血管内栓塞治疗基底动脉顶端动脉瘤

目的评价血管内栓塞治疗基底动脉顶端动脉瘤的疗效。方法回顾性分析2000年7月～2010年12月血管内栓塞治疗17例基底动脉顶端动脉瘤的临床资料。6例在出血2天内1、1例在出血3～10天内进行血管内栓塞治疗。应用Neuroform支架辅助弹簧圈栓塞宽颈动脉瘤3例,弹簧圈栓塞14例。结果 17例中成功栓塞16例,其中10例100%栓塞,3例95%栓塞,3例90%栓塞,术中动脉瘤破裂1例（弹簧圈栓塞,次日死亡）。出院时格拉斯哥预后评分（GOS）,恢复良好12例;中度病残,但生活能自理3例;重度病残,生活不能自理1例。16例随访6～36个月,平均15个月,无术后再出血,2例复发。结论血管内栓塞是治疗基底动脉顶端动脉瘤的一种微创、相对安全有效的治疗方法。     

基底动脉分叉部动脉瘤夹闭的手术体会

目的分析两种不同的手术入路行夹闭基底动脉分叉部动脉瘤,探讨该手术入路方式、规范和改进手术操作等措施,提高手术成功率和改善患者预后。方法回顾性分析10例基底动脉分叉部动脉瘤在显微镜下经两种不同手术入路夹闭治疗的临床资料。结果 10例患者术后存活9例,1例患者术前患合并多种并发疾病,全身状况差,术后1个月因多器官功能衰竭死亡。结论根据基底动脉分叉部动脉瘤的形态、位置采用不同的手术入路进行规范夹闭术操作,能提高手术成功率,改善患者预后。     

椎基底动脉狭窄血管介入治疗进展

椎基底动脉狭窄可引起脑缺血、脑卒中，后果严重。药物治疗疗效有限，且无法改善血管狭窄状况；外科手术治疗因难度大、并发症多而极少采用。血管介入治疗以其创伤小、疗效好、病人易接受的优点得到迅速发展。本就椎基底动脉狭窄的血管内治疗新进展进行综述回顾。     

肠系膜上动脉分支动脉瘤破裂一例

患者 ,男 ,5 0岁。主诉“发作性上腹痛 4ｄ ,加重伴血压下降 2ｈ”。 2 0 0 0年11月 5日起 ,患者劳累后发作左上腹、脐周阵发性隐痛 ,夜间为甚。外院对症处理好转。 8日下午加重 ,伴恶心、呕吐 ,来我院急诊留观。 9日上午突发上腹部剧痛 ,以仰卧位为著 ,左侧卧位稍轻 ,伴轻度腰痛 ,血压下降。既往有高血压病史 ,无其他特殊病史。查体 :ＢＰｌ2 0 /80ｍｍＨｇ ,急性失血病容 ,自主左侧卧位 ,腹部平坦 ,无肌紧张 ,上腹部压痛阳性 ,反跳痛阴性 ,未触及包块。腹腔穿刺抽出少量不凝血 (约 0 .5ｍｌ) ,Ｂ超示腹部积液 ,脾脏未见异常。诊断腹腔内出…     

血管内治疗大脑前动脉远端动脉瘤

目的观察血管内治疗大脑前动脉远端(DACA)动脉瘤的效果。方法回顾性分析14例接受血管内治疗的DACA动脉瘤患者(共15个动脉瘤),对10个动脉瘤行单纯弹簧圈栓塞、4个动脉瘤行支架辅助下弹簧圈栓塞,1个以Onyx胶栓塞。之后复查DSA,根据Raymond分级评价即刻疗效。术后6个月复查DSA,以改良Rankin量表(mRS)评估预后,mRS评分0~2分为结局良好。结果术后即刻12个动脉瘤Ⅰ级栓塞,3个Ⅱ级栓塞。术中、术后均未发生缺血等并发症。1例术后12 h死于动脉瘤再次破裂出血。术后6个月随访显示1例复发,10例结局良好(mRS评分0~2分),另2例mRS评分分别为3分、4分。结论个体化血管内治疗DACA动脉瘤安全、有效。     

