创伤性假性动脉瘤与动静脉瘘血管内治疗

Intravascular Treatment of False Aneurysms and Arteriovenous Fistulas

目的：探讨创伤性假性动脉瘤与动静脉瘘治疗效果．方法：本组共１１８例病人，其中颈内动脉海绵窦瘘８８例、动静脉瘘８例、假性动脉瘤２２例．采用可脱性球囊栓塞６４例；弹簧圈与钨丝螺旋圈栓塞３４例；肌瓣“放风筝”法治疗６例；眼上静脉穿刺注入栓塞材料２例；瘤腔直接穿刺注入栓塞材料２例；气囊导管暂时阻断动脉腔内血流与手术相结合治疗１０例．结果：除４例颈内动脉海绵窦瘘术后出现偏瘫、半年内恢复外，余皆治愈．结论：可脱性球囊栓塞颈动脉海绵窦瘘是目前国内外首选治疗方法．气囊导管暂时阻断动脉腔内血流，然后施行血管重建，可控制大出血并减少术中出血．本法是直接手术时安全有效的辅助措施，可提高邻近躯干部位大血管损伤救治成功率．

Aim: To study therapeutic approaches to false aneurysms and arteriovenous fistulas due to trauma. Methods: From 1979 to 1995, 118 cases were given endovascular treatment. Carotid cavernous fistulas were found in 88 cases, arteriovenous fistulas in 8 cases, and false aneurysms in 22 cases. In these, 64 cases were treated with detachable balloons, 34 with spring coils and tungsten nicro coils, 6 by muscle mass “fly a kite”, 2 by injecting embolic material via superior ophthalmic vein, 2 by injecting embolic material into aneurysmal wall, 10 by repair of the blood vessel after temporary occlusion of blood circulation with balloon catheter. Results: All of the patients were cured except 4 cases in whom hemiparalysis occurred and recovered within 6 months. Conclusion: Arteriovenous fistula and the cavity of false aneurysm can be embolized by detachable balloons, spring coils and tungsten micro coils. The lesion would be closed up and free circulation be protected. It is a safe and reliable auxiliary method and may contribute to a successful rate in the management of injuries to large blood vessels closed to the trunk.