瘤内及载瘤动脉栓塞治疗假性动脉瘤的体会

Initial experience in the treatment of pseudoaneurysms through embolization of pseudoaneurysm itself together with its parent artery

目的探讨使用瘤内及载瘤动脉栓塞治疗假性动脉瘤（pseudoaneufysms，PSA）的可行性。方法2012年1月至2012年12月收治7例PSA患者，均经血管造影及相关外伤及手术病史证实，采用瘤内及载瘤动脉栓塞治疗，术后随访3～6个月。结果所有PSA患者瘤腔栓塞良好，主干保留。椎动脉、臀上动脉和胫前动脉PSA患者的体表搏动性包块、血管杂音消失；子宫动脉、支气管动脉及肝动脉PSA患者出血停止。术后随访3～6个月，血管彩色多普勒超声提示PSA瘤腔内未见彩色血流显示；肝动脉PSA患者未再次便血。支气管动脉PSA患者6个月内未再次咯血，所有患者未出现相应肢体或器官缺血症状。结论采用瘤内及载瘤动脉栓塞法治疗PSA安全有效，适应性较广，操作相对简单。

Objective To explore the feasibility of embolization of the pseudoaneurysm itself together with its parent artery for the treatment of pseudoaneurysms. Methods During the period from Jan. 2012 to Dec. 2012, a total of 7 patients with pseudoaneurysm were admitted to authors＇ hospital. The diagnosis was confirmed by angiography, trauma- related history and surgery in all patients. Embolization of the pseudoaneurysm itself and its parent artery was carried out in all patients. After the treatment, the patients were followed up for 3 - 6 months. The results were analyzed. Results The aneurysmal cavity was well obstructed in all patients, with the main stem being reserved. In patients with pseudoaneurysms that were located at the vertebral artery, superior gluteal artery or anterior tibial artery, the superficial pulsatilc lump and vascular murmur disappeared immediately after the procedure. And in patients with pseudoaneurysms that were located at the uterine artery, bronchial artery or hepatic artery the bleeding stopped soon after the treatment. During the follow-up period, vascular Doppler uhrasonography showed that no colored blood flow was detected in the previous aneurysmal cavity. No recurrent hematochezia was seen in patients previously having pseudoaneurysm located at the hepatic artery, and no recurrent hemoptysis was found in patients previously having pseudoaneurysm located at the bronchial artery. No ischemic symptoms related to corresponding organ or extremity occurred. Conclusion For the treatment of pseudoaneurysms, embolization of the pseudoaneurysm itself together with its parent artery is safe and effective. This technique carries wide indications although its manipulation is simple.（J Intervent Radiol, 2013, 22： 761-764）