术中自制髂动脉分支支架治疗主髂动脉瘤的单中心经验

目的:总结术中自制髂动脉分支支架(IBD)在主髂动脉瘤腔内修复术中保留髂内动脉的经验。方法:回顾性分析2018年1月至2018年12月在南京大学医学院附属鼓楼医院13例主髂动脉腔内修复术中使用自制髂动脉分支支架重建髂内动脉患者资料,其中2例重建双侧髂内动脉,11例单侧髂内动脉,术后观察盆腔缺血症状发生、髂内分支支架通畅率、有无内漏及瘤体扩张等情况。结果:应用自制IBD保留髂内动脉技术成功率为100%,术中出现2例Ⅲ型内漏,1例Ⅱ型内漏,围术期无其他并发症发生。术后平均随访9(4~12)个月,无瘤体扩张,支架内未见明显血栓形成,无瘤体相关性死亡,2例Ⅲ型内漏消失,1例Ⅱ型内漏持续存在,但瘤体无增大;IBD支架和髂内动脉通畅率为100%。1例对侧髂内栓塞患者术后出现对侧臀肌跛行,随访3个月后症状消失,无勃起、大小便功能障碍等症状出现。结论:术中自制IBD的应用是一种安全、有效的选择,近期效果理想,远期管腔通畅率还有待进一步随访。     

血管内治疗不同分期动脉粥样硬化性椎基底动脉闭塞性脑梗死

目的 观察血管内治疗不同分期动脉粥样硬化性椎基底动脉闭塞性脑梗死(ASVBOCI)的效果。方法 回顾性分析77例接受血管内治疗的ASVBOCI患者,包括急性期组(发病≤24 h,AP组)23例、亚急性早期组(发病>24 h且≤14 d,SAEP组)23例、亚急性晚期及慢性期组(发病>14 d,SALCP组)31例,对比观察3组术中情况、围手术期不良事件及预后。结果 AP组、SAEP组及SALCP组血管再通率分别为78.26%(18/23)、95.65%(22/23)及93.55%(29/31),差异无统计学意义(P>0.05);AP组、SAEP组术中机械取栓率均高于SALCP组(P均<0.05),AP组球囊扩张及支架植入均低于SAEP组和SALCP组(P均<0.05)。围手术期AP组1例、SAEP组2例颅内出血,SALCP组无出血。术后3个月SALCP组预后良好率高于、死亡率低于AP组及SAEP组(P均<0.05),后二者差异均无统计学意义(P均>0.05)。结论 血管内治疗不同分期ASVBOCI安全、有效。     

椎动脉型颈椎病椎-基底动脉系统TCD分析

椎动脉型颈椎病椎基底动脉系统ＴＣＤ分析马玉龙吴毅文朱永霞陈惠德傅佳作者单位：２３００３１解放军第１０５医院合肥（马玉龙）；安徽医科大学附属医院（吴毅文，朱文霞，陈惠德，傅佳）颈椎间盘退变，Ｌｕｓｃｈｋａ关节增生可刺激或压迫椎动脉，成为椎基底动脉供...     

创伤性基底动脉动脉瘤1例并文献复习

目的报告1例创伤性基底动脉动脉瘤,总结治疗经验和教训。方法对1例创伤性基底动脉动脉瘤的诊治进行报告,并结合文献对创伤性动脉瘤进行回顾分析。结果创伤性颅内动脉瘤是颅脑损伤的少见并发症,破裂出血可导致灾难性后果。结论创伤性颅内动脉瘤缺乏特有的临床症状,可疑病例可行3D-CTA和DSA检查确诊,开颅手术和血管内治疗是有效的治疗方法。     

蕲蛇酶治疗椎基底动脉供血不足体会

椎基底动脉供血不足性眩晕 ,好发于中老年人 ,我院于 2 0 0 0年 1月— 2 0 0 1年 7月 ,采用蕲蛇酶治疗70例 ,取得满意效果。现将资料报告如下。1　临床资料本组病例均符合以下诊断条件 :中老年 ,常伴有动脉管壁硬化及颈椎病。突发性、反复发作性眩晕 ,可伴有恶心、呕吐、面色苍白、出冷汗、耳鸣等 ,神经系统体征可伴有眼球震颤。排除美尼尔病、小脑疾病、多发性硬化、前庭神经炎、神经官能症等。发作间歇无神经系统体征。Ｘ线检查常有颈椎骨质增生、椎间隙变窄等特点。 70例中 ,男 31例 ,女 39例。年龄 4 5～ 75岁 ,平均 5 3岁。病程最长 2 …     

