超选择插管技术在硬脑膜动静脉瘘治愈性栓塞治疗中的作用

Role of superselective catheterization techniques in curative embolization of dural arteriovenous fistula

目的探讨超选择插管技术在硬脑膜动静脉瘘（DAVF）治愈性栓塞治疗中的作用。方法回顾性分析20例血管内栓塞治疗的DAVF患者。依据术前CT及DSA资料评估,选择经动脉入路19例,经静脉入路1例;17例选用Onyx-18栓塞,3例选用球囊栓塞。术后3个月~1年随访患者瘘口栓塞情况及临床疗效。结果患者手术均获得成功,术中18例（18/20,90.00%）达到超选择性插管栓塞,2例（2/20,10.00%）通过血流压力梯度灌注栓塞。术后即刻造影示瘘口完全栓塞15例（15/20,75.00%）,次全栓塞2例（2/20,10.00%）,不完全栓塞3例（3/20,15.00%）,无再发出血及置管等情况。术后3个月~1年复查,治愈性栓塞17例（17/20,85.00%）,好转3例（3/20,15.00%）,无效0例。结论超选择插管技术是血管内治愈性栓塞DAVF,减少相关并发症的关键。

Objective To explore the role of superselective catheterization techniques in curative embolization of dural arteriovenous fistula（DAVF）. Methods A total of 20 cases DAVF patients who underwent endovascular embolization were analyzed retrospectively. Based one data of preoperative CT and DSA, transarterial approach in 19 cases, transvenous approach in 1 cases; 17 cases using Onyx-18 embolization, 3 cases selected balloon embolization. After 3 months to 1 year, the fistula and clinical efficacy were followed up. Results Operations were successful in all patients, 18 cases（18/20, 90.00%） achieved super-selective embolization, 2 cases（2/20, 10.00%） with embolic perfusion pressure gradient through the bloodstream. Immediate postoperative angiography showed complete thrombosis of the fistula 15 cases（15/20, 75.00%）, subtotal embolism 2 cases（2/20, 10.00%）, incomplete embolization 3 cases（3/20, 15.00%）, without rebleeding and indwelling catheter and so on. After 3 months to 1 year review, curative embolization 17 cases（17/20, 85.00%）, improvement in 3 cases（3/20, 15.00%）, ineffective in 0 case. Conclusions Superselective catheterization technique is the key to curative embolization DAVF and reduce related complications.