血管内支架置入术治疗创伤性假性动脉瘤19例分析
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摘要
目的探讨创伤性假性动脉瘤(traumatic pseudoaneurysm,TPA)应用血管内支架置入术治疗的效果及安全性。方法 19例TPA患者,12例行覆膜支架置入术,7例行多层裸支架重叠置入术,术后即刻造影了解治疗效果;随访观察症状改善情况,有无内漏及支架内狭窄等情况发生。结果 19例支架均成功置入,12例置入覆膜支架后造影显示假性动脉瘤消失,载瘤动脉远端血流均通畅;7例多层裸支架重叠置入后造影示动脉瘤基本不显影或显影浅淡,无重要侧支血管闭塞;术后随访6~47个月,中位随访21.3个月,1例多层裸支架重叠置入者术后1a行CT血管造影显示轻度狭窄(狭窄<30%),无明显临床症状,余患者未见支架狭窄、移位、断裂,内漏等并发症。结论 TPA患者行覆膜支架和多层裸支架重叠置入术安全可行,近中期效果满意。
Objective To discuss the effect and safety of endovascular stent for traumatic pseudoaneurysm(TPA).Methods In 19 patients with TPA,12 received implantation of stent-graft and 7 were implanted multiple overlapping bare stents.The effect was evaluated by angiography immediately after operation.All patients were followed up to observe the alleviation of the symptoms,and whether there was internal leakage or stent stenosis.Results Stents were successfully implanted in all 19 patients.The TPA disappeared after stent-graft was implanted in 12 patients,and the blood flow to the distant parent artery was unobstructed.In the remaining 7 patients,angiography after stent implantation revealed that the TPA was faintly visualized and no important collateral vascular occlusion.All these 19 patients were followed up for 6 to 47 months(mean of 21.3 months),1 from the 7 patients undergoing multiple overlapping bare stents received CT angiography one year later with the result of mild stenosis in stents(<30%)and no obvious clinical symptoms,and the other patients were not found the complications such as stent stenosis,displacement,fracture or leakage.Conclusion Both stent-graft and multiple overlapping bare stents are safe and feasible for TPA,with fine short-and mid-term effect.
Objective To discuss the effect and safety of endovascular stent for traumatic pseudoaneurysm(TPA).Methods In 19 patients with TPA,12 received implantation of stent-graft and 7 were implanted multiple overlapping bare stents.The effect was evaluated by angiography immediately after operation.All patients were followed up to observe the alleviation of the symptoms,and whether there was internal leakage or stent stenosis.Results Stents were successfully implanted in all 19 patients.The TPA disappeared after stent-graft was implanted in 12 patients,and the blood flow to the distant parent artery was unobstructed.In the remaining 7 patients,angiography after stent implantation revealed that the TPA was faintly visualized and no important collateral vascular occlusion.All these 19 patients were followed up for 6 to 47 months(mean of 21.3 months),1 from the 7 patients undergoing multiple overlapping bare stents received CT angiography one year later with the result of mild stenosis in stents(<30%)and no obvious clinical symptoms,and the other patients were not found the complications such as stent stenosis,displacement,fracture or leakage.Conclusion Both stent-graft and multiple overlapping bare stents are safe and feasible for TPA,with fine short-and mid-term effect.
引文
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[10]潘力,杨铭,马廉亭,等.创伤性颈内动脉假性动脉瘤的覆膜支架治疗[J].中华创伤杂志,2014,30(2):118-119.
[11]顾翔,李俊,陈刚,等.覆膜支架治疗创伤性颈内动脉假性动脉瘤[J].中国临床神经外科杂志,2009,14(11):658-659.
[12]ZHANG L,YIN C P,LI H Y,et al.Multiple overlapping bare stents for endovascular visceral aneurysm repair:a potential alternative endovascular strategy to multilayer stents[J].Ann Vasc Surg,2013,27(5):606-612.
[13]ZHONG S,ZHANG X Q,CHEN Z,et al.Endovascular repair of blunt popliteal arterial injuries[J].Korean J Radiol,2016,17(5):789-796.
[14]魏宁,祖茂衡,徐浩,等.气管支架置入术联合经动脉灌注术治疗恶性气管狭窄[J].中华全科医学,2011,9(12):1857-1859.
[15]ADLAKHA S,SHEIKH M,WU J,et al.Stent fracture in the coronary and peripheral arteries[J].J Interv Cardiol,2010,23(4):411-419.
[16]RUFFINO M A,RABBIA C.Endovascular repair of peripheral and visceral aneurysms with the Cardiatis multilayer flow modulator:one-year results from the Italian Multicenter Registry[J].J Endovasc Ther,2012,19(5):599-610.
[2]湛杨,周兴立,尹存平,等.创伤性假性动脉瘤的腔内微创治疗[J].西南国防医药,2016,6(8):837-840.
[3]袁锋,梁惠民,韩萍,等.腔内介入治疗锁骨下动脉外伤性假性动脉瘤[J].临床放射学杂志,2013,32(10):1484-1488.
[4]廖登辉,叶财盛,李松奇,等.覆膜支架治疗12例假性动脉瘤的体会[J].介入放射学杂志,2012,21(5):374-376.
[5]刘文贵,梁定,郭山峰,等.肢体及肾脏假性动脉瘤的介入治疗[J].介入放射学杂志,2008,17(5):365-367.
[6]RATHOD J R,DHOMNE S,TAORI K,et al.Endovascular stent graft for post-traumatic superficial femoral artery pseudoaneurysms with arteriovenous fistula:6months follow-up of 2cases[J].J Radiol Case Rep,2011,5(11):26-34.
[7]SPANOS K,KARATHANOS C,STAMOULIS K,et al.Endovascular treatment of traumatic internal carotid artery pseudoaneurysm[J].Injury,2016,47(2):307-312.
[8]ZHANG C W,XIE X D,YOU C,et al.Endovascular treatment of traumatic pseudoaneurysm presenting as intractable epistaxis[J].Korean J Radiol,2010,11(6):603-611.
[9]YANG Z,LIU J,HONG B,et al.Endovascular treatment of traumatic aneurysms:a review or 37cases[J].J Neurotraum,2011,28:A38.
[10]潘力,杨铭,马廉亭,等.创伤性颈内动脉假性动脉瘤的覆膜支架治疗[J].中华创伤杂志,2014,30(2):118-119.
[11]顾翔,李俊,陈刚,等.覆膜支架治疗创伤性颈内动脉假性动脉瘤[J].中国临床神经外科杂志,2009,14(11):658-659.
[12]ZHANG L,YIN C P,LI H Y,et al.Multiple overlapping bare stents for endovascular visceral aneurysm repair:a potential alternative endovascular strategy to multilayer stents[J].Ann Vasc Surg,2013,27(5):606-612.
[13]ZHONG S,ZHANG X Q,CHEN Z,et al.Endovascular repair of blunt popliteal arterial injuries[J].Korean J Radiol,2016,17(5):789-796.
[14]魏宁,祖茂衡,徐浩,等.气管支架置入术联合经动脉灌注术治疗恶性气管狭窄[J].中华全科医学,2011,9(12):1857-1859.
[15]ADLAKHA S,SHEIKH M,WU J,et al.Stent fracture in the coronary and peripheral arteries[J].J Interv Cardiol,2010,23(4):411-419.
[16]RUFFINO M A,RABBIA C.Endovascular repair of peripheral and visceral aneurysms with the Cardiatis multilayer flow modulator:one-year results from the Italian Multicenter Registry[J].J Endovasc Ther,2012,19(5):599-610.