DSA对外伤后动脉损伤的诊断与介入治疗

The value of DSA for diagnosis and treatment of blood vessel injury

目的 :探讨DSA对外伤后动脉损伤的诊治价值。方法 :对外伤后疑合并血管损伤患者进行DSA检查 ,40例患者均采用Seldinger法经健侧股动脉穿刺 ,当导管插管至可疑血管近端时行DSA造影 ,栓塞材料使用弹簧圈或明胶海绵。结果 :检查结果阳性 3 8例 ,阳性率为 95 % ,损伤血管有 48条。造影征象 :血管闭塞 2 6条 ,充盈缺损 7条 ,近端扩张 7条 ,对比剂外渗 5例 ,对比剂滞留 5例 ,管腔细小 15例 ,血流变慢 9例 ,侧支增多 19例 ,假性动脉瘤 5例 ,动静脉瘘 1例。病理分析 :血管断裂 9条 ,血管痉挛 3条 ,血管挫伤 17条 ,血栓形成 2 0条 ,血管受压 4条 ,假性动脉瘤 5例 ,动静脉瘘 1例 ,筋膜间隙综合征 2例。对 3 8例阳性患者行带皮瓣移植 9例 ,行弹簧圈栓塞介入治疗 4例 ,保守治疗 5例 ,其余为手术治疗 ,疗效为治愈 2 9例 ,好转 8例 ,转院 1例。结论 :DSA对外伤后动脉损伤的诊治中具有重要价值 ;外伤后 1～ 2d为血管闭塞的高危时期 ,对可疑病例应立即行DSA检查 ,明确诊断 ;DSA检查可提高带血管皮瓣移植术的成功率 ;适当病例行介入治疗可替代传统手术治疗。

Objective:To assess the value of DSA in the diagnosis and treatment of traumatic blood vessel injury.Methods:40 patients with suspected blood vessel injury after trauma were performed DSA,using Seldinger′s technique via the femoral artery of the healthy side.When the catheter was placed at the proximal portion of the injured vessel,angiography was carried out.For embolization of the traumatic vessel metallic coils or gelatine sponge were used.Results:There were positive findings in 38 patients with 48 injured blood vessels,the positive rate was 95%.The findings on DSA were as follows:occlusion in 26 blood vessels,filling defect in 7,proximal dilatation in 7,extravasation and retention of contrast material in 5 respectively,stenosis of the vessel in 15,slow down of blood flow in 9,collateral circulation formation in 19,pseudoaneurysm in 5,arteriovenous fistula in 1.The pathological findings were as follows:rupture in 9 blood vessels,angiospasm in 3,contusion in 17,thrombosis in 20,compression of vessel in 4,pseudoaneurysm in 5,arteriovenous fistula in 1,spatium interfasciale syndrome in 2.For 38 positive patients shown by DSA,skin flap grafting was carried out in 8,coils embolization in 4,conservative treatment in 5 and surgical operation in the remains.From those treated patients,there were 29 cases of recovery,8 of improvement,1 transferring to other hospital.Conclusion:DSA is of great value in the diagnosis and treatment of blood vessel injury,1～2 days after trauma is the risk period of blood vessel occlusion and DSA should be performed immediately.This can improve the successful rate of skin flap grafting.Interventional therapy can replace the conventional surgical operation in proper patient with blood vessel trauma.