Case of arterial hemorrhage after endoscopic papillary large balloon dilation for choledocholithiases using a covered self-expandable metallic stent

A 78-year-old male was admitted to our hospital because of choledocholithiasis.ERC demonstrated choledocholithiases with a maximum diameter of 13 mm, and we performed endoscopic papillary large balloon dilation(EPLBD) with a size of 15 mm.Immediately following the balloon deflation, spurting hemorrhage occurred from the orifice of the duodenal papilla.Although we performed endoscopic hemostasis by compressing the bleeding point with the large balloon catheter, we could not achieve hemostasis.Therefore, we placed a 10 mm fully covered selfexpandable metallic stent(SEMS) across the duodenal papilla, and the hemorrhage stopped immediately.After 1 wk of SEMS placement, duodenal endoscopy revealed ulcerative lesions in both the orifice of the duodenal papilla and the lower bile duct.A direct peroral cholangioscopy using an ultra-slim upper endoscope revealed a visible vessel with a longitudinal mucosal tear in the ulceration of the lower bile duct.We believe that the mucosal tear and subsequent ruptured vessel were caused by the EPLBD procedure.     

Willis覆膜支架治疗颈内动脉海绵段假性动脉瘤与瘘

目的 探讨使用Willis覆膜支架治疗颈内动脉海绵窦段假性动脉瘤与瘘的可行性、有效性。方法 回顾性分析2013年1月到2017年12月收治的15例颈内动脉海绵窦段假性动脉瘤和1例颈内动脉海绵窦瘘的临床资料,均采用Willis覆膜支架置入术治疗。结果 术后即刻血管造影显示病变完全消失,载瘤动脉通畅。术后死亡2例;其余14例术后随访6~24个月,均恢复正常工作,DSA或CTA随访未见复发,但1例放疗病人出现颈内动脉海绵窦段慢性闭塞。结论 Willis覆膜支架治疗颈内动脉海绵窦段假性动脉瘤与瘘成功率高,操作简单。     

Use of Radiofrequency Then Stent Implantation for Recanalization of Complete Aorta Coarctation

Recanalization of a complete coarctation with isthmus occlusion was successfully accomplished in a 16-year-old patient using radiofrequency. This allowed the insertion and deployment of a covered stent to reestablish flow continuity across the isthmus. No complications were encountered. To the authors’ knowledge this is the first case of radiofrequency use for complete coarctation, and among the rare cases of complete coarctation addressed primarily percutaneously to be reported.     

动脉瘤性颈内动脉海绵窦瘘的血管内治疗

目的总结应用血管内技术治疗颈内动脉海绵窦段动脉瘤破裂导致颈内动脉海绵窦瘘(CCF)的经验体会。方法回顾性分析8例颈内动脉海绵窦段动脉瘤破裂致CCF患者的临床资料以及应用的血管内技术,其中单纯应用可脱球囊治疗1例,弹簧圈结合可脱球囊进行治疗2例,球囊辅助弹簧圈栓塞治疗2例,覆膜支架治疗1例。结果8例患者中6例治疗成功,无技术相关性并发症;1例治疗前突然死亡;1例放弃治疗。结论血管内技术是治疗颈内动脉海绵窦段动脉瘤破裂致CCF的安全、有效方法。     

医源性假性动脉瘤的研究进展

假性动脉瘤已成为介入治疗较常见的并发症,可产生局部症状,有较大的危险性,甚至危及患者生命。传统的单纯局部加压包扎及外科手术治疗均有较大的局限性,不宜在临床推广应用。超声引导下局部压迫、瘤内凝血酶注射、瘤内血小板胶注射及覆膜支架瘤腔内隔绝等方法,成功率较高,并发症较少,有很大的优越性。该文就假性动脉瘤的诊断及防治进展予以综述。     

Endovascular treatment of traumatic internal carotid artery pseudoaneurysm

IntroductionTraumatic internal carotid artery pseudoaneurysm (TICAP) is the most common cause of stroke in young adults. The treatment of TICAP with open surgery poses excess risk, thus during last decade endovascular treatment strategies have been applied.AimTo assess the efficacy and the existing experience of endovascular treatment of TICAP.MethodologyA systematic review of the literature was undertaken to identify all reported cases of endovascular treatment of TICAP from 1998 to 2015 in MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials.ResultsA total of 193 patients (139 males, 75%) with mean age of 30.8 ± 2.2 years in 23 case studies, were treated for their TICAP with endovascular treatment. The main causes of TICAP were road traffic accidents 51%, assaults 12%, fall from height 8% and other miscellaneous causes were 29%. In 8/23 studies, the patients were operated emergently, in 9/23 at least 1 month after the carotid injury, and in 6/23 the time between the injury and the operation was not reported. The total success rate of pseudoaneurysm occlusion was 84% (162/193). The reported peri-procedural morbidity rate was 6% (11/185; 3 TIA, 7 strokes and 1 subclavian artery dissection), and the peri-operative mortality rate was 1.2% (2/162). Most patients received post-operatively antiplatelet therapy (either single or dual) and the duration of the administration ranged from 3 months to long term. During their follow up (ranging from 4 days to 13 years) only 6 patients required re-intervention, and this was undertaken with endovascular approach.ConclusionEndovascular therapy tends to be an effective option for the treatment of TICAP with low morbidity and mortality rates.     

覆膜支架在食管破裂中的临床应用和经验总结

目的探讨覆膜食管内支架治疗食管破裂的可行性及安全性。方法7例食管破裂患者经食管碘水造影确诊,选用国产覆膜食管内支架进行治疗,常规方法置入,每天经胸腔引流管冲洗胸腔,7～10周后取出支架,食管造影复查。结果全部病例支架置人成功,6例在规定时间内取出支架,1例因支架移位调整位置后,延长至13周后取出支架,复查食管造影均提示破口愈合。结论覆膜食管内支架置入治疗食管破裂安全有效,适合在临床上推广应用。     

头臂动脉瘤和动静脉瘘的腔内治疗

目的探讨头臂血管假性动脉瘤(BCPA)或颈动脉静脉瘘(CVEF)患者的腔内治疗效果。方法 2003年9月—2011年3月笔者诊治10例假性动脉瘤和动静脉瘘患者并行腔内治疗,其中假性动脉瘤7例,先天性动静脉畸形2例,外伤性动静脉瘘1例。假性动脉瘤的病因为外伤或医源性损伤;临床表现为颈部或锁骨下搏动性肿块,病程2 h至40年不等。10例均经股动脉穿刺造影明确病变性质、部位、大小,然后采用放射介入方法,用带膜支架封堵病变处破口,重朔血管。结果 8例假性动脉或外伤性动脉静脉瘘及1例先天性动静脉瘘达到满意疗效,1例先天性动静脉瘘畸形明显好转,动静脉瘘流量明显减少。结论头臂部动脉瘤或动静脉瘘采用带膜支架腔内隔绝治疗方法微创、简便、迅速、安全、有效,有实用价值。     

带膜支架治疗6例颅内动脉瘤的临床分析

目的探讨应用带膜支架治疗颅内动脉瘤的效果。方法根据靶血管的直径和病变的长度,选择合适带膜支架行病变隔绝术,共治疗椎动脉颅内段动脉瘤3例、颈内动脉动脉瘤3例。结果在6例患者带膜支架被成功释放于靶动脉,动脉瘤消失,并保持载瘤动脉畅通,临床效果满意。支架放置后6个月造影随访病例载瘤动脉畅通。结论带膜支架是采用血管内治疗技术处理部分颅内动脉瘤的有效手段。