经导管组织黏合剂结合弹簧圈栓塞脾动脉瘤

目的 探讨采用组织黏合剂NBCA结合弹簧圈经导管栓塞脾动脉瘤的可行性及安全性.方法 3例脾动脉瘤患者,2例位于脾动脉主干,1例位于脾动脉分支.均先经导管置入弹簧圈栓塞载瘤动脉的远端,再以NBCA与碘化油混合物栓塞载瘤动脉的近端包括瘤体.术后采用CT增强扫描随访4~20个月.结果 3例脾动脉瘤均成功栓塞,未出现严重并发症...     

Onyx联合弹簧圈经导管栓塞脾动脉瘤

目的探讨Onyx联合弹簧圈经导管栓塞脾动脉瘤的可行性及疗效。方法 3例脾动脉瘤患者,其中中间型1例,远端型2例,均为真性动脉瘤。术中均先采用弹簧圈栓塞瘤体及载瘤动脉远端,后应用Onyx栓塞瘤体及载瘤动脉近端,其中1例应用球囊辅助栓塞。术后预防性应用抗生素3天,3天及1周复查血常规及血淀粉酶,1～3个月CT增强复查上腹部。结果 3例成功栓塞,均出现不同程度的脾梗死,梗死面积10%～30%,1例出现术后低热,2例出现左上腹不同程度隐痛,症状于3～7天内缓解及消失,1例3天血淀粉酶不同程度升高,1周内恢复正常,术后随访CT未见瘤体破裂、复发。结论 Onyx结合弹簧圈经导管栓塞脾动脉瘤可行、安全、有效。     

经导管动脉栓塞治疗8例脾动脉瘤

目的 探讨经导管动脉栓塞治疗脾动脉瘤的可行性和疗效.方法 对8例脾动脉瘤患者,经导管通过脾动脉使用弹簧圈栓塞瘤体远近端动脉而将瘤体隔绝,术后采用CT或血管彩色多普勒超声随访3～36个月.结果 8例脾动脉瘤均成功栓塞,无严重并发症.1例术后10个月因腹腔大出血死亡,其余7例随访3～36个月情况良好,未见血管再通.结论 经导管动脉栓塞治疗脾动脉瘤安全可行,术后定期影像随访非常重要.     

“三明治法”栓塞治疗巨大脾动脉瘤六例的疗效分析

目的 评估"三明治法"栓塞治疗巨大脾动咏瘤的可行性及安全性.方法 在2000年3月至2008年12月,共治巨大脾动脉瘤6例,其中真性脾动脉瘤5例,2例位于脾动脉起始部,3例位于脾动脉中段;假性脾动脉瘤1例,位于脾动脉中段.所有患者均经多普勒超声和(或)CTA确诊.治疗方法均为经导管置入弹簧圈栓塞动脉瘤的流入动脉和流出动脉,即所谓"三明治法".术后随访1～9年,依据CT增强扫描、彩色多普勒超声检查及术后临床症状评估疗效.结果 所有6例脾动脉瘤均通过"三明治法"成功孤立,未出现严重并发症.1例患者术后4个月因伴发恶性骨肿瘤死亡.其余5例存活患者随访CT检查显示动脉瘤腔封闭良好,未见血管再通,2例患者有小面积扇形脾梗死表现.结论 经导管弹簧圈栓塞治疗脾动脉瘤安全、有效,"三明治法"对于巨大脾动脉瘤栓塞效果好.     

21例假性动脉瘤的治疗策略

目的 探讨假性动脉瘤的部位、类型和发生原因,选择不同的治疗方法.方法 对21例假性动脉瘤患者(四肢动脉11例、脾动脉3例、肾动脉2例、髂总动脉2例、髂内动脉1例、胆囊动脉1例、阴茎动脉1例)选择不同的治疗方法,9例肢体动脉近大关节处假性动脉瘤采用球囊临时阻断血流下瘤体切除、血管吻合术或直接切开修补术,4例主干型假性动脉瘤采用覆膜支架腔内隔绝术,其中2例发生于髂内动脉开口处的髂总动脉主干型假性动脉瘤采用分支动脉栓塞和覆膜支架腔内隔绝术,6例终末型假性动脉瘤采用明胶海绵结合不锈钢圈栓塞术.结果 21例假性动脉瘤采用不同的方法治疗后瘤腔全部消失,11例肢体动脉假性动脉瘤患者术后远端血管搏动正常,未出现神经损伤,2例脾动脉主干近端、2例髂总动脉主干假性动脉瘤覆膜支架隔绝术后无内漏、远端血流通畅,6例终末型假性动脉瘤患者栓塞后瘤腔消失,出血停止,未出现脏器缺血坏死,其中1例髂内动脉二级分支多发假性动脉瘤患者,栓塞后1周因骨盆复合伤并发重度感染死亡.结论 根据假性动脉瘤的部化、类型和产生原因,选择不同的治疗方法,在尽量小的创伤下使各部位假性动脉瘤得到有效的治疗.     

