脑动静脉畸形出血的相关血管构筑学研究(附80例分析)

Study of relationship between angioarchitecture of brain AVM and their bleeding risk(analysis of 80 cases)

目的 :探讨DSA的超选择造影显示畸形血管团构筑学与脑AVM的出血关系 ,以期预测脑AVM出血的危险性。方法 :血管内栓塞治疗的脑AVM 80例 ,栓塞材料为不同长度 5 / 0的手术丝线、IBCA或NBCA。单因素、多因素回归分析。结果 :①出血风险评估 :术前年平均出血率 2 .18% ,栓塞治疗后年平均出血率 2 .0 2 % ,与术前比较无明显差异。②单因素分析结果 :对出血危险有显著性影响的因素依次是 :引流静脉支数、AVM位置、合并动脉瘤、AVM大小、供应动脉类型及年龄。出血危险与供血动脉支数、静脉引流形式和合并静脉瘤无相关性。多因素回归分析结果 :静脉引流支数越少危险性越大。位于基底节、后颅凹的AVM ,合并动脉瘤的AVM出血危险性亦大。结论 :①单支引流静脉、位于脑深部基底节或后颅凹以及合并动脉瘤的AVM最易破裂出血。AVM出血的影响因素还有AVM大小、供血动脉类型和年龄 ,②血管内栓塞治疗不能有效地防止AVM的再出血 。

Objective:To study the angioarchitecture of brain AVM by DSA and to reveal the relationship between their characteristics and risk of bleeding.Methods:1.Clinical data: The group consists of 80 patients of brain AVM who underwent intravascular therapy.Single and multiple variable analysis were used. Results:1.The annual bleed rate is 2.18% before intravascular embolization and 2 02% after that.No significant difference is found between them.2.Analysis demonstrates the following factors are relative to the risk of bleeding.According to importance,they are number of draining veins, site of AVM,present of aneurysm,size of AVM,type of supplying arteries and age. Conclusion:1.The number of draining veins, the site of AVM and the present of aneurysm are the most important factors relative to risk of AVM bleeding.The AVM with a single draining vein,located at basal ganglion or subtentorium part of the brain are inclined to bleed.The risk of AVM bleeding is also relative to the size of AVM,the type of supplying arteries and the age of patients.