经皮腔内血管成形术治疗髂-股动脉狭窄或闭塞

目的探讨经皮腔内血管成形术（PTA）及血管内支架植入术治疗髂-股动脉狭窄或闭塞的应用价值。方法 66例髂-股动脉狭窄或闭塞患者,患肢均有不同程度的缺血症状,均采用PTA和（或）支架植入术进行介入治疗,分别于治疗前、后测定踝/肱指数（ABI）。结果 66例患者成功完成介入治疗,共植入支架73枚,其中髂动脉植入27枚,股浅动脉植入32枚,髂-股动脉植入14枚,无严重并发症发生。术后患者患肢缺血症状明显减轻或消失。ABI由术前0.39±0.12上升至0.72±0.15,术后随访3～24个月（平均15个月）,10例患者因复发而再次接受介入治疗。结论 PTA及血管内支架植入术,因其创伤小、可重复性高、疗效显著等特点已成为治疗髂-股动脉狭窄或闭塞的有效手段。     

彩色多普勒超声评价支架植入术治疗移植肝血管狭窄

目的探讨彩色多普勒血流显像技术（CDFI）在移植肝血管狭窄支架植入术疗效评估中的价值。方法13例肝动脉狭窄,1例门静脉狭窄,2例肝静脉狭窄。于支架植入术前、后行CDFI检查并每隔3～4个月随访复查,取多普勒参数肝内动脉血流阻力指数和加速度、门静脉吻合口管径及其两端血流速度比值、肝静脉狭窄处管径及肝静脉和下腔静脉肝下段血流频谱进行统计学分析。结果肝动脉狭窄者支架植入术后RI升高,SAT缩短,治疗前后差异有显著性意义（P〈0.05）。门静脉和肝静脉狭窄者支架植入术后狭窄段管径增宽,植入的支架呈并行相间的线样强回声,门静脉吻合口两端血流速度梯度下降,肝静脉和下腔静脉肝下段血流频谱由术前的平坦波恢复为两相或三相波。结论CDFI检查是评价移植肝血管狭窄支架植入术疗效的可靠方法。     

B超引导下经皮肝穿刺肝静脉成形术 在布-加综合征介入治疗中的应用

目的 探讨B超引导下经皮肝穿刺肝静脉成形术在布-加综合征的介入治疗中的应用价值和疗效。方法 对7例下腔静脉狭窄同时合并肝静脉狭窄或闭塞的布-加综合征患者，在施行下腔静脉成形术后，采用B超引导下经皮肝静脉穿刺的方法，实施肝静脉球囊扩张术或支架植入术。结果 7例患者在单独实施下腔静脉成形术效果不显著的情况下，在B超引导下实施肝静脉成形术，2例单纯球囊扩张，5例植入支架，无严重并发症，术后腹水、下肢水肿等症状有不同程度改善。结论 B超引导下的经皮肝静脉穿刺肝静脉成形术，定位准确，实施快捷，对合并肝静脉狭窄或梗阻的布-加综合征患者症状的缓解有明显效果。     

节段性狭窄闭塞Budd-Chiari综合征的介入治疗

目的　研究Budd Chiari综合征 (BCS)下腔静脉节段性狭窄闭塞合并肝静脉阻塞及血栓形成的介入治疗。方法　本组 13例下腔静脉节段性狭窄闭塞长 2～ 5cm ,其中 8例肝静脉闭塞 ,5例下腔静脉血栓形成。下腔静脉开通术应用房间隔穿刺针。闭塞肝静脉开通术应用RUPS 10 0肝穿装置。用 0 5～ 1 0cm球囊扩张 ,下腔静脉开通后用 1 0～ 2 0cm球囊扩张后放入金属内支架。术后抗凝治疗 3个月。结果　 13例患者成功的进行了经皮穿刺球囊扩张术 (PTA)和血管内支架植入治疗。术后患者肝脾缩小 ,腹水吸收。随访 3～ 2 6个月未见复发及消化道出血。结论　下腔静脉闭塞有血栓形成 ,必须在下腔静脉开通前用药物溶栓治疗。下腔静脉开通后放内支架要避开副肝静脉开口。肝静脉开通成形术应放在BCS介入治疗的首要位置。     

