Subclavian Steal Syndrome in Anomalous Connection of the Left Subclavian Artery to the Pulmonary Artery in D-Transposition of the Great Arteries

Several reports have documented the occurrence of an isolated left subclavian artery in association with both tetralogy of Fallot and double-outlet right ventricle. In certain cases a congenital subclavian or pulmonary artery steal syndrome exists in which the left subclavian artery is connected to the main pulmonary artery via a ductus arteriosus. We describe a subclavian steal syndrome secondary to anomalous origin of the left subclavian artery from the pulmonary artery in d-transposition of the great arteries in a patient with Spondylocostal dysostosis (SCD). Cardiac anomalies are rare in SCD and this constellation of findings have not previously been described.     

彩超对锁骨下动脉窃血综合征的诊断分析

目的 探讨彩超对锁骨下动脉窃血综合征（SSS）的诊断价值。方法 分析20例临床诊断为SSS的椎动脉血流与锁骨下动脉、颈动脉、无名动脉病变及上肢动脉血流频谱的关系。结果 SSS的椎动脉血流可分为完全性椎动脉反流、部分性椎动脉反流和无椎动脉反流三种。结论 超声诊断SSS方法简便、经济、无创。     

介入治疗右锁骨下动脉狭窄或闭塞的技术与疗效评价

目的 评价右锁骨下动脉狭窄或闭塞介入治疗技术与疗效.方法 8例右锁骨下动脉狭窄和9例闭塞患者,原发病14例动脉硬化、3例大动脉炎,男13例、女4例,平均年龄(56±11)岁,接受介入开通治疗.经股或联合经右肱动脉途径入路行动脉闭塞段的开通、球囊扩张及支架置入.其中6例应用颈动脉脑保护装置.结果 1例双向均未开通闭塞段,16例获得成功治疗.手术成功的患者中,狭窄和闭塞患者各8例,5例行单纯球囊扩张、11例球囊扩张后行支架置入,术后即刻血流通畅.完成治疗后6例脑保护装置均安全回收,无脑梗死事件发生.手术后随访1～ 66个月,平均(24±18)个月.术后10个月1例(置入支架者)再狭窄,球囊扩张后狭窄开通;1例大动脉炎患者术后18个月死于脑梗死;其余患者均无缺血症状再发,超声及CTA检查(9例患者)SA血流均通畅.结论 球囊扩张及支架置入可安全、有效解决右锁骨下动脉狭窄和闭塞病变.     

锁骨下静脉的解剖特点与上腔静脉置管路径的研究

目的　研究锁骨下静脉走向 ,探讨经此路径行上腔静脉置管的最佳方法 ,并分析相关并发症的原因。方法　对6 8例锁骨下静脉穿刺上腔静脉置管的临床病例进行造影透视、摄片 ,统计最适宜的置管长度 ,比较改良穿刺技术与旧Seldinger技术的效果及与相关并发症的关系。结果　锁骨下静脉穿刺上腔静脉置管的长度右侧为 (8.5 +d)cm(d为穿刺点至锁骨头上缘距离 ) ,左侧为 (11.5 +d)cm。原Seldinger技术一次置管成功率为 75 0 % ,改进后为 92 .5 % ;原操作方法置管操作时间为(43 3± 10 9)min ,改良后为 (2 8 6± 10 3)min ;原方法并发症发生率 39 2 9% ,改进后为 10 0 % ,差异均有显著性 (P <0 0 1)。结论　置管长短主要取决于穿刺点距锁骨头上缘的距离 ;改良穿刺技术是一种安全、有效的中心静脉置管方法 ,选择右侧路径比左侧更安全     

不同部位穿刺对锁骨下静脉置管成效的影响

目的 :研究不同部位穿刺对锁骨下静脉置管成效的影响。方法 :将随机分组的锁骨上进针置管组 60例及锁骨下进针置管组70例 ,对置管的成功率、气胸发生率、淋巴管损伤、臂丛神经损伤等并发症指标记录分析。结果 :锁骨下进针穿刺成功率高于锁骨上进针穿刺 ( χ2 =5 .5 0 ,P <0 .0 5 ) ,并可减少并发症的发生 (P =0 .0 16,P <0 .0 5 )。结论 :从锁骨下进针行锁骨下静脉置管能减少穿刺过程中可能对穿刺成功不利因素的影响 ,提高置管的成功率     

