angiographic classification of intracranial arteriovenous fistulae and malformations

We propose an angioarchitectural classification of intracranial vascular lesions as arteriovenous, arteriolovenous and arteriolovenulous fistulae. In order to validate this classification, 99 intracranial arteriovenous lesions were reviewed in 98 patients. Arteriolovenulous fistulae included 39 isolated brain arteriovenous malformations (AVMs) and 1 AVM associated with a giant arteriovenous fistula (AVF). Arteriovenous fistulae included 8 giant AVFs of the brain, 6 vein of Galen aneurysms and 10 direct caroticocavernous fistulae. Arteriolovenous fistulae included 1 isolated brain AVM, 4 vein of Galen aneurysms and 30 dural AVMs. The angioarchitectural classification has three advantages. It is simple and accurate, with no reference to the congenital or acquired nature of the lesion. It allows separate identification of a special group, the arteriolovenous fistulae. It also indicates the endovascular approach: arteriolovenulous fistulae should be treated via the arterial route only, while arteriovenous and arteriolovenous fistulae can be treated via transarterial or transvenous approaches.     

Initial clinical experience with spiral CT and 3D arterial reconstruction in intracranial aneurysms and arteriovenous malformations

We studied 32 consecutive patients with known or suspected cerebrovascular abnormalities studied with spiral CT following a intravenous bolus injection of iodinated contrast medium with a power injector. Flow was 3 or 4 ml/s. In an attempt to define the appropriate delay time and scan duration a cranial angio-CT without table increment was performed on 10 patients. Enhancement was measured by manually placed regions of interest within the left middle cerebral artery and the inferior sagittal sinus. All patients except one had intraarterial angiography (DSA) for comparison. In 6 patients with an arteriovenous malformation (AVM) follow-up was possible after one and/or two embolisation procedures. These patients had plain and contrast-enhanced spiral CT. The diagnosis was aneurysm in 9 (8 berry aneurysms, one giant fusiform aneurysm), AVM in 13 (all supratentorial) and traumatic arteriovenous fistula in one. In 9 patients there were no detectable pathological vascular findings. After 3D reconstruction the size (between 5 and 28 mm), location and the relationship to the parent vessel of the aneurysms, the extent of the AVMs and the distribution of the embolisation material could be demonstrated clearly. The main feeding vessel(s), nidus and draining veins were reliably shown. The decreased extent of the AVMs after embolisation was clearly demonstrated. There was no difference in diagnosis when DSA and 3D-CT were compared by two independent radiologists. We consider arterial spiral CT with 3D reconstruction to have the potential of offering important diagnostic information for the treatment of intracranial AVMs and aneurysms.The authors would like to dedicate this paper to Prof. Dr. sc. med. R. Lehmann     

Cerebrovascular occlusion by catheterization and embolization: clinical experience

Intravascular occlusion by various catheterization techniques was used to treat 27 cases of carotid-cavernous fistula, giant intracavernous aneurysm, and cerebral or dural arteriovenous malformation. Several case reports are presented. The detachable balloon technique proved valuable in the treatment of traumatic carotid-cavernous fistula and giant aneurysm. Calibrated-leak balloon catheterization with fluid embolization was used to treat cerebral arteriovenous malformation. Selection of embolic material is discussed.     

Intracranial arteriovenous fistula caused by endovascular stent-grafting and dilatation

A 58-year-old man developed a self-occluding arteriovenous fistula following stent-grafting of the right internal carotid artery (ICA). Due to prolonged ischaemic neurological deficits carotid angiography had been performed 3 weeks previously. It revealed marked atherosclerotic lesions predominantly narrowing the distal right carotid siphon. MRI confirmed ischaemic lesions and massive deficits of perfusion in the right ICA cerebral territory. Stent-grafting was performed successfully, but subsequent angiography revealed a new arteriovenous fistula adjacent to the stent, between the right carotid siphon and the cavernous sinus. On angiography 10 days later, the fistula no longer was present, and flow MRI were normal; the patient was by then asymptomatic. Arteriovenous fistula can thus complicate following endovascular stenting.     

Anterior cranial fossa dural arteriovenous fistula with a varix mimicking an anterior communicating artery aneurysm

We report an anterior cranial fossa dural arteriovenous fistula with a varix mimicking an aneurysm on CT and MRI.     

Endovascular Recanalization of a Thrombosed Native Arteriovenous Fistula Complicated with an Aneurysm: Technical Aspects and Outcomes

Objective

To evaluate the technical aspects and outcomes of endovascular recanalization of a thrombosed native arteriovenous fistula (AVF) complicated with an aneurysm.

Materials and Methods

Sixteen patients who had a thrombosed AVF complicated with an aneurysm (two radiocephalic and 14 brachiocephalic) were included in this study. Recanalization procedures were performed by mechanical thrombectomy using the Arrow-Trerotola percutaneous thrombectomy device and adjunctive treatments. We evaluated dose of thrombolytic agent, underlying stenosis, procedure time, technical and clinical success, and complications. The primary and secondary patency rates were calculated using the Kaplan-Meier analysis.