肝移植术后并发症的介入治疗

目的评价肝移植术后多种并发症的介入治疗。方法回顾性的分析肝移植术后出现各种并发症并进行介入治疗的82例患者,胆管病变62例;肝动脉病变8例;下腔静脉病变13例;肝静脉狭窄7例;门静脉病变9例。胆管并发症采用经T管置入引流管、经皮肝穿刺胆管行胆汁引流或球囊扩张术。球囊扩张成形术或(和)金属支架植入术处理血管狭窄的患者;局部溶栓治疗用于术后血管内血栓形成的病例。结果在胆管并发症患者中,41例经T管置入引流管,34例行经皮穿刺胆汁引流(PTBD),球囊扩张胆道成形术9例。3例肝动脉狭窄的患者接受了球囊扩张成形术或支架植入术,1例肝动脉形成血栓者行插管溶栓,效果良好。9例下腔静脉狭窄患者行支架植入术,1例接受了球囊扩张成形术。5例肝静脉狭窄患者接受了球囊扩张成形术或支架治疗。门静脉狭窄患者中6例接受支架治疗,1例门脉血栓形成行局部溶栓,治疗不满意。结论介入治疗是处理肝移植术后胆管和血管并发症不可或缺的临床治疗方法。     

腔内血管技术用于治疗布加综合征15例分析

目的：探讨布加综合征（BCS）的腔内血管外科治疗。方法：在15例BCS患者中,应用PTA使闭塞或严重狭窄的下腔静脉成功再通后,13例同时置入血管内支架,4例肝静脉完全闭塞者在介入再通下腔静脉后1周内行肠系膜上静脉－下腔静脉间人工血管“H”型分流术。结果：在腔内介入治疗后,本组仅有1例患者出现轻度心功能不全,分流患者术后无严重手术并发症,随访2－42个月,除1例支架远端有部分再狭窄外,所有血管支架均通畅,无移位,分流血管无血栓形成,门体静脉高压症状明显缓解,结论：血管腔内介入治疗是BCS首选治疗方法。     

经皮穿刺球囊导管扩张金属支架成形术治疗布-加综合征(附31例报告)

目的　对31例下腔静脉膜型及狭窄型布加综合征经皮穿刺球囊导管扩张成形金属支架植入术。方法　其中肝段下腔静脉模型阻塞17例(有孔者7例,完全闭塞10例;3支主肝静脉通畅者5例,2支通畅者8例,1支通畅者4例);下腔静脉狭窄者14例,狭窄长度3～10cm,无1例显示肝静脉。结果　治疗前下腔静脉压29.38±3.37cmH2O,治疗后平均下降14.69±3.10cmH2O;1例导管刺破下腔静脉进入心包,造成心包填塞,虽经手术但死于感染;另2例手术后21d和35d死于食道静脉破裂出血;其余28例均获成功,随访3～48个月,平均295个月,全部体征消失22例,6例仍有轻度肝脾肿大。结论　讨论了该法的适应证,技术操作对效果的影响及术后处理。     

下腔静脉滤器术后闭塞合并复杂双下肢静脉血栓的腔内治疗方案：病例报告

目的 滤器引起的下腔静脉闭塞是一种罕见但可以致命的严重并发症,本文目的是报告1例下腔静脉滤器术后闭塞合并左肢体急性血栓形成及右髂静脉慢性血栓形成的诊治。方法 患者46岁,男性,因“左大腿进行性胀痛3天”入院,彩超和CT静脉成像（CTV）所示下腔静脉可见金属支架影及下腔静脉、双侧髂总静脉、左侧髂内、外静脉、左侧股静脉、左侧腘静脉、胫前、胫后、腓总静脉广泛血栓形成。随后行腔内治疗手术：经导丝穿刺后置入球囊扩张并在静脉闭塞处植入支架,下腔静脉回流不畅处使用双侧髂外静脉植入球囊对吻扩张后再植入支架。术后常规服用抗凝药至少3个月。结果 术后患者腹痛及消化道不适感消失,左大腿肿胀逐渐消失如常。1月及3月常规复查显示下肢深静脉通畅,支架内无血栓形成。结论 针对滤器引起的血栓性下腔静脉闭塞以及下肢深静脉血栓的复杂病例,腔内治疗有效及安全。开通双侧髂静脉后的球囊对吻扩张下腔静脉,以及放置支架后球囊扩张,展现了腔内治疗的灵活性,为后续腔内治疗的术式变化以及相应的复杂病例治疗提供了指导作用。     

