经导管栓塞术治疗急性重症胰腺炎并发假性动脉瘤

目的 评价经导管栓塞术治疗急性重症胰腺炎并发假性动脉瘤的价值。方法 7例急性重症胰腺炎并发腹部假性动脉瘤患者进行了腹部动脉造影及经导管栓塞治疗，观察假性动脉瘤出现的部位、术中及术后并发症、再出血情况及临床结果。结果 造影共发现假性动脉瘤7例，位于脾动脉5例、胃网膜右动脉1例和胃左动脉1例，3例动脉瘤见活动性出血征象。6例动脉瘤用弹簧圈栓塞载瘤动脉，出血立即停止，其中5例1次栓塞成功，1例经2次栓塞成功。3例再次出血，再出血时间为14～60d，1例再次造影发现脾动脉假性动脉瘤形成，弹簧圈栓塞后出血停止，2例再次造影均未见明显出血原因，死亡。1例用明胶海绵颗粒栓塞无效，3d后出血死亡。2例发生与插管和造影操作相关的并发症，1例为动脉破裂，1例为动脉内膜夹层。无严重术后并发症发生。结论 经导管栓塞术治疗急性重症胰腺炎并发假性动脉瘤是1种有效和相对安全的方法。     

内脏动脉瘤出血栓塞治疗分析（附3例报告）

目的:总结经导管栓塞治疗腹腔内脏动脉瘤的经验。材料和方法:采用Seldinger’s穿刺技术行腹腔干、肠系膜上下动脉造影,明确出血原因和部位后行栓塞治疗。结果:3例病例中,脾动脉瘤、肝动脉瘤及回结肠动脉瘤各1例。DSA造影表现类圆形高密度影,栓塞后再次造影见动脉瘤染色消失,随访出血停止。结论:选择性DSA造影能明确疑难性出血的部位和原因,经导管栓塞治疗可有效控制出血。     

胃十二指肠动脉假性动脉瘤血管造影诊断及栓塞治疗

目的探讨血管造影诊断及栓塞治疗胃十二指肠动脉假性动脉瘤的方法。资料与方法12例胃十二指肠动脉假性动脉瘤均为腹部外科手术后急性消化道出血,经内科保守治疗无效而急诊行血管造影及栓塞治疗。其中消化道出血前2例有感染征象,2例腹腔引流液淀粉酶升高。结果11例栓塞后迅速止血;1例消化道出血栓塞胆囊动脉6h后再出血,再次造影发现胃十二指肠动脉残端假性动脉瘤破裂,栓塞胃十二指肠动脉残端后止血。栓塞后复查造影示假性动脉瘤供血动脉完全闭塞,假性动脉瘤未见显影;栓塞术后3例有一过性上腹部疼痛。术后随访3～46个月,无复发及并发症。结论血管造影诊断及经导管栓塞是诊断及治疗胃十二指肠动脉假性动脉瘤迅速、安全、有效的方法。     

血管内栓塞治疗外周假性动脉瘤

目的探讨血管内栓塞治疗外周假性动脉瘤的方法及疗效。方法本组21例患者,肝动脉瘤2例,肾动脉瘤12例,直肠上动脉瘤1例,胃十二指肠动脉瘤1例,下肢动脉瘤3例及子宫动脉瘤2例。均行相关动脉造影,明确假性动脉瘤部位、范围、程度及血供情况,然后超选择插管至病变处,进行栓塞治疗,栓塞方法及栓塞剂的种类、剂量根据病变性质、造影表现及插管具体位置进行选择。结果 21例患者均通过动脉造影明确诊断,DSA造影假性动脉瘤呈现类圆形囊状突起。栓塞后再次造影见动脉瘤及其供血动脉消失,21例介入治疗均获成功。随防1~18个月,均未复发。结论血管内栓塞治疗外周假性动脉瘤,安全有效、创伤小、并发症少,是行之有效的治疗方法。     

经导管栓塞治疗肝脏外伤出血

目的 探讨经导管栓塞治疗肝脏外伤出血的疗效、适应证、并发症等.方法 回顾性分析我院从1996年5月到2006年5月收治肝脏外伤出血患者33例,其中24例行肝动脉造影证实为肝动脉假性动脉瘤形成,再超选择插管至病变部位,根据载瘤动脉受损情况,予明胶海绵和(或)弹簧圈栓塞.结果 24例28枚假性动脉瘤栓塞技术上均一次成功.2例分别在栓塞后48 h、72 h再次出血.再次栓塞后1例康复,1例在第2次栓塞后1周因再出血和严重腹腔感染死亡.发热9例,均与栓塞无直接相关.结论 经导管栓塞治疗肝脏外伤出血安全、迅速、有效.     

