肢体和颅面部血管畸形的血管造影诊断及介入治疗

Angiographic Diagnosis and Interventional Therapy for Limbs and Craniofacial Vascular Malformation

目的探讨肢体和颅面部血管畸形的血管造影诊断及介入治疗的临床价值。资料与方法56例肢体和颅面部血管畸形患者,颅面部14例,上肢18例,下肢24例。先行血管造影,了解病变部位、累及范围、供血动脉、引流静脉及侧支循环情况。然后行栓塞治疗,超选择插管至病变供血动脉内,根据病变性质、造影表现、插管的具体位置及治疗目的,选择不同种类、大小的栓塞剂及栓塞方法。对四肢近端局限性动静脉瘘患者置入带膜支架封堵瘘口。结果56例患者通过选择性动脉造影均明确诊断,其中44例表现为动静脉畸形,供血动脉与引流静脉之间有明显迂曲扩张畸形血管团;12例表现为动静脉瘘。23例行介入治疗,其中21例栓塞后临床症状和体征均有不同程度的缓解,表现为局部包块缩小,血管杂音减轻或消失,心脏功能改善等,2例带膜支架置入后血管杂音消失。随访4～48个月,除2例臀部血管畸形患者栓塞后1年左右又出现临床症状而接受相应治疗外,其余患者均未出现明显临床症状。结论经导管动脉造影是肢体和颅面部血管畸形的可靠诊断方法;介入治疗血管畸形创伤小、安全、有效,并发症少。

Objective To explore the clinical value of angiographic diagnosis and interventional therapy for limbs and craniofacial vascular malformation. Materials and Methods 56 patients with limbs and craniofaeial vascular malformation,including 14 patients of eraniofacial, 18 patients of upper limb,24 patients of lower limb. Selective angiographic diagnosis was performed in order to understand the diseased region, involving scope, feeding artery, draining vein and bypass circuit by using seldinger method. The embolotherapy with various embolism materials and embolism method was performed according to disease character, arteriography manifestation, catheter headend location and goals of treatment. The covered stent insertion was performed according to the arterio-venous fistula site of limb for blocking orificium fistulae. Results All patients had obtained definite diagnosis through angiography. The arteriography manifestation of 44 patients was arteriovenous malformation,the circuity distension abnormity blood vessel between feeding artery and draining vein; 12 patients manifestation was arteriovenous fistula. 23 patients was performed interventional therapy after angiography. The clinical symptom and signs of 21 patients had different relief after interventional embolism, the principal clinical manifestation included the region lump minification, the vascular murmur relieving or vanishing, the cardiac function improving; clinical manifestation in 2 patients with covered stent insertion was the vascular murmur vanishing; there was no obviously clinical symptom occurring during 4 -48 months follow up except that 2 buttocks vascular malformation patients accepted corresponding treatment after about 1 year of embolism operation. Conclusion Transeatheter arteriography is a reliable method in diagnosis of limbs and craniofacial vascular malformation ; interventional therapy of vascular malformation is safety and effective with less invasion and complication.