Results

The thrombolytic agents used were 100000 U urokinase mixed with 500 IU heparin (n = 10) or a double dose of the mixture (n = 6). The thrombi in aneurysms were removed in all but two patients with non-flow limiting residual thrombi. One recanalization failure occurred due to a device failure. Aspiration thrombectomy was performed in 87.5% of cases (n = 14). Underlying stenoses were found in the outflow draining vein (n = 16), arteriovenous anastomosis or juxtaanastomosis area (n = 5), and the central vein (n = 3). Balloon angioplasty was performed for all stenoses in 15 patients. Two patients with a symptomatic central vein stenosis underwent insertion of a stent after balloon angioplasty. Mean procedure time was 116.3 minutes. Minor extravasation (n = 1) was resolved by manual compression. Both technical and clinical success rates were 93.8% (n = 15). The primary patency rates at 3, 6, and 12 months were 70.5%, 54.8%, and 31.3%, respectively. The secondary patency rates at 3, 6, and 12 months were 70.5%, 70.5%, and 47.0%, respectively.

Conclusion

Thrombosed AVF complicated with an aneurysm can be successfully recanalized, and secondary patency can be prolonged with endovascular treatment.     

Superselective Embolization in Posttraumatic Priapism with Glubran 2 Acrylic Glue

Two patients with posttraumatic priapism underwent transcatheter embolization using microcoils, resulting in temporary penile detumescence and an apparent resolution of the artero-venous fistula. In both cases, priapism recurred 24 hours after the procedure and was successfully treated through selective transcatheter embolization of the nidus using acrylic glue (Glubran 2). The patients showed complete recovery of sexual activity within 30 days from the procedure and persistent exclusion of the artero-venous fistula after a 12-month follow-up.     

Percutaneous transvenous balloon occlusion of arteriovenous fistula

Summary The closure of arteriovenous fistulas, using a balloon catheter introduced through the vein draining the fistula, is discussed. The application of this method to the closure of an iatrogenic vertebrovertebral fistula is described.     

Cauda equina syndrome and arteriovenous fistula

Summary Traumatic arteriovenous fistulae, resulting in delayed damage to the cervical spinal cord and roots, are well documented. This report concerns an iliac arteriovenous fistula with damage to the cauda equina.     

Arteriovenous fistula of the internal maxillary artery in a child: case report

Summary Direct arteriovenous fistulae supplied by the external carotid artery are unusual. Rarely, congenital fistulae have been described involving the head and neck. We describe the first case of congenital internal maxillary arteriovenous fistula in a child. Balloon embolization is currently considered the method of choice for treatment of direct arteriovenous fistula.     

前臂动静脉内瘘术狭窄血管内介入治疗的临床意义

目的探讨糖尿病血液透析患者前臂动静脉内瘘术狭窄的血管内介入治疗的疗效及方法。方法 5例患者中4例经患侧肱动脉穿刺、1例经右侧股动脉穿刺,行前臂动脉DSA检查及动静脉内瘘术狭窄血管内球囊成形术（PTA）。结果 5例狭窄程度达到90%～98%,范围4～9cm,血管内球囊成形术后狭窄程度改善到10%以下,技术成功率达100%,无严重并发症发生。结论前臂动静脉内瘘术狭窄血管内球囊成形术是安全有效的治疗方法。     

颅内动静脉瘘的CT和MRI诊断价值

目的:探讨CT和MRI对颅内动静脉瘘的诊断价值。方法:回顾性分析18例颅内动静脉瘘的CT和MRI表现。18例均经DSA检查明确诊断。其中12例行CT检查;16例行MRI检查,同期6例行MRA检查。结果:颅内动静脉瘘的CT和MRI的特征性表现为脑沟、脑裂、基底池内血管影增粗、增多,呈散在分布,受累及的静脉窦增粗,且病变区没有畸形血管团。海绵窦硬脑膜动静脉瘘在T2WI上表现为局部流空信号增宽,MRA原始图像显示局部有较丰富的异常纤细血流信号。结论:认识颅内动静脉瘘的CT和MRI表现,有助于早期诊断及治疗。MRI对显示软脑膜血管扩张优于CT。选择性脑血管造影是确诊本病的可靠手段。     

Atypical Developmental Venous Anomaly Associated with Single Arteriovenous Fistula and Intracerebral Hemorrhage: a Case Demonstrated by Superselective Angiography

We present a case of developmental venous anomaly associated with arteriovenous fistula supplied by a single arterial feeder adjacent to a large acute intracerebral hemorrhage. The arteriovenous fistula was successfully obliterated by superselective embolization while completely preserving the developmental venous anomaly. Two similar cases, including superselective angiographic findings, have been reported in the literature; however, we describe herein superselective angiographic findings in more detail and demonstrate the arteriovenous shunt more clearly than the previous reports. In addition, a literature review was performed to discuss the association of a developmental venous anomaly with vascular lesions.