脾动脉栓塞治疗胰源性假性脾动脉瘤

目的探讨动脉栓塞术治疗急、慢性胰腺炎合并假性脾动脉瘤的临床可行性，并观察其临床效果。方法8例假性脾动脉瘤病人，6例为急性胰腺炎坏死组织清除术后腹腔和胃肠道出血；2例为慢性胰腺炎，其中1例消化道出血，1例无症状偶然发现瘤体者。运用弹簧钢圈栓塞脾动脉破口的近、远两端。术后CT观察瘤体灌注情况及出血情况。结果8例病人均栓塞成功，7例出血者成功止血，无症状者CT复查瘤体无对比剂灌注；随访3—21个月，6例无再发出血。结论经皮穿刺脾动脉栓塞术是1种简便、安全、有效的治疗假性脾动脉瘤方法。     

血管内栓塞术治疗37例假性动脉瘤

目的 探讨血管内栓塞术治疗内脏和外周假性动脉瘤的应用价值.方法 回顾性分析37例假性动脉瘤的血管内栓塞治疗前后的临床资料,3 ～ 36个月随访期内观察栓塞疗效及术后并发症等.结果 37例患者DSA造影发现41枚假性动脉瘤,其中来源于内脏动脉26例,臀上、臀下动脉5例,颈外动脉分支4例,肢体动脉2例.36例患者成功栓塞40枚假瘤,其中明胶海绵栓塞7枚,PVA颗粒栓塞9枚,弹簧圈栓塞11枚,弹簧圈辅以明胶海绵或PVA栓塞13枚.随访期内36例患者中34例出血停止,假瘤完全闭塞,有2枚假瘤复发,术后无严重并发症发生.结论 血管内栓塞术治疗假性动脉瘤安全、有效,假性动脉瘤的性质和栓塞材料的选择在一定程度上会影响疗效.     

电解可脱式弹簧圈瘤腔栓塞术治疗移植肾吻合口假性动脉瘤

目的 探讨电解可脱式弹簧圈瘤腔栓塞术在多种原因所致移植肾吻合口假性动脉瘤介入治疗中的应用和技术要点,评价其可行性和疗效,为处理移植肾血管并发症和提高移植肾长期存活率提供经验.方法 回顾性分析2012年至2015年收治的9例临床和影像学检查确诊为移植肾吻合口假性动脉瘤患者的介入诊疗资料.9例患者移植肾血管吻合方式均为移植肾动脉-右侧骼外动脉端侧吻合,根据动脉瘤位置特殊均选择电解可脱式弹簧圈瘤腔栓塞术,并视不同情况辅以支架植入术.术后定期复查实验室检查和影像学检查,综合评价治疗效果.结果 9例移植肾吻合口假性动脉瘤瘤腔均成功完全栓塞.术后随访3～21个月,平均12个月,复查实验室检查示血清肌酐(SCr)值、尿常规等未见明显异常;影像学复查示弹簧圈及支架无移位,未见假性动脉瘤残留或复发,移植肾动脉和髂外动脉保持通畅,未出现移植肾或下肢缺血等并发症.结论 对于因位置特殊不适合常规载瘤动脉栓塞术和覆膜支架瘤腔隔绝术治疗的移植肾吻合口假性动脉瘤患者,采用电解可脱式弹簧圈瘤腔栓塞术可以完全栓塞瘤腔,同时保持移植肾动脉和髂外动脉通畅.该治疗方法微创、安全有效,一定程度上可代替外科手术,但远期疗效尤其是复发情况有待进一步观察.     

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。     

不锈钢弹簧圈填塞治疗内脏动脉瘤8例

目的 探讨不锈钢弹簧圈填塞治疗内脏动脉瘤(VAA)的安全性和远期疗效.方法 回顾性分析2007年5月至2013年12月间采用不锈钢弹簧圈填塞治疗8例VAA患者临床资料及术后随访结果.结果 8例患者填塞治疗均获成功,其中6例瘤腔完全填塞,2例大部填塞.术中除1例脾动脉瘤填塞时发生1枚弹簧圈游走至脾动脉远端外,余均无操作相关并发症.术后平均随访55个月(12～90个月),CT检查显示6例完全填塞患者瘤腔完全闭塞,8例患者载瘤动脉管腔仍通畅,远端血供良好.2例瘤腔大部填塞患者中1例术后1个月复查CTA显示瘤腔显著缩小,另1例6年后CTA显示仍有残余瘤腔且有逐渐扩张趋势,再次不锈钢弹簧圈填塞成功.结论 采用不锈钢弹簧圈填塞可安全有效、经济地治疗VAA,但完全填塞精确度有限,需注意适应证选择.     