锁骨下动脉窃血综合征:椎动脉和乳内动脉彩色多普勒超声血流变化

目的探讨锁骨下动脉窃血综合征患者椎动脉和乳内动脉血流变化。方法应用彩色多普勒超声检查17例锁骨下动脉窃血综合征患者的患侧椎动脉和乳内动脉,判断血流方向和进行血流频谱分析。结果椎动脉Ⅰ度窃血5例,乳内动脉血流方向均为正向血流。椎动脉Ⅱ度窃血7例,乳内动脉有3例收缩期出现低速短暂的反流,其余4例为正向血流。椎动脉Ⅲ度窃血5例中,有4例乳内动脉为全心动周期的反向血流,1例收缩期出现反向血流。结论锁骨下动脉窃血综合征患者患侧椎动脉可出现不同程度的窃血;而乳内动脉也可通过侧支循环发生反向血流,参与代偿上肢动脉供血。椎动脉和乳内动脉的收缩期血流变化均早于舒张期。     

锁骨下动脉完全性闭塞的血管内治疗

目的讨论锁骨下动脉完全性闭塞介入治疗方法的可行性、安全性和有效性。方法对28例锁骨下动脉（28支）近端完全闭塞合并有椎-基底动脉供血不足和（或）上肢缺血症状患者进行回顾性分析。其中男20例,女8例;年龄为42～76岁,平均为56岁。根据DSA显示闭塞段形态,应用导丝开通、球囊扩张及支架置入的方法进行治疗。经股动脉穿刺为顺行方式,经病变的股动脉和桡动脉穿刺为逆行方式。结果通浏顷行方式开通19例,逆行开通9例。25例开通成功并置入自膨式支架,失败3例,成功率为89％（25／28）;25例患者置入支架后,症状、体征明显改善。患者双上肢收缩压差由术前〉20舢心,恢复至术后〈10mmHg;术后TCD显示,椎动脉血流均由逆向转为正向。25例成功置入支架患者中,术后随访23例,失访2例,随访时间为2～48个月,平均24个月。有2例分别于术后12个月和15个月时出现支架内再狭窄,再次予以球囊扩张术和支架置入术,取得满意疗效。结论掌握好适应证,血管内机枕眭再通及支架置入术治疗锁骨下动脉闭塞是一种安全、可行、有效的方法。     

Doppler-guided cannulation of internal jugular vein,subclavian vein and innominate (brachiocephalic) vein—a case-control comparison in patients with reduced and normal intracranial compliance

Objective A case-control comparison of Doppler guidance on the success rate of central venous cannulation in patients with normal or reduced intracranial compliance.Design A single operator performed central venous access procedures with continuous wave Doppler guidance. It was used on patients on a ventilator. The position of patients with reduced intracranial compliance (RIC) was not changed for the procedure. Patients with normal intracranial compliance (NIC) were put in the Trendelenburg position.Setting We prospectively evaluated 249 Doppler-guided central venous access procedures performed over a 12-month period at our 10-bed neuro-intensive care unit at a university hospital.Patients and participants The group with RIC included 26 males and 35 females (n=61) aged 16–79 years. In this group 155 Doppler-guided cannulation procedures (62%) were performed. The group with NIC (n=52) comprised 29 males and 23 females aged 34–76 years; 94 Doppler-guided cannulation procedures (38%) were carried out.Measurements and results The veins cannulated in RIC and NIC, respectively, were: right innominate vein: 24/18, left innominate vein 26/12, right subclavian vein 12/7, left subclavian vein 25/14, and right internal jugular vein 33/18 and left internal jugular vein 35/24. The absence of one left internal jugular vein was identified in the NIC group. The success rate of first needle pass in patients with RIC was 92% and in patients with NIC 89%.Conclusions This study showed that Doppler guidance allows the cannulation of central veins in patients with RIC placed in head-up position. Cannulation can be ensured and first-pass needle placement maximised.All work was performed at the Intensive Care Unit of the Clinic for Neurology, University Hospital Hamburg-Eppendorf, Germany.There are no possible conflicts of interest, sources of financial support, corporate involvement, patent holdings etc. for any author.     

颈内动脉瘤合并锁骨下动脉瘤1例

患者女,45岁,7天前突然头痛、头晕伴恶心呕吐,既往健康。查体：生命体征平稳。头颅CT平扫双侧裂池、前纵裂略高密度影。DSA（图1～4）：右侧颈内动脉前床突段向后侧方囊状膨突动脉瘤10mm×9mm,可见附壁血栓,外缘不规则。左侧锁骨下动脉、椎动脉开口远端可见向上前方囊状膨突动脉瘤7．0mm×4．2mm,外缘光滑。