医用胶栓塞肾脏假性动脉瘤疗效分析

目的：探讨液体医用胶结合微导管超选择插管技术栓塞治疗肾脏假性动脉瘤的安全性及有效性。方法回顾性分析2009年10月至2014年1月肾动脉造影诊断为肾脏假性动脉瘤并接受福爱乐医用胶栓塞出血血管的23例患者临床资料。23例患者有28枚肾脏假性动脉瘤（18例医源性损伤患者有21枚,5例外伤患者有7枚）,均经3 F微导管超选择插管至肾脏假性动脉瘤载瘤动脉,造影明确后在减影下经微导管向假性动脉瘤内注入福爱乐医用胶－碘化油1∶1混合液栓塞出血血管。观察假性动脉瘤栓塞成功率、术后血尿及肾功能。结果23例28枚肾脏假性动脉瘤均栓塞成功,福爱乐医用胶平均用量0．4 ml（0．2～1 ml）。3例患者载瘤动脉邻近3级分支血管出现异位栓塞,无2级分支血管及肾动脉主干血管异位栓塞。1例假性动脉瘤直径＞2 cm患者术后2 d持续存在血尿,再次造影后于载瘤动脉补充塔形弹簧圈1枚,出血停止。其余患者在3个月随访期间均未再出现血尿情况。4例术后血清肌酐有轻度升高。结论福爱乐医用胶结合微导管超选择插管栓塞肾脏假性动脉瘤迅速,栓塞成功率高,术后再出血发生率低,疗效确切。     

创伤性假性动脉瘤介入治疗的疗效分析

目的 探讨利用介入栓塞方法治疗创伤性假性动脉瘤的临床疗效.方法 对24例经DSA检查确诊为创伤性假性动脉瘤的患者行介入栓塞治疗.结果 经DSA造影检查,均能清楚显示创伤性假性动脉瘤的位置、形态、开口及大小.其中17例行弹簧钢圈栓塞供血动脉,5例用无水乙醇栓塞供血动脉,2例行假性动脉瘤孤立术.24例患者全部得以有效止血.结论 介入治疗是创伤性假性动脉瘤治疗的有效方法,可以达到立即止血的目的.     

臀部创伤性假性动脉瘤的栓塞治疗及其并发症

目的 探讨臀部创伤性假性动脉瘤的栓塞治疗方法及其并发症。资料与方法 9例臀部创伤性假性动脉瘤患者,行选择性动脉插管至载瘤动脉,造影明确诊断后采用明胶海绵和／或弹簧钢圈栓塞,并对栓塞治疗的方法和可能出现的并发症进行分析。结果 9例均发生于髂内动脉分支,其中臀上动脉3例,阴部内动脉3例,臀下动脉2例,闭孔动脉1例,均成功栓塞,随访2个月均痊愈,无严重并发症发生。结论 经导管栓塞臀部创伤性假性动脉瘤是一种安全、有效且并发症少的治疗方法。     

血管腔内治疗创伤性下肢假性动脉瘤(附5例分析)

目的探讨血管内治疗创伤性下肢假性动脉瘤的方法及疗效。方法本组5例左下肢假性动脉瘤患者,左侧股深动脉分支动脉瘤2例,股浅动脉主干1例,臀上动脉分支1例,腓动脉分支1例,均行相关动脉造影,明确假性动脉瘤部位、范围、程度及血供情况,然后行血管腔内治疗。治疗方法根据病变部位、大小及造影表现进行选择。结果 5例患者均通过动脉造影明确诊断,DSA造影假性动脉瘤呈现不规则形囊状突起。血管腔内治疗后再次造影见动脉瘤及其供血动脉消失,5例介入治疗均获成功。随防2~15个月,均未复发,且无并发症发生。结论血管腔内治疗下肢创伤性假性动脉瘤,安全有效、创伤小、并发症少,是有效的治疗方法。     

