血管损伤的介入治疗

Interventional treatment of vascular injuries

目的探讨血管损伤的介入治疗方法及临床疗效。方法2006年1月至2008年3月，采用介入方法治疗血管损伤13例。损伤部位包括颈内静脉、锁骨下动脉、腋动脉、下腔静脉、腹主动脉、肠系膜上动脉、髂动静脉和股动脉，病变类型表现为刀刺伤后动静脉内瘘形成3例、血管裂伤伴周围血肿4例、外伤后假性动脉瘤3例、动脉损伤修复术后狭窄3例。行覆膜支架置入9例（10枚）、网状支架置入1例、球囊封堵2例、弹簧圈栓塞1例。结果13例介入手术均取得成功，无围手术期死亡，无严重并发症。胸主动脉假性动脉瘤覆膜支架置入后有少量内漏、左锁骨上动脉．颈内静脉瘘患者覆膜支架置入后有少量造影剂从颈内静脉渗出，均未作进一步处理，患者痊愈。随访12例，随访时间1～26个月，平均9．3个月。胸主动脉假性动脉瘤患者术后12个月出现少量咯血，CTA检查无明显异常。未发现支架断裂、移位、变形或支架内狭窄，无病变复发。结论介入治疗血管损伤具有创伤小、手术时间短、操作简单、术后恢复快的优点，但需严格掌握手术适应证以确保操作安全有效。

Objective To discuss the methods and the efficacy of interventional treatment of vascular injuries. Methods From January 2006 to March 2008, interventional therapy was performed in 13 cases of vascular injuries including injuries of internal jugular vein, subelavieal artery, axillary artery, inferior vena cave, abdominal aorta, superior mesenteric artery, arteria iliaca, vena iliaea and femoral artery. Types of these injuries included arteriovenous fistula in 3, vascular rupture complicating haematoma in 4, pseudoaneurysm in 3 and arterial stenosis ensuing from injury repair in 3. Covered stent-grafts were used in 9 cases （10 stent-graft）, mesh stent in 1, sealed with balloon in 2 and introcoil embolism in 1. Result Interventional procedure was successful in all these 13 cases, there was no mortality nor severe complications. Small amount of endoleak developed in thoracic aorta pseudoaneurysm and contrast leaked from internal jugular vein in left subclavical arteriovenous fistula after stent-graft insertion, these were healed conservatively. Twelve cases were followed up from 1 to 26 months. Hemoptysis occurred in patient with thoracic aorta pseudoaneurysm 12 months after intervention but without abnormality in CTA. There were no stent break, shift, deformation or stenosis and there were no recurrence of primary disease. Conclusion Interventional therapy is of less invasion, short performation duration, simple manipulation and quick postoperative recovery for vascular injuries.