腘静脉置管溶栓联合髂静脉支架治疗髂股静脉血栓

目的探讨腘静脉置管溶栓联合髂静脉球囊扩张或支架植入术治疗髂股静脉血栓的临床疗效。方法回顾性分析山东省立医院血管外科2004年2月至2006年9月收治的30例髂股静脉血栓，均采用超声引导下惠肢腘静脉置管溶栓联合髂股静脉球囊扩张或支架植入的方法进行治疗。其中15例行球囊扩张及髂静脉支架术，5例行单纯球囊扩张术，20例行临时性下腔静脉滤器置入术。术中以及静脉造影评价静脉通畅程度，门诊以彩超随访髂静脉通畅率。结果置管溶栓后经导管静脉造影显示髂静脉再通率30％-90％（平均55％），股静脉再通率40％-100％（平均70％）。术后患肢临床症状明显减轻或消失。住院费用（5．2—8．4）万元，平均7．7万元，30例随访1-31个月，平均11个月，25例髂静脉支架植入者髂静脉通畅率100％，5例单纯球囊扩张者髂静脉再通率0—20％。结论腘静脉置管溶栓术联合髂静脉支架植入术是治疗髂股静脉血栓的安全有效方法之一，但是价格昂贵，广泛临床应用困难，远期效果有待于进一步随访。     

Viabahn覆膜支架治疗血液透析患者中心静脉狭窄的初探

目的探讨Viabahn覆膜支架用于血液透析患者中心静脉狭窄的临床疗效。方法回顾性分析本院2015年1月至2016年9月收治的18例中心静脉狭窄的血液透析患者的临床资料。结果通过临床症状、体征和静脉造影检查,18例血液透析患者确诊为中心静脉狭窄。行经皮腔内血管成形术(PTA)后发生弹性回缩或残余狭窄30%,或伴有PTA术后短期出现再狭窄,植入Viabahn覆膜支架。一期植入18枚Viabahn血管内覆膜支架,二期再狭窄植入2枚。随访2~21个月。术后6个月和12个月的一期支架通畅率为85.2%和75.8%,一期辅助通畅率为100%。结论血液透析患者中心静脉狭窄治疗首选PTA,但PTA和金属裸支架(BMS)通畅率较低,对于中心静脉再狭窄的患者使用新型Viabahn血管内覆膜支架近期通畅率令人满意,远期通畅率有待进一步观察。     

支架联合125I粒子条植入术治疗上腔静脉综合征

目的 观察支架联合¹²⁵I粒子条植入术治疗上腔静脉综合征(SVCS)的短期效果。方法 回顾性分析40例SVCS,其中23例接受上腔静脉支架植入术(支架组)、17例接受支架联合¹²⁵I粒子条植入术(联合组);比较组间技术成功率、临床成功率、并发症发生率、支架通畅率,以及患者肿瘤无进展生存期(PFS)和总生存期(OS)的差异。结果 2组技术成功率均为100%;联合组与支架组临床成功率(94.12% vs. 91.30%)、并发症发生率(17.65% vs. 8.70%),术后1个月支架通畅率(100% vs. 91.30%)、2个月支架通畅率(100% vs. 82.61%),以及患者中位PFS(4.12个月vs. 3.83个月)和中位OS(22.44个月vs. 20.36个月)差异均无统计学意义(P均>0.05)。术后4个月联合组支架通畅率高于支架组(100% vs. 78.26%,P<0.05)。结论 支架联合¹²⁵I粒子条植入术治疗SVCS短期效果确切。     

Percutaneous stenting of superior vena cava syndrome: treatment outcome in patients with benign and malignant etiology

Symptomatic obstruction of the superior vena cava (SVC) can be caused by either intrathoracic malignancy or nonmalignant etiology resulting in superior vena cava syndrome (SVCS). The objective of this study was to evaluate the clinical outcome of percutaneous stenting of SVCS in patients with malignant and benign disease. During a 9-year period, 56 patients with SVCS underwent percutaneous stenting placement. Among them, malignant and benign disease was responsible for 40 patients (71%) and 16 patients (29%), respectively. The Wallstent was the most commonly used stent and was used in 45 patients (80%), whereas the Palmaz stent was used in 6 patients (11%). In 38 patients (68%), a single stent was deployed to treat an SVC lesion. In contrast, bilateral kissing stents were deployed in 9 patients (16%), which extended from bilateral brachiocephalic veins to the proximal SVC. Technical success was achieved in all patients while symptomatic improvement was noted in 54 patients (96%). No procedural complications occurred in this series. Primary patency in malignant and benign cases at 1 year was 64% and 76%, respectively. Overall symptom-free survival ranged from 1 to 34 months. Our study showed that endovascular treatment with percutaneous stenting provides an effective treatment strategy in patients with SVCS caused by either malignant or benign disease.     

Use of self-expanding vascular endoprostheses in superior vena cava syndrome.