Glubran-2胶联合弹簧圈栓塞治疗外科术后内脏假性动脉瘤

【摘要】目的：评价Glubran-2胶联合弹簧圈经导管动脉栓塞治疗内脏假性动脉瘤的临床疗效和安全性。方法：12例开放手术后腹腔假性动脉瘤患者行DSA血管造影，并采用Glubran-2胶联合弹簧圈行栓塞治疗，分析12例患者的止血效果及栓塞后并发症。结果：12例假性动脉瘤中位于胃十二指肠动脉主干和分支4例，肝左动脉分支2例，肝右动脉分支4例，脾动脉近脾门处1例，脾动脉中段1例。根据假性动脉瘤的部位和血流速度，选择合适的弹簧圈和Glubran-2胶浓度进行栓塞治疗。12例患者均栓塞成功，其中3例栓塞治疗后出现一过性胆红素增高，1例脾动脉瘤栓塞后脾脏部分梗死。结论：Glubran-2胶联合弹簧圈治疗外科术后内脏假性动脉瘤安全有效。根据血流动力学及血管情况配制合适的Glubran-2胶浓度，掌握注射速度，可提高栓塞成功率，减少异位栓塞的发生风险。     

Endovascular management of major arterial hemorrhage as a complication of inflammatory pancreatic disease

PURPOSE: Major arterial hemorrhage is an important complication of inflammatory pancreatic disease, with an overall mortality of 37%. The present study was undertaken to evaluate the experience of a tertiary referral center for pancreaticobiliary disease in the management of major arterial complications of pancreatitis with selective visceral angiography and transcatheter arterial embolization (TAE). MATERIALS AND METHODS: A 6-year retrospective analysis of all patients undergoing visceral angiography for major bleeding as a complication of pancreatitis identified 35 patients (26 male, 9 female) with a mean age of 51.2 years (range, 11-73 y). Patient demographics, history, clinical presentation, angiographic findings, angiographic treatment, and follow-up outcomes were retrospectively noted. Technical success was defined as the devascularization of a focal lesion or reduction or cessation of blood flow to a target vascular bed or organ, and clinical success was defined as the resolution of the symptoms and signs that prompted the initial embolization. RESULTS: Angiography identified the site of bleeding in 54.3% of patients (n=19) and angiographic intervention was performed in 77.1% of patients (n=27). Technical success was achieved in 81.5% of those 27 patients (n=22), with overall clinical success in 80.0% (n=28). Multiple angiograms were required in 12 patients, with four demonstrating bleeding from new sites. The mortality rate was 20% (7 of 35). CONCLUSIONS: In major arterial hemorrhage resulting from pancreatic inflammatory disease, visceral angiography can identify the site of bleeding and hemostasis can be achieved. Repeat angiography is often required with bleeding from new sites. The mortality rate is comparable to that associated with surgery and reflects multisystem involvement in acute severe pancreatitis.     

Transcatheter arterial embolization in gastric cancer patients with acute bleeding

The safety and clinical effectiveness of transcatheter arterial embolization for bleeding associated with unresectable gastric cancer was evaluated. Twenty-three patients with bleeding from unresectable gastric cancer underwent transcatheter arterial embolization. Of the 23 patients, eight showed signs of active bleeding, such as contrast extravasation or pseudoaneurysm, seven showed only tumor staining, and the remaining eight patients showed negative angiographic findings. All embolization procedures were successful without procedure-related complications. In all eight active bleeding patients, immediate hemostasis was achieved. The overall clinical success rate was 52% (12/23). Recurrent bleeding within 1 month occurred in one (8%) in 12 patients with initial clinical success. One patient showed partial splenic infarction after embolization of the splenic artery for active bleeding from the short gastric artery. Overall 30-day mortality rate was 43% (10/23). The median overall survival period was 38 days. In patients with bleeding from unresectable gastric cancer, transcatheter arterial embolization was found to be safe and effective for achieving immediate hemostasis for active bleeding. Although the clinical success rate was not high, the recurrent bleeding rate was low at 1 month post procedure.     

Transcatheter arterial embolization for intractable epistaxis secondary to gunshot wounds

PURPOSE: To evaluate the efficacy of transcatheter arterial embolization for intractable epistaxis secondary to gunshot wounds. MATERIALS AND METHODS: Seven patients with intractable epistaxis secondary to penetrating trauma (gunshot wounds) were studied with angiography and subsequently underwent embolization with particles (polyvinyl alcohol, gelatin sponge) and/or microcoils. Clinical follow-up included standard hemodynamic monitoring, serial hematocrit determinations, and clinical observation for recurrent bleeding. RESULTS: Diagnostic angiography demonstrated evidence of acute arterial injury in all patients. All patients subsequently underwent embolization to complete angiographic stasis. Two patients had persistent bleeding following embolization. One of these patients required maintenance of his nasal packing for 7 days after embolization; no blood products were required during this time. The second patient's bleeding resolved following correction of his coagulopathy. No complications occurred in any of the patients. CONCLUSIONS: Transcatheter arterial embolization for epistaxis secondary to gunshot wounds is efficacious in the acute setting when conservative management fails.     

