肢体创伤性动脉病变的介入诊断与治疗

目的 评价介入放射方法诊断治疗肢体创伤性动脉病变的效果。方法 8例肢体动脉创伤伴有远端肢体缺血改变，其中2例伴大出血，伤者接受了选择性患肢动脉造影检查；7例随后进行了动脉病变的血管腔内介入治疗。治疗方法包括动脉分支或主干栓塞、动脉内溶栓和血管内支架置放。结果 血管造影精确显示了动脉破裂、假性动脉瘤、血栓形成或动脉内膜损伤等病变性质。3例假性动脉瘤、3例动脉血栓病变综合应用介入治疗方法取代外科手术获得满意疗效。1例溶栓后证实动脉破裂和1例造影证实动静脉瘘后转手术治疗。结论 介入放射与外科方法相结合能明显提高肢体动脉创伤的诊断治疗水平，有效挽救伤者肢体和生命。

Artery injuries in extremity trauma: interventional diagnosis and treatment

Objective To assess the diagnostic and therapeutic value of interventional processes for artery injuries in extremity trauma. Methods Eight patients suffered from extremity trauma underwent angiography. Two of them were with massive bleeding incidental and all cases presented ischaemia in some degree. Endovascular therapies including embolization, thrombolysis and stent placement were performed in 7 patients. Results Lesion characteristics of artery leakage, pseudoaneurysm, thrombosis or artery intima laniate were exactly proved by angiographic findings. Three cases of pseudoaneurysm were treated successfully with embolization therapy by using gelfoam and spring coil. Incidental bleeding stopped immediately. Thrombolysis got a satisfactory result in 3 cases of thrombosis. A local intima injury was treated by stent placement procedure after thrombolysis. In a severe leg damage with poplitea artery thrombosis, vessel rupture was recognized as the original lesion via thrombolysis and finally lead to amputation. A case of angiographic proved femoral arteriovenous fistula received surgical treatment. Conclusion Combined interventional therapy is safe and effective for artery injuries in extremity trauma and could probably replace surgical process in many circumstances.