系统性血管炎并发症的介入诊治(附5例报告)

Interventional Diagnosis and Treatment of the Complications of Systemic Vasculitis( Attached Report 5 Cases)

目的探讨系统性血管炎并发动脉瘤及动脉夹层的诊断和介入治疗。方法搜5例以多发动脉夹层及动脉瘤为首发表现的系统性血管炎患者资料,经CT及动脉造影证实。行血管腔内修复治疗,同时完善相关实验室检查,诊断考虑有血管炎基础,并予激素试验性治疗,定期复查随访。结果 4例多发动脉夹层患者介入术后坚持激素治疗,3个月或6个月后复查提示原多发动脉夹层均较前明显好转,部分动脉夹层完全消失。1例动脉瘤患者在激素治疗前,2次行介入治疗疗效不佳,予激素治疗至血管炎缓解期后再次行介入治疗,复查提示疗效满意,原动脉瘤未再显影。结论对以动脉夹层或动脉瘤为首诊疾病患者,考虑病因时应注意其有无血管炎基础;对其行血管腔内修复治疗时,需同时重视对血管炎的治疗。

Objective To investigate the diagnosis and interventional treatment of systemic vasculitis complicated aneurysm and arterial dissection. Methods Study was done on 5 cases with multiple arterial dissection and aneurysm as the first manifestation of patients,confirmed by CT and arteriography. Patients had endovascular repair treatment after relevant laboratory examination and diagnostic considerations concluded a diagnosis of vasculitis,followed by regular experimental hormonal treatment. Results 4 cases of the patients with multiple arterial dissection continued hormone therapy after interventional therapy. The original examination after 3 months or 6 months showed multiple artery dissection was obviously improved and part of the arterial dissection had completely disappeared. 1 case which had aneurysm before hormone treatment showed that the therapeutic effect was poor with 2 cycles of interventional treatment. The review after interventional therapy and hormonal treatment for vasculitis remission suggest that the curative effect is satisfactory and the original aneurysm is not developing. Conclusion In patients with arterial dissection or aneurysm,the etiology should be carefully considered. Endovascular repair needs to concurrently focus on the treatment of vasculitis itself as well.