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。     

Endovascular management of pseudoaneurysms of the splenic artery: experience with six patients

The purpose of this paper was to describe our experience with the endovascular management of splenic artery pseudoaneurysms (SAPA). Seven patients with documented SAPA on CT and/or angiography were considered for endovascular treatment. The pseudoaneurysms were located in the main splenic artery (n = 4) or its branches (n = 3). In one patient in whom the pseudoaneurysm was located in a hilar branch, selective catheterization of splenic artery failed. Metallic coils (n = 1), gelfoam and hydrogel particles (n = 1), metallic coils and gelfoam (n = 2), metallic coil, gelfoam and acrylic glue (n = 2) were used as embolization material in the remaining six patients. These patients were followed for a mean period of 11.3 months. Transcatheter embolization was successful in five patients with no procedure-related complications. In one patient, embolization was incomplete and the patient underwent surgery, but died on the 10th postoperative day because of irreversible shock. Another patient, after successful embolization, underwent surgery for management of an associated pseudocyst. Endovascular treatment is a safe and effective method of management of SAPA.     

Endovascular treatment of splenic artery aneurysms

PURPOSE: To assess the feasibility and effectiveness of endovascular treatment of splenic artery aneurysms (SAAs). MATERIALS AND METHODS: Between May 2000 and June 2003 we treated 11 true SAAs in 9 patients (7 females and 2 males; mean age 58 years), 8 saccular and 3 fusiform, 4 located at the middle tract of the splenic artery, 5 at the distal tract and 2 intra-parenchymal. The diagnosis was performed with colour-Doppler ultrasound and/or CT-angiography; 7 patients were symptomless, 1 had left hypochondriac pain, and 1 had acute abdomen caused by a ruptured SAA. Four SAAs were treated by microcoil embolization of the aneurysmal sac with preservation of splenic artery patency; in 2 cases this was associated with transcatheter injection of N-butyl-2-cyanoacrylate. Four cases were treated by endovascular ligature, with sectoral spleen ischaemia. One ruptured SAA received emergency treatment with splenic artery cyanoacrylate embolization. Two intra-parenchymal SAAs were excluded, one by cyanoacrylate embolization of the afferent artery and the other by transcatheter thrombin injection in the aneurysmal sac. RESULTS: Technical success was observed in all cases (in 10/11 at the end of the procedure; in 1/11 at CT performed 3 days after the procedure). The follow-up (mean 18 months; range 6-36) was performed by colour-Doppler ultrasound and/or CT-angiography 3, 6 and 12 months after the procedure and subsequently once a year; the complete exclusion of the aneurysms was confirmed in 11/11 cases. The complications were: 4 cases of mild left pleuritis; fever and left hypochondriac pain 1 day after the procedure (in the same 4 patients and in one other case); 5 cases of sectoral spleen ischaemia and 1 case of diffuse spleen infarction with partial revascularization by collateral vessels. No alteration of the levels of pancreatic enzymes was found; a transitory increase in platelet count occurred only in the patient with diffuse spleen infarction. CONCLUSIONS: Using different techniques, endovascular treatment is feasible in nearly all SAAs. It ensures good immediate and long term results, and no doubt presents some advantages in comparison to surgical treatment, as it is less invasive and allows the preservation of splenic function.     

Elective Embolization of Splenic Artery Aneurysms with an Ethylene Vinyl Alcohol Copolymer Agent (Squid) and Detachable Coils

PurposeTo report the safety and efficacy of the embolization of splenic artery aneurysms (SAAs) with coils plus ethylene vinyl alcohol copolymer (EVOH) agent.Materials and MethodsA single-center retrospective study was conducted from 2016 to 2019 to collect SAAs. Twelve asymptomatic patients (mean age, 59 years) with 15 SAAs (mean size, 23.6 mm; size range, 15–40 mm) were treated with embolization. Embolization was performed with EVOH (Squid 8/34) and fibered detachable coils. Transfemoral embolization was performed with a microcatheter to achieve a splenic artery occlusion embolizing the SAA and its efferent and afferent branches. Follow-up was based on color Doppler ultrasound at 24 hours and on computed tomography (CT) angiography at 1 (n = 12) and 6 months (n = 12) after embolization. Mean number of coils and Squid vials used for each patient, major/minor complications, technical success, 30-day clinical success, cases of revascularization/reintervention, and mortality were assessed. Technical success was defined as complete exclusion of the aneurysmal segment and cessation of blood flow into the sac. Clinical success at 1 month was based on the absence of clinical symptoms and the exclusion of aneurysm revascularization on CT angiography.ResultsThe mean number of coils and Squid vials was 5.75 (standard deviation [SD], 1.58; range, 3–9) and 1.41 (SD, 0.49; range, 1–2), respectively. Both technical and 30-day clinical success were 100%, with no cases of aneurysm revascularization (CT angiography performed in all patients at 1 month and 6 months and in 3 patients at 24 months). No major complications or fatal events were recorded. In terms of minor complications, 2 cases of mild pancreatitis (transient amylases increase) and 1 case of focal splenic ischemia without clinical sequelae were recorded.ConclusionsEmbolization in SAAs using coils plus EVOH was safe and effective without SAA revascularization     

