经导管血管内栓塞术治疗肺动静脉畸形

目的 评价经皮穿刺经导管栓塞术治疗肺动静脉畸形(PAVMs)的安全性和疗效。资料与方法 对10例PAVMs患者进行了经导管栓塞治疗，男4例，女6例，平均年龄12岁(6个月～28岁)，均为先天性。临床表现有紫绀和杵状指／趾7例，劳力性呼吸困难6例，胸部血管杂音4例，咯血2例和心功能不全2例。栓塞时用微型钢丝圈2例，普通钢丝圈8例。结果 PAVMs病灶为多发性7例，单发性3例。10例共做栓塞治疗12次，技术成功率为100％，治疗结束时复查肺动脉造影显示单发病灶完全消失，多发病灶者主要异常血管不再显影。术后血氧饱和度从平均78％增至96％。2例术前存在心功能不全，术后症状消失；胸部血管杂音消失。术后出现轻微胸痛5例，少量胸腔积液3例；1例术后2个月死于栓塞肺叶肺梗死继发化脓性感染。9例随访18个月～9年，一般情况良好，日常生活正常，无神经系统症状和体征，除2例弥漫型动静脉畸形血氧饱和度持续在85％～90％外，其余缺氧症状未再复发。结论 经导管血管内栓塞术是治疗PAVMs的安全、有效方法。

Percutaneous Transcatheter Endovascular Embolization of Pulmonary Arteriovenous Malformations

Objective To evaluate the effect and safety of percutaneous transcatheter embolization of pulmonary arteriovenous malformations (PAVMs).Materials and Methods Ten patients with congenital PAVMs were underwent percutaneous transcatheter endovascular embolization. There were 6 females and 4 males ranging in age from six months to twenty-eight years (average, 12 years). Presenting symptoms included cyanosis and clubbing in 7 patients, exertional dyspnea in 6, vascular murmur in the chest in 4, hemoptysis in 2, and congestive heart failure in 2 patients. The embolization devices were microcoils (n=2) and standard stainless steel coils (n=8).Results On the pulmonary angiography, 7 patients were presented with multiple lesions, and 2 with a solitary lesion. A total of 12 embolization procedures were performed in the 10 patients. Technical rate success was 100%, which was defined as complete disappearance of the solitary lesion or occlusion of macro shunts in diffuse lesions. Systemic arterial oxygen saturation improved strikingly, with a mean of 78% before embolization to 96% after embolization. The symptoms of congestive heart failure were improved immediately in two patients after the embolotherapy. The chest bruit was disappeared. Minor chest pain occurred in 5, and small pleural effusions in 3 cases, after the treatment. One patient died 2 months after the embolization due to pulmonary infarction and pneumonia in the embolized lobes. The follow-up period was from 18 months to 9 years in nine patients who had remained in good condition without further intervention. There were no recurrent sympotoms of hypoxia except 2 cases with diffuse PAVMs who arterial oxygen saturation remained 85%-90%. Conclusion Percutaneous transcatheter endovascular embolization is an effective and safe treatment of congenital PAVMs.