INTRODUCTION: Superior vena cava syndrome (SVCS) is associated to a malignant tumor in more than 90% of cases; being the lung cancer the most frequent (80%). SVCS has a benign cause in less than 5% of cases. Endovascular stenting has been proposed as the primary treatment of choice. We report our experience in SVC recanalization through the use of self-expanding vascular stents as treatment of life-threatening SVCS of benign and malignant etiology. MATERIALS AND METHODS: Between January 1994 and April 2002 44 patients with critical SVCS, were treated at the Hospital Italiano de Buenos Aires. Forty nine self-expanding endovascular metallic stents were percutaneously placed in the SVC. Thirty-one (70%) patients were male and 13 (30%) were female. The mean age was 55.6 years (range: 21-77). The etiology of SVCS was malignant in 40 cases and benign in 4. The malignant causes included lung cancer: 37 (37/44 - 92.5%), lymphoma: 1 (2.5%), chondrosarcoma 1 (2.5%), melanoma 1 (2.5%). The benign etiology corresponded to central catheters (N: 2) and post-radiation fibrosis (N: 2). Cavography showed complete occlusion of SVC in 12 cases (27%) and significant partial stenosis in 32 cases (73%). Thrombi associated with tumor stenosis were present in 25 (57%) patients. RESULTS: All procedures were technically successful. No stent migration was observed. Thirty-two patients with malignant tumor ultimately died due to the progression of the disease. Mean survival time was 193 days (range: 25-578). SVCS recurrence was observed on six occasions. In four patients a new stent was placed. Symptomatic improvement was dramatically seen within 24-48 h after stent placement in 40 patients (90.9%) and 83.3% out of the cases (38/44) were symptoms-free during the rest of the disease. Three patients died in the 7 following days. CONCLUSION: The use of self-expanding vascular endoprostheses in the recanalization treatment of SVC in SVCS due to a malignant or benign etiology offers excellent results with rapid and prolonged remission of symptoms.     

Stent placement in superior vena cava syndrome

BACKGROUND: Superior vena cava syndrome (SVCS) is often seen in the natural history of malignant thoracic diseases. SVCS is characterized by unpleasant symptoms that usually lead to death. The purpose of our study is to show the efficiency of percutaneous stenting in the superior vena cava for relieving SVCS and the possibility of repeated stenting after recurrence. METHODS: Twenty patients with SVCS caused by malignant diseases who had one or more stents placed in the superior vena cava or its main tributaries were evaluated. RESULTS: Out of 20 patients, 1 died of myocardial infarction 24 hours after the procedure without any signs of pulmonary embolus, hemorrhage, or malposition of the stent. SVCS was successfully controlled in 94% of patients until death or completion of the study. In 3 patients the procedure was repeated (3 to 20 weeks later) because of the recurrence of symptoms. CONCLUSIONS: Percutaneous venous stent placement in the superior vena cava is a simple and effective technique to relieve rapid SVCS caused by malignancies. When recurrence occurs, repeated stenting can be performed successfully.     

Retrievable covered metallic segmented Y airway stent for gastrorespiratory fistula of carina or main bronchi

ObjectiveTo evaluate the feasibility of new retrievable covered metallic segmented Y airway stents modified with 3-dimensional (3D) printing for gastrorespiratory fistula involving carina or main bronchi.MethodsWe designed a new retrievable covered metallic segmented Y airway stent to fit the anatomical characteristics of the carina region in individual patients. All stents were individually customized based on a 3D-printed mold. Six patients with gastrorespiratory fistula and aspiration pneumonia after esophagectomy underwent the stent implantation. The stents were retrieved when the fistula was cured or stent-related complications occurred.ResultsSeven Y stents were successfully implanted and removed in 6 patients. All stents expanded well, and the fistulas were completely sealed. Aspiration pneumonia was controlled in 6 patients. The median Karnofsky Performance Status scores significantly improved after stenting compared with those before stent implantation (P = .024). Sputum retention was the most common complication after stenting and was treated with aspiration under bronchoscopy (33.33%). Excessive granulation tissue proliferation was found in 1 patient (16.7%) and was treated with cryotherapy. The indwelling time of the stent was 64 days (interquartile range, 52-69 days). After stent removal, bronchoscopy, gastroscopy, and computed tomography of the chest showed cured fistulas in all patients, and no stents showed fractures.ConclusionsRetrievable covered metallic segmented Y airway stents modified with 3D printing appear to be feasible for the treatment of gastrorespiratory fistula involving carina or main bronchi.     