Multimodal approach to endovascular treatment of visceral artery aneurysms and pseudoaneurysms

PURPOSE: To assess the feasibility and the effectiveness of endovascular treatment of visceral arteries aneurysms (VAAs) using a "multimodal approach". MATERIAL AND METHODS: Twenty-five patients (mean age 60.1 years) with 29 VAAs (13 splenic, 4 hepatic, 3 gastroduodenal, 6 renal, 2 pancreatic-duodenal, 1 superior mesenteric) were considered suitable for endovascular treatment; 8/29 were ruptured. Saccular aneurysms (9/29) were treated by sac embolization with coils (in 4 cases associated with cyanoacrylate or thrombin) with preservation of artery patency. Fusiform aneurysms (6/29), were treated by an "endovascular exclusion". In 10/29 cases, supplied by a terminal branch, we performed an embolization of the afferent artery, with coils and cyanoacrylate or thrombin. 2/29 cases were treated with a stent-graft and 2/29 cases with a percutaneous ultrasound-guided thrombin injection and coils embolization of the afferent artery. The follow-up was performed by ultrasonography and/or CT-angiography 1 week after the procedure and then after 1, 6, and 12 months and thereafter annually. RESULTS: In 29/29 cases we obtained an immediate exclusion. Two patient died for other reasons. Complication rate was 27.6% (7 spleen ischemia and 1 stent-graft occlusion). During the follow-up (range: 7 days-36 months, mean 18.7 months), we observed 3/29 (10.3%) cases of reperfusion in the first month, all treated successfully with a further endovascular procedure. Primary technical success was 89.7%; secondary technical success was 100%. CONCLUSION: Endovascular therapy can be considered a feasible and effective approach for VAAs with good primary and secondary success rates.     

创伤性假性动脉瘤的介入治疗及临床观察

目的探讨创伤性假性动脉瘤介入治疗的方法及疗效。方法对18例假性动脉瘤患者(肝动脉瘤2例,肾动脉瘤4例,脾动脉瘤1例,胸主动脉2例,周围血管9例),采用不同方法治疗。6例置入带膜支架,10例采用明胶海绵栓塞或弹簧圈栓塞,1例采用部分动脉瘤内填塞加供血动脉栓塞治疗,1例股动脉穿孔型假瘤采用压迫法。结果技术成功率100%。17例动脉瘤闭塞,症状体征消失;1例胸主动脉假瘤出现内瘘;未出现其他并发症。结论介入方法治疗假性动脉瘤安全有效。     

Percutaneous transcatheter embolization of deep visceral pseudoaneurysms]

The authors present their experience with the percutaneous embolization of 13 splanchnic aneurysms and pseudoaneurysms (2 pseudoaneurysms of gastroduodenal artery, 3 of the hepatic artery, 7 renal pseudoaneurysms, 1 aneurysm of the splenic artery). In 9 of 13 cases the lesions were iatrogenic. Embolizing devices and techniques are described. Percutaneous embolization was successful in 12 of 13 cases, and useless in 1 case of renal pseudoaneurysm. In the 12 successfully treated cases the lesions were still occluded in the follow-up period. Transcatheter percutaneous embolization is the elective treatment in splanchnic aneurysms and pseudoaneurysms; surgery must be performed only when embolization fails.     

支架辅助弹簧圈介入栓塞颅内宽颈动脉瘤

目的探讨支架辅助弹簧圈介入栓塞治疗颅内宽颈动脉瘤的方法和疗效。方法回顾性分析16例患者的临床资料,应用支架包括Neuroform 6枚和Fnterprise 10枚。结果所有支架均成功释放并行弹簧圈栓塞,即刻造影动脉瘤获得完全及大部分栓塞13例,瘤颈残留1例,部分栓塞2例.14例患者术后3～12个月复查,13例完全及大部分栓塞中11例复查未见复发,瘤颈残留1例6个月后复查复发,再次行支架植入完全栓塞.部分栓塞2例复查时瘤腔消失。结论通过支架辅助对宽颈动脉瘤瘤颈重塑及弹簧圈的介入栓塞作用,使动脉瘤栓塞疗效满意。