目的 提高对创伤性假性动脉瘤并动静脉瘘的影像诊断水平。 方法 报告1例腰椎间盘手术所致的创伤性假性动脉瘤并动静脉瘘，比较分析MRA和DSA对该病的诊断价值。 结果 MRA能够明确创伤性假性动脉瘤及动静脉瘘的诊断，与DSA有良好的相关性。 结论 MRA对创伤性假性动脉瘤并动静脉瘘的确诊有重要价值，在一定程度上能够代替常规血管造影。
目的:探讨彩色多普勒超声在诊断冠状动脉造影术后引发的医源损伤性假性动脉瘤的临床价值。方法: 经股动脉穿刺,行冠状动脉造影术而发生的股动脉假性动脉瘤共39例,所有患者都采用高频彩色多普勒诊断仪,对动脉瘤的二维超声图像、彩色多普勒图像及脉冲多普勒图像进行分析。结果: 39例假性动脉瘤患者在穿刺部位动脉的一侧均显示一搏动性无回声区或混合性低回声区;彩色多普勒显示无回声区内呈涡流或旋转样血流信号,表现为一半红色一半蓝色;脉冲多普勒显示典型的双期双向频谱。39例假性动脉瘤彩色多普勒超声诊断完全明确。其中32例在彩色多普勒超声监控下行人工加压包扎修复。7例经血管外科手术修补治疗。结论: 彩色多普勒超声在诊断冠状动脉造影术后造成的医源损伤性假性动脉瘤,在观察动脉瘤的大小、形态、瘤体的结构,判断来源动脉破口定位上准确、简便、无创,且可在超声引导下行安全无创治疗,可作为该病诊断及治疗的首选方法。
Objective To evaluate surgical treatment of infected femoral artery pseudoaneurysm. Methods The data on surgical treatment of 45 patients with infected femoral artery pseudoaneurysm admitted from January 2003 to June 2008 were analyzed retrospectively. Fourty-three patients underwent operative treatment including excision of infected femoral artery pseudoaneurysm, exhaustive debridement and bypass graft with vascular prosthesis. Two patients were unavoidable to undergo removing of infected femoral artery pseudoaneurysm and ligating the proximal and distal artery of pseudoaneurysm because of severe infection and large volume. Results The patients were followed up from 3 to 12 months (mean 7.82 months). The limbs of all the patients underwent bypass graft with vascular prosthesis were salvaged successfully, patients of which had secondary wound healing and had not intermittent lameness. One of two patients performed ligation of artery was salvaged successfully but had severe intermittent lameness, another patient underwent high amputation above knee because of ischemic gangrene. Conclusion For infected femoral artery pseudoaneurysm, the operative treatment including excision of infected femoral artery pseudoaneurysm, exhaustive debridement and bypass graft with vascular prosthesis is effective and safe.
ObjectiveTo summarize the etiology and prevention measures of carotid artery pseudoaneurysms following carotid endarterectomy (CEA) and discuss the complications and prognosis of it performed surgery and endovascular treatment. MethodsThe process and experience of diagnosis and treatment of two patients with carotid pseudoaneurysm following CEA admitted in this hospital from January 2000 to March 2014 were analyzed retrospectively. The related English literatures concerning carotid artery pseudoaneurysm following CEA in PubMed, SpringerLink, ELSEVIER, and ScienceDirect database were searched and then made a conclusion. Results①The incidence of carotid artery pseudoaneurysms following CEA in this hospital was 0.31% (2/641). These two patients were treated with surgery and endovascular therapy respectively, and both recovered well after the treatment.②Thirty-nine related literatures totally were collected, including 187 patients with carotid artery pseudoaneurysm. One hundred and forty patients were treated with artificial patches during CEA, and 36 patients suffered secondary infection in the surgical sites. One hundred and fifty-two patients were treated with surgery, while 33 patients were treated with endovascular therapy, the residual two patients were accepted hybrid surgery. The overall incidence of cranial nerve injuries, the incidence of 30-day stroke, and the incidence of 30-day mortality were 6.4% (9/141), 7.4% (12/163), and 2.7% (5/182), respectively. ConclusionsSurgical site infection is one of the important reasons which lead to carotid artery pseudoaneurysm following CEA. Aneurysm resection and carotid artery reconstruction is still the main treatment of the carotid artery pseudoaneurysm; endovascular therapy could be used as a choice for a part of the patients. How to reduce the perioperative cranial nerve damage and the incidence of complications such as stroke still need further to be studied.
ObjectiveTo summarize the mid-term follow-up results and postoperative aortic remodeling of treating blunt aortic injuries (BAI) with thoracic endovascular aortic repair (TEVAR).MethodsA retrospective study was conducted on BAI patients treated with TEVAR, who were admitted into the Department of Vascular Surgery in Zhongshan Hospital, Affiliated to Fudan University between September 2003 and December 2015. There were 15 males and 9 females at an average age of 45.6±14.0 years. The mechanism of BAI was mainly auto car crash. Totally 25 entry tears were detected and most of them were located at the aortic isthmus.ResultsTwenty-four BAI patients survived and eventually went through TEVAR. One patient died of pulmonary embolism 1 week post-TEVAR. Rate of technical success, clinical success and perioperative mortality was 100.0%, 95.8%, and 4.2%, respectively. Nineteen patients were followed up with a mean time of 35.1(13-87) months. All of them survived this period. Based on the follow-up imaging of CTA, 18 of them revealed no endoleak or stent migration, and 1 patient of transection still had perfusion of distal false lumen at the abdominal aorta. None of the aortic segments measured in this study showed expansion of ≥5 mm during follow-up. The aorta remodeled well in 94.7% of them.ConclusionTEVAR for treating BAI appears feasible with high rates of technical and clinical success rates. The mid-term follow-up results seems satisfying, but the long-term results are yet to be assessed with further follow-up.
目的 探讨肢体假性动脉瘤的病因、发病机理以及手术方式的选择，评价各种手术的治疗效果，以提高对假性动脉瘤的诊治水平。方法 30例假性动脉瘤患者（股动脉18例，腘动脉7例，肱动脉2例，桡动脉3例），其中8例为感染或破裂性假性动脉瘤，1例肢体坏死。30例患者均行外科手术治疗,其中11例行假性动脉瘤破口修补术，2例行股动脉结扎术，2例行血管端端吻合术，8例行自体大隐静脉移植术，6例行人工血管移植术，1例行截肢术。结果 30例患者术后恢复顺利，除1例行下肢截肢术外，其余29例术后效果良好。随访7个月～8年,平均(4.4±2.3）年； 行人工血管移植术者4例移植段发生血栓，经溶栓治疗后好转，其余血供状况良好。结论 外科手术治疗肢体假性动脉瘤是一种有效的方法。
The diameter of the giant coronary artery aneurysm is at least 4 times bigger than that of the normal coronary artery and 2-3 times bigger than that of the normal coronary artery aneurysm. Giant coronary artery aneurysm is rare in clinic with a reported morbidity which is less than 0.3%. Just like ordinary coronary artery aneurysm, coronary artery atherosclerosis is the main cause of the giant coronary artery aneurysm. Most giant coronary artery aneurysms are asymptomatic, but some patients may have heart-related clinical emergency in short term and may have thrombosis which can lead to embolism and fistula which can cause rupture in long term. Surgical treatment is the first chioce for giant coronary artery aneurysm now. However, the interventional therapy will also be an important way to treat the disease in the future. In this article, we review the diagnosis, clinical manifestation, treatment and other aspects of giant coronary artery aneurysm as follows.