Glubran-2胶联合弹簧圈栓塞治疗外科术后内脏假性动脉瘤
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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。
Objective:To evaluate the clinical efficacy and safety of glubran-2 glue in combination with coils used in the treatment of visceral artery pseudoaneurysms.Methods:DSA was performed in 12 patients with abdominal pseudoaneurysm after surgery and treated with glubran-2 glue in combination with coils.Clinical outcomes about therapeutic effect and complication were analyzed respectively.Results:Of the 12 patients with pseudoaneurysm,the location included gastroduodenal artery and its branches(n=4),branch of left hepatic artery(n=2),branch of right hepatic artery(n=4),splenic artery adjacent to splenic hilum(n=1)and the middle segment of splenic artery(n=1).According to the location and blood flow velocity of pseudoaneurysm,appropriate coils and concentration of glubron-2 glue were selected for transcatheter arterial embolization.All of the 12 patients were treated successfully with mild side effects including increase of bilirubin in a short period in 3 patients and partial splenic infarction in 1 patient.Conclusion:Transcatheter arterial embolization using glubran-2 glue in combination with coils is safe and effective in the treatment of abdominal pseudoaneurysm.Increase of the rate of successfulness and decrease of the risk of ectopic location of embolization could be obtained by using appropriate concentration of glubran-2 glue as well as the speed of injection.
Objective:To evaluate the clinical efficacy and safety of glubran-2 glue in combination with coils used in the treatment of visceral artery pseudoaneurysms.Methods:DSA was performed in 12 patients with abdominal pseudoaneurysm after surgery and treated with glubran-2 glue in combination with coils.Clinical outcomes about therapeutic effect and complication were analyzed respectively.Results:Of the 12 patients with pseudoaneurysm,the location included gastroduodenal artery and its branches(n=4),branch of left hepatic artery(n=2),branch of right hepatic artery(n=4),splenic artery adjacent to splenic hilum(n=1)and the middle segment of splenic artery(n=1).According to the location and blood flow velocity of pseudoaneurysm,appropriate coils and concentration of glubron-2 glue were selected for transcatheter arterial embolization.All of the 12 patients were treated successfully with mild side effects including increase of bilirubin in a short period in 3 patients and partial splenic infarction in 1 patient.Conclusion:Transcatheter arterial embolization using glubran-2 glue in combination with coils is safe and effective in the treatment of abdominal pseudoaneurysm.Increase of the rate of successfulness and decrease of the risk of ectopic location of embolization could be obtained by using appropriate concentration of glubran-2 glue as well as the speed of injection.
引文
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[15] Leyon JJ,Littlehales T,Rangarajan B,et al.Endovascular embolization:review of currently available embolization agents[J].Curr Probl Diagn Radiol,2014,43(1):35-53.
[16] Vaidya S,Tozer KR,Chen J.An overview of embolic agents[J].Semin Intervent Radiol,2008,25(3):204-215.
[17]刘涛,姜在波,李征然,等.外周介入治疗中应用NBCA/Glubran-2胶的临床经验[J].当代医学,2010,16(29):536-541.
[18] Song HH,Won YD,Kim YJ.Transcatheter N-butyl cyanoacrylate embolization of pseudoaneurysms[J].J Vasc Interv Radiol,2010,21(10):1508-1511.
[19]Madhusudhan KS,Gamanagatti S,Garg P,et al.Endovascular embolization of visceral artery pseudoaneurysms using modified injection technique with N-Butyl cyanoacrylate glue[J].J Vasc Interv Radiol,2015,26(11):1718-1725.
[20]陈鹏飞,段旭华,任建庄,等.内脏假性动脉瘤的血管内栓塞治疗42例[J].世界华人消化杂志,2015,23(23):3797-3803.
[21]方勇,高晓东,束平,等.介入栓塞术治疗腹部手术后继发内脏假性动脉瘤16例[J].中华胃肠外科杂志,2016,19(7):816-818.
[22]肖景坤,吕维富,张正峰,等.血管内栓塞术治疗37例假性动脉瘤[J].介入放射学杂志,2013,22(1):60-63.
[23] Yap FY,Omene BO,Patel MN,et al.Transcatheterembolotherapy for gastrointestinal bleeding:a single center review of safety,efficacy,and clinical outcomes[J].Dig Dis Sci,2013,58(7):1976-1984.
[24]杨敏玲,谢春明,庞宁东,等.经导管选择性动脉栓塞治疗创伤性假性动脉瘤[J].中国介入影像与治疗学,2010,7(4):382-385.
[25]李彦豪.实用临床介入诊疗学图解(第三版)[M].北京:科学出版社,2012:671.