Transcatheter Arterial Embolization of Acute Arterial Bleeding in the Upper and Lower Gastrointestinal Tract with N-Butyl-2-Cyanoacrylate

PurposeTo assess the clinical utility and safety of transcatheter arterial embolization with N-butyl-2-cyanoacrylate (NBCA) for urgent control of acute arterial bleeding in the upper and lower gastrointestinaltract.Materials and MethodsTherapeutic NBCA embolization was performed in 37 patients (39 cases; mean age, 67.8 years) with acute upper (n = 16) or lower (n = 23) gastrointestinal tract bleeding after endoscopic management had failed. Transcatheter arterial embolization was performed using 1:1 to 1:5 mixtures of NBCA and iodized oil. The most common etiologies of bleeding were colonic diverticulosis (n = 13), malignancy (n = 11), and benign ulcer (n = 7). Coagulopathy was present in 11 patients, and 23 patients were hemodynamically unstable before NBCA embolization. Histologic examination for bowel ischemia was also performed in five patients who underwent excision of the lesion after NBCA embolization.ResultsThe technical success rate was 100%. Recurrent bleeding occurred in two patients. Complete hemostasis was achieved in all 11 patients with coagulopathy. Ulcers induced by transcatheter arterial embolization were noted in 6 of 20 patients who underwent endoscopic examination; the ulcers were successfully treated with conservative measures. Histologic examination revealed that despite inflammatory reactions in and around the vessels, no intestinal necrosis secondary to NBCA embolization was found. Hepatic abscess occurred in two cases, and ischemia of the lower limb occurred in one case; these complications were managed by percutaneous drainage and bypass surgery.ConclusionsTranscatheter arterial embolization with NBCA is a good treatment option with a high rate of complete hemostasis and a low recurrent bleeding rate, even in patients with coagulopathy.     

Transcatheter Arterial Embolization for Upper Gastrointestinal Nonvariceal Hemorrhage: Is Empiric Embolization Warranted?

Purpose

To determine whether transcatheter arterial embolization performed in the setting of active gastric or duodenal nonvariceal hemorrhage is efficacious when the bleeding source cannot be identified angiographically.

Methods

Records of 115 adult patients who underwent visceral angiography for endoscopically documented gastric (50 patients) or duodenal (65 patients) nonvariceal hemorrhage were retrospectively reviewed. Patients were subdivided into three groups according to whether angiographic evidence of arterial hemorrhage was present and whether embolization was performed (group 1?=?no abnormality, no embolization; group 2?=?no abnormality, embolization performed [empiric embolization]; and group 3?=?abnormality present, embolization performed). Thirty-day rates and duration of primary hemostasis and survival were compared.

Results

For patients with gastric sources of hemorrhage, the rate of primary hemostasis at 30?days after embolization was greater when embolization was performed in the setting of a documented angiographic abnormality than when empiric embolization was performed (67% vs. 42%). The rate of primary hemostasis at 30?days after angiography was greater for patients with duodenal bleeding who either underwent empiric embolization (60%) or embolization in the setting of angiographically documented arterial hemorrhage (58%) compared with patients who only underwent diagnostic angiogram (33%). Patients with duodenal hemorrhage who underwent embolization were less likely to require additional invasive procedures to control rebleeding (p?=?0.006).

Conclusion

Empiric arterial embolization may be advantageous in patients with a duodenal source of hemorrhage but not in patients with gastric hemorrhage.     

子宫动脉栓塞术预防和治疗子宫大出血的临床效果

目的探讨子宫动脉栓塞术预防和治疗子宫大出血的临床效果。资料与方法对12例人工流产大出血、胎盘植入性大出血和宫颈妊娠为主要表现的患者用明胶海绵颗粒进行双侧子宫动脉栓塞术,观察治疗效果。结果 12例患者全部栓塞成功,随访2～5个月无再次大出血,无严重并发症。结论子宫动脉栓塞术预防和治疗子宫大出血是一种安全、微创和有效的治疗方法,而且可以保留患者的子宫和生育功能,值得临床推广应用。     