Recovery of isolated third nerve palsy related to treatment of unruptured posterior communicating artery aneurysm

Aim: To investigate the timing and degree of recovery of isolated third nerve palsy due to unruptured posterior communicating artery aneurysm among a Chinese population. Methods: A total of seven eligible patients were studied during a 4‐year period by retrospective review. The degree of recovery and time to achieve recovery after presentation were the main outcome measures. Results: There were seven patients with isolated third nerve palsy related to posterior communicating artery aneurysm. After treatment the median recovery time from the initial symptoms was 14 weeks, ranging from 1 to 60 weeks. Two patients (29%) in this group had mild residual symptoms. Conclusion: The present study demonstrated that in patients with isolated third nerve palsy related to posterior communicating artery aneurysm, recovery occurred within the first year and the prognosis of recovery was good.     

Extracorporeal circulation with deep hypothermia and circulatory arrest in the treatment of intracranial arterial aneurysms

Extracorporeal circulation with circulatory arrest and deep hypothermia in surgery on certain giant intracranial arterial aneurysms or on aneurysms difficult to access is described. The series includes a giant left carotid aneurysm, an aneurysm of the basilar artery bifurcation, a patient with two aneurysms, one on the right middle cerebral artery and the other at the end of the basilar artery, and a fourth patient with two aneurysms, one on the right middle cerebral and the other on the right carotid. Closed-thorax extracorporeal circulation with femoral cannulation was performed on all the patients. Surgical procedure is described and the advantages and disadvantages discussed. Results are encouraging. The authors suggest that the technique be used during surgical treatment of certain intracranial aneurysms that are in awkward positions or are very large in size. They emphasize that the procedure should be confined to exceptional cases.     

Balloon embolization in the treatment of basilar aneurysms

Summary Some vertebro-basilar aneurysm may not be treatable at a reasonable risk by direct clipping. A possible alternative is transvascular obliteration, using the means of modern interventional neuroradiology in combination with neurophysiological monitoring.These possibilites and related difficulties are outlined and discussed and the example of two cases with different types of vertebrobasilar aneurysms (top of the basilar artery and basilar trunk aneurysm) which have been treated by balloon embolization.Prof. Poeck to his 60th birthday.     

67例腹及胸腹主动脉瘤人工血管移植术的诊疗体会

１９８６～１９９７年间收治的腹及胸腹主动脉瘤６７例。其中胸腹主动脉瘤８例，腹主动脉瘤５９例。采用真丝人工血管吻合６例，涤纶人工血管３９例，ｅ－ＰＴＦＥ（膨体聚四氟乙烯人工血管）２２例。重点讨论了破裂性、炎症性、感染性动脉瘤和肾动脉领域的腹主动脉瘤的诊疗以及人工血管应用等问题。还讨论了真丝、涤纶和ｅ－ＰＴＦＥ的应用问题。详尽阐述了改进人工血管表面与血液相容性、表面的伪饰、表面引入生物活性物质和人工血管向器官样发展等问题。     

前交通动脉瘤破裂急性期的血管内栓塞治疗

目的探讨血管内栓塞治疗前交通动脉瘤的方法,技术特点及疗效。方法回顾性分析应用血管内栓塞治疗的54例破裂前交通动脉瘤患者的临床资料。结果54例中成功栓塞53例,其中32例100％栓塞,19例95％栓塞,2例90％栓塞;3例出现严重血管痉挛;2例死于脑疝及严重血管痉挛继发脑梗塞。随访6～24个月,无术后再出血病例。结论血管内栓塞是治疗前交通动脉瘤的一种微创、相对安全而有效的方法。     

Evolution of intracranial aneurysm treatment: From Hunterian ligation to the flow diverter

Background: Intracranial aneurysm rupture has the highest levels of mortality and morbidity among all stroke types. To answer the question of how and why different well‐established and novel treatment techniques were developed, it is crucial to understand the historic hurdles and breakthroughs in intracranial aneurysm treatment over the years. Methods: Literature review was carried out using PubMed and the electronic database of Surgical Practice. Relevant articles were retrieved for further appraisal. Results: The neuro‐endovascular treatment field has evolved from the use of detachable balloons or coils to the use of bioactive coils, balloon test occlusion, the balloon‐ and stent‐assisted techniques, and the flow‐diverting stent. The application of intraoperative indocyanine green angiography has also improved microsurgical treatment in recent years. Conclusions: Advances in endovascular technology have made coiling the cornerstone of intracranial aneurysm treatment. However, the roles played by different endovascular tools need to be better understood.     

