血管内介入治疗头颈部创伤性血管损伤

Endovascular treatment of traumatic vascular lesions of the head and neck

目的评估血管内介入治疗颈部外伤性血管损伤的治疗效果。方法回顾血管内介入治疗外伤性颈动脉或椎动脉损伤16例,分析其临床及影像表现,血管内介入治疗(栓塞或支架植入)和预后。结果 16例患者中,男性14例,女性2例,年龄17～46岁。血管损伤的原因有车祸,摔伤,刀伤和斗殴。2例(12.5%)有多处损伤;12例假性动脉瘤,5例动静脉瘘,2例动脉破裂有活动性出血。共20处病变中,行栓塞治疗14处,支架植入6处。随访一年内,临床改善或稳定14例,1例支架完全闭塞,1例动静瘘复通。结论合理采用血管内介入治疗头颈部创伤性血管损伤是安全、有效的治疗方法。

Objective To evaluate the endovascular therapy of patients with traumatic vascular injuries of the head and neck. Methods Sixteen patients with traumatic vascular lesions of the head and neck were admitted to our hospital and diagnostic angiography of the carotid artery and vertebral circulation was performed and endovascular therapy （embolization and stent planting） and outcome were analyzed retrospectively. The angiographic findings, clinical presentation and hospital course were reviewed. Results There were sixteen patients, fourteen males and two females, aged 17-46. The mechanisms of injury included motor vehicle accident, stab wound in a fall aggravated assault. Two patients （12.5o/oo） had mul- tiple lesions; twelve had pseudoaneurysms, five with fistula formation and two with active arterial hemorrhage. A total of 20 lesions were treated. Fourteen of 20 lesions were embolized by coils and six were received stents. In one year follow-up, fourteen of the eighteen patients remained clinically improved or stable at varying follow-up intervals in one year. One patient presented completely occluded stent at the 2th month follow-up. One patients had a reopened arteriovenous fistula at the 2-week post-embolization follow-up. Conclusion Endovascular therapy of traumatic vascular lesions of the head and neck are minimally invasive, attractive options in selected cases.