N-butyl cyanoacrylate embolization for control of acute arterial hemorrhage

PURPOSE: To report the initial clinical experience with the use of n-butyl cyanoacrylate (NBCA) for embolization of acute arterial hemorrhage from varied etiologies and at varied anatomic sites. MATERIALS AND METHODS: Sixteen patients who demonstrated active extravasation of contrast material and/or arterial abnormality underwent NBCA embolization. Sites of embolization included the gastrointestinal tract, kidney, liver, uterus, adrenal gland, extremity, and chest wall. Standard coil or particulate embolization had previously failed in 10 patients. NBCA was used as the initial embolic agent in the remaining six patients. After treatment, serial hematocrit levels, transfusion requirements, and clinical signs and symptoms were monitored for stabilization. Patients were evaluated for signs and symptoms of end-organ damage. RESULTS: NBCA embolization was successful in 12 of 16 patients (75%), who exhibited complete cessation of bleeding. In four patients (25%), NBCA embolization was of no benefit. Embolization failed in two of 16 patients (12.5%), who showed evidence of recurrent bleeding after use of NBCA. The remaining two patients (12.5%) died within 24 hours of the procedure. None of the 16 patients developed clinical signs of end-organ damage or iatrogenic ischemia attributable to NBCA. CONCLUSIONS: In this initial limited series, NBCA embolization was shown to be a feasible and effective method to control acute arterial hemorrhage. NBCA embolization was able to stop arterial bleeding even when previous coil or particulate embolization had failed.     

骨和肌肉组织肿瘤的超选择动脉栓塞术

目的 :探讨骨和肌肉组织肿瘤的超选择动脉栓塞术的临床价值。方法 :运用Seldinger技术 ,对 18例骨和肌肉组织肿瘤进行造影 ,灌注和超选择动脉栓塞术 ,栓塞材料运用明胶海绵粒加抗癌药浸泡。结果 :18例骨和肌肉组织肿瘤中14例进行了栓塞 ,其中彻底栓塞者 8例 ,部分栓塞 6例 ;栓后肿块明显缩小 ,有 10例栓后肿瘤切除术 ,术中出血减少 ,肿瘤切除容易、彻底 ;4例孤息性栓塞 ,疼痛减轻 ,生存质量改善。结论 :骨和肌肉组织肿瘤的超选择动脉栓塞术 ,能使肿块缩小 ,提高生存质量 ;特别是术前栓塞能减少术中出血 ,以利肿瘤切除     

Usefulness of Pelvic Artery Embolization in Cesarean Section Compared with Vaginal Delivery in 176 Patients

PurposeTo evaluate the efficacy and safety of transcatheter arterial embolization of the pelvic arteries for the treatment of postpartum hemorrhage (PPH) associated with cesarean section compared with vaginal delivery.Materials and MethodsA retrospective analysis of 176 patients undergoing transcatheter arterial embolization of the pelvic arteries for PPH from January 2006 through August 2011 was conducted at two institutions. The mean patient age was 33.9 years (range, 24–46 years). Data including delivery details, hematology and coagulation results, embolization details, and clinical outcomes were collected. Technical success was defined as cessation of bleeding on angiography or angiographically successful embolization of the bleeding artery. Clinical success was defined as the obviation of repeated embolization or surgical intervention.ResultsThe technical success rate was 98.8% (n = 174), and the clinical success rate was 89.7% (n = 158). Among 176 patients, 71 had cesarean sections, and 105 underwent normal vaginal deliveries. Of the 105 patients who underwent normal vaginal deliveries, 11 (10.5%) required repeat embolization or surgical intervention. Of the 71 patients who had cesarean sections, 7 (9.8%) required repeat embolization or surgical intervention. The clinical success rate and complication rate were not related to the mode of delivery. All women resumed menses after transcatheter arterial embolization, and most (n = 125) described their menses as unchanged. Subsequent spontaneous pregnancies occurred in 13 women.ConclusionsThe cesarean mode of delivery is not a predictor of poorer outcomes of transcatheter arterial embolization; however, further study is needed to clarify this relationship.     

经导管栓塞治疗恶性肿瘤急性膀胱出血的临床疗效

目的评价经导管动脉栓塞术治疗对恶性肿瘤导致的急性膀胱出血的临床疗效。 方法回顾性分析2008年1月～2011年12月应用介入栓塞治疗恶性肿瘤导致的急性膀胱出血的42例患者临床资料,对栓塞术后血尿控制、并发症状况进行分析。 结果技术成功率100%（50/50）,35例患者术后1~6天血尿停止或减少,近期成功率83.33%（35/42）。10例患者在随访期间再次出现血尿症状,远期成功率为76.19%(32/42),无误栓、膀胱坏死、肾功能损伤等严重并发症发生。 结论经导管动脉栓塞术治疗恶性肿瘤急性膀胱出血疗效确切,安全有效。