Proximal clipping and bypass between bilateral vertebral arteries using a radial arterial graft for the treatment of a dissecting aneurysm of the vertebral artery

Proximal clipping has been performed recently as the main surgical treatment for a dissecting aneurysm of the vertebral artery. When there is a contralateral vertebral artery of a smaller size with arteriosclerotic changes, some form of bypass to prevent cerebellar and brain stem infarction is needed in addition to proximal clipping. We treated a 50-year-old man with a ruptured dissecting aneurysm of the left vertebral artery and stenosis at the V3 segment of the right vertebral artery. The caliber of the right vertebral artery was smaller than the left. After an anastomosis between bilateral vetebral arteries using a radial arterial graft, dissecting aneurysm was clipped at the proximal portion of the aneurysm.     

Dissecting aneurysms of the vertebrobasilar system. A comprehensive review on natural history and treatment options

Vertebral artery dissection has been recognized as an uncommon cause of ischemic stroke. However, it is less well known as a cause of subarachnoid hemorrhage. Even if dissecting aneurysms of the vertebral artery are rare, their importance arise from their high morbidity and mortality with rebleeding occurring more often than in cases of saccular aneurysms. Dissecting aneurysms of the vertebrobasilar system are a complex entity which requires a rapid and effective treatment to prevent rerupture. The sole stenting technique stands as a promising approach, allowing to occlude the aneurysm while preserving the vessel patency and reconstructing the diseased segment.     

Aneurysmal rupture of the pancreaticoduodenal artery successfully treated by transcatheter arterial embolization

We report a case of aneurysmal rupture of the pancreaticoduodenal artery successfully treated by transcatheter arterial embolization. A 61-year-old man with a history of hypertension underwent surgery at our hospital in November 1995 for local peritonitis caused by perforation of the sigmoid colon secondary to cancer. On the 9th postoperative day, he developed shock, with complaints of epigastric and back pain. Abdominal computed tomography showed an enhanced mass, thought to be a peripancreatic aneurysm. Emergency angiography demonstrated an aneurysm arising from the arcade of the anterior pancreaticoduodenal artery. After diagnostic angiography, transcatheter arterial embolization was performed. With steel coils, the anterior superior pancreaticoduodenal artery and anterior inferior pancreaticoduodenal artery were embolized near the origin of the aneurysm. Angiography 7 weeks later revealed no recanalization of the aneurysm and the absence of anomalous collateral vessels. The patient has been well for 19 months without re-bleeding or recurrence of sigmoid colon cancer. Transcatheter arterial embolization is an effective therapeutic approach for aneurysm of the pancreaticoduodenal artery and is the preferred initial treatment. Received for publication on July 14, 1997; accepted on Sept. 30, 1997     

Different laparoscopic treatment modalities for splenic artery aneurysms: about 3 cases with review of the literature

Introduction: The first laparoscopic treatment of splenic artery aneurysm (SAA) was performed in 1993. Since then, many papers have been published mentioning different laparoscopic treatment modalities, including splenectomy, aneurysmectomy, ligation or even occlusion.

Patients and methods: An updated literature review of the English medical literature using the following MeSH, ‘Lapaorscopic splenic artery aneurysm’, ‘laparoscopic aneurysectomy’, ‘Laparoscopic Splenic artery Aneurysm Ligation’ and ‘Laparoscopic Splenic artery aneurysm excision’ was done. Also three cases performed at our institutions are discussed, in terms of techniques, morbidity, mortality and postoperative outcomes.

Results: About eight case series and 16 case reports were retrieved from the literature. Different techniques were described by the authors, including splenectomy, aneurysmectomy, splenic aneurysm ligation or even occlusion. Few morbidity cases were reported and none of the authors has mentioned a single mortality case. In our three cases, the postoperative course was uneventful, with good long-term results.

Conclusions: Despite the variations in the adopted operative techniques, the laparoscopic approach seems to be harmless. However, no treatment algorithm or consensus has been published.