Wallstent endovascular prosthesis for the treatment of superior vena cava syndrome

Objective: We assessed the clinical outcome of self-expanding Wallstent endovascular prosthesis in the treatment of superior vena cava syndrome due to malignant tumors.Methods: Eleven patients with malignant superior vena cava syndrome were treated by percutaneous implantation of the self-expanding Wallstent endovascular prosthesis across the stricture site. Patency was defined by the absence of symptoms and signs of superior vena cava syndrome.Results: Ten of the 11 experienced complete symptomatic relief within 3 days of stent implantation. The remaining 1 did not benefit, and required a second procedure, dying of heart failure 5 days after stent implantation. Ten patients remain symptomatically free of superior vena cava syndrome to date or until death in follow-up lasting 17 to 227 days.Conclusion: Implantation of the self-expanding Wallstent endovascular prosthesis for malignant superior vena cava syndrome provides rapid symptomatic relief and improves the patient’s quality of life.     

上腔静脉综合征的诊断与外科治疗(附27例报告)

目的　总结上腔静脉综合征(superiorvenacanasyndrome ,SVCS)的外科诊治经验,提高手术成功率。方法　2 7例SVCS患者,13例在腔内转流下,采用自体心包补片加宽上腔静脉;5例在腔外转流下,采用自体心包成形血管,间置上腔静脉;3例采用人造血管置换上腔静脉;2例行人造血管转流;4例在阻断带完全阻断上腔静脉下行上腔静脉成形。结果　术后患者均恢复顺利,解除上腔静脉回流受阻满意,平均上腔静脉压由术前的2 3 .4cmH2 O降至术后的9.6cmH2 O。凡良性疾病引起的上腔静脉阻塞均得到根治,恶性肿瘤所致上腔静脉阻塞手术后改善了患者生存质量。结论　任何疾病所致上腔静脉阻塞,选择性采取手术治疗是必要的。自体心包替代上腔静脉组织相容性强,不易形成血栓及退变,在腔内或腔外转流下进行手术,可有效预防脑组织损害。     

Treatment of malignant obstruction of the superior vena cava with the self-expanding Wallstent.

BACKGROUND--Obstruction of the superior vena cava (SVC) in malignant disease can cause considerable distress to patients. Symptomatic relief can be achieved by the percutaneous implantation of a self-expanding stent (Wallstent) into the stenosis. METHODS--Fourteen patients with obstruction of the SVC were treated with one to three Wallstent endoprostheses. They suffered from advanced bronchogenic carcinoma (n = 12), thyroid carcinoma (n = 1), and breast carcinoma (n = 1). The indication for stent placement was symptomatic obstruction of the SVC and incurable disease. Stenting was performed for symptom relief, and before, during, and after courses of radiotherapy or chemotherapy as needed. RESULTS--Twelve patients experienced complete symptomatic relief within two days of stent placement. Two patients did not benefit. Three patients not given anticoagulation developed stent thrombosis between one week and eight months after initial placement, and within one day of endobronchial stent implantation with bronchial laser therapy or balloon dilatation in all three. Patency of the SVC was achieved again by a repeat procedure. CONCLUSIONS--Stent placement for obstruction of the SVC gives rapid symptomatic relief. Subsequent endobronchial stent implantation with bronchial laser therapy or balloon dilatation could be a risk for caval stent occlusion. Stent thrombosis remains a problem in patients who are not anticoagulated.     

采用裸支架联合覆膜支架建立经颈静脉肝内门体分流术的中远期疗效

目的探讨经颈静脉肝内门体分流术(TIPS)中采用裸支架联合覆膜支架建立分流道的中远期疗效。方法回顾性分析我院连续71例采用裸支架+覆膜支架方式建立TIPS分流道的患者资料。术中均采用8mm直径支架建立分流道,首先置入相应长度裸支架,再于其内置入同等直径覆膜支架,覆膜支架长度小于裸支架2cm,使分流道远心端门静脉内2cm为裸区,近心端裸支架与覆膜支架平齐达下腔静脉开口部。分析术后分流道通畅率、肝性脑病发生率及生存率。结果对所有患者均成功建立肝内分流道。术前、术后门静脉压力分别为(3.67±0.82)kPa、(2.31±0.62)kPa(P0.01)。随访2~63个月,平均(25.83±11.34)个月;共置入裸支架76枚,覆膜支架73枚;术后1、2、3年的分流道通畅率为87%、72%、61%,肝性脑病发生率为16%、34%、46%,生存率为83%、74%、67%。结论采用裸支架联合覆膜支架方式建立TIPS分流道的中远期疗效与TIPS专用覆膜支架近似,可作为必要时的替代产品。     

Use of an expandable metallic stent in 4 patients with superior vena syndrome

Recently developed expandable metallic stents have been adopted to superior vena cava syndrome with good results. We inserted stents into the superior vena cava in 4 patients with superior vena cava syndrome. The results were comfortable and no complications. We should consider the stenting as the first choice for superior vena cava syndrome.