[2] Carroccio A,Jacobs TS,Faries P,et al.Endovascular treatment of visceral artery aneurysms[J].Vasc Endovascular Surg,2007,41(5):373-382.
[3] Raffi L,Simonetti L,Cenni P,et al.Use of Glubran 2acrylic glue in interventional neuroradiology[J].Neuroradiology,2007,49(10):829-836.
[4] Nosher JL,Chung J,Brevetti LS,et al.Visceral and renal artery aneurysms:apictorial essay on endovascular therapy[J].Radiographics,2014,26(6):1687-1704.
[5] Julianov A,Georgiev Y.Hepatic artery aneurysm causing obstructive jaundice[J].Quant Imaging Med Surg,2014,4(4):294-295.
[6] Lu M,Weiss C,Fishman EK,et al.Review of visceral aneurysms and pseudoaneurysms[J].J Comput Assist Tomogr,2015,39(1):1-6.
[7] Cordova AC,Sumpio BE.Visceral artery aneurysms and pseudoaneurysms-should they all be managed by endovascular techniques?[J].Ann Vasc Dis,2013,6(4):687-693.
[8] Jesinger RA,Thoreson AA,Lamba R.Abdominal and pelvic aneurysms and pseudoaneurysms:imaging review with clinical,radiologic,and treatment correlation[J].Radiographics,2013,33(3):71-96.
[9] Loffroy R,Favelier S,Pottecher P,et al.Endovascular management of visceral artery aneurysms:when to watch,when to intervene?[J].World J Radiol,2015,7(7):143-148.
[10] Otah E,Cushin BJ,Rozenblit GN,et al.Visceral artery pseudoaneurysms following pancreatoduodenectomy[J].Arch Surg,2002,137(1):55-59.
[11] Saad NE,Saad WE,Davies MG,et al.Pseudoaneurysms and the role of minimally invasive techniques in their management[J].Radiographics,2005,25(Suppl):S173-189.
[12] Venturini M,Marra P,Colombo M,et al.Endovascular treatment of visceral artery aneurysms and pseudoaneurysms in 100patients:covered stenting vs transcatheter embolization[J].J Endovasc Ther,2017,24(5):709-717.
[13] Keeling AN,Mcgrath FP,Lee MJ.Interventional radiology in the diagnosis,management,and follow-up of pseudoaneurysms[J].Cardiovasc Intervent Radiol,2009,32(1):2-18.
[14] Okazaki M,Higashihara H,Ono H,et al.Embolotherapy of massive duodenal hemorrhage[J].Gastrointest Radiol,1992,17(4):319-323.
[15] Leyon JJ,Littlehales T,Rangarajan B,et al.Endovascular embolization:review of currently available embolization agents[J].Curr Probl Diagn Radiol,2014,43(1):35-53.
[16] Vaidya S,Tozer KR,Chen J.An overview of embolic agents[J].Semin Intervent Radiol,2008,25(3):204-215.
[17]刘涛,姜在波,李征然,等.外周介入治疗中应用NBCA/Glubran-2胶的临床经验[J].当代医学,2010,16(29):536-541.
[18] Song HH,Won YD,Kim YJ.Transcatheter N-butyl cyanoacrylate embolization of pseudoaneurysms[J].J Vasc Interv Radiol,2010,21(10):1508-1511.
[19]Madhusudhan KS,Gamanagatti S,Garg P,et al.Endovascular embolization of visceral artery pseudoaneurysms using modified injection technique with N-Butyl cyanoacrylate glue[J].J Vasc Interv Radiol,2015,26(11):1718-1725.
[20]陈鹏飞,段旭华,任建庄,等.内脏假性动脉瘤的血管内栓塞治疗42例[J].世界华人消化杂志,2015,23(23):3797-3803.
[21]方勇,高晓东,束平,等.介入栓塞术治疗腹部手术后继发内脏假性动脉瘤16例[J].中华胃肠外科杂志,2016,19(7):816-818.
[22]肖景坤,吕维富,张正峰,等.血管内栓塞术治疗37例假性动脉瘤[J].介入放射学杂志,2013,22(1):60-63.
[23] Yap FY,Omene BO,Patel MN,et al.Transcatheterembolotherapy for gastrointestinal bleeding:a single center review of safety,efficacy,and clinical outcomes[J].Dig Dis Sci,2013,58(7):1976-1984.
[24]杨敏玲,谢春明,庞宁东,等.经导管选择性动脉栓塞治疗创伤性假性动脉瘤[J].中国介入影像与治疗学,2010,7(4):382-385.
[25]李彦豪.实用临床介入诊疗学图解(第三版)[M].北京:科学出版社,2012:671.