经导管弹簧圈漂流法治疗脾动脉瘤的疗效与安全性

目的：评价弹簧圈漂流法治疗脾动脉瘤的疗效及安全性。方法：回顾分析2005—2010年介入治疗25例共28个脾动脉瘤患者的临床资料,其中女性16例,男性9例;年龄33-86岁,中位年龄54岁。真性动脉瘤占85.7%（24/28个）,单发者占76%（19/25例）,囊状占89.3%（25/28个）,伴门脉高压者占36%（9/25例）;瘤体直径15-65mm,中位直径32mm,瘤体位于脾动脉近端8个,中段9个,脾门以远11个。20例患者行经导管载瘤动脉远近段栓塞术＋动脉瘤腔栓塞术,1例行动脉瘤腔填塞术,1例采用瘤腔完全填塞＋远端脾动脉栓塞术。其中15例采用弹簧圈漂流法栓塞脾动脉远端分支,脾动脉近端采用NESTER弹簧圈＋普通弹簧圈彻底栓塞;2例行覆膜支架植入术＋远端脾动脉栓塞术;1例合并肝动脉瘤者因脾动脉瘤体直径〈2cm选择临床随访。结果：24例患者手术成功率为100%,术后有10例（28%）患者中出现轻度栓塞后综合征,其余病例无明显手术相关并发症。栓塞术后随访2-37个月（平均18.1个月）未见动脉瘤复发、增大或破裂出血。2例覆膜支架植入患者分别随访12和18个月,支架血流均保持通畅,瘤腔未见造影剂再灌注。1例未干预动脉瘤者随访48个月,动脉瘤体无明显增大。7例出现〈30%的脾梗死,无其他动脉瘤相关并发症。弹簧圈漂流法栓塞治疗组与非弹簧圈漂流法栓塞治疗组相比在一次手术成功率、30d病死率、栓塞后综合征、脾脏梗死例数、随访出现内漏等方面均无显著差异。结论：经导管弹簧圈漂流法治疗脾动脉瘤安全、有效。

Transcather Embolization of Splenic Artery Aneurysms by Drifting-Coils Method

Objective：To evaluate the efficacy and safety of the techniques of transcatheter embolization by drifting-coils in treatment of splenic artery aneurysms（SAAs）.Methods： The Clinical data of 25 patients with SAAs between 2005 and 2010 for treated with catheter-based techniques were reviewed retrospectively.Sixteen were women,the median age was 54 years.Among 25 patients,28 were SAAs,4 were pseudoaneurysms,19 were solitary aneurysms,25 were saccular forms,of which 9 involved the middle portion of splenic artery,11 involved the splenic hilum and 8 involved the proximal portion of the splenic artery.And 36% of them had portal hypertension.The median aneurysm diameter was 32mm（range,15–65 mm）.Transcatheter endovascular coil embolization was used in 22 procedures,the techniques of transcatheter embolization by Drifting-coils was used in 15 of them.Stent graft placements were used to treat 2 patients with combined embolization of distal splenic artery.Results： Technical success was achieved in 100% of 24 of procedures.No significant complication was observed except for 10 slight post operative embolization symptoms and 7 slight splenic infarctions.An average follow-up duration of 18.1 months revealed no recurrence of areurysms and Doppler ultrasound scan showed patency of 2 stent grafts.One SAA with no intervention showed no changes.No significant difference between the embolization by drifting-coils group and no drifting-coils in embolization group was found by evaluating their technical success,30-day mortality,post-embolization symptoms,splenic infarction,the reperfusion of sac during follow-up period.Conclusions： The techniques of transcatheter embolization by drifting-coils are safe and effective methods for the treatment of splenic artery aneurysms.