弹簧圈联合无水乙醇介入栓塞治疗腮腺区动静脉瘘

Embolization of congenital arteriovenous fistula in the parotid region using coils and absolute ethanol

目的探讨弹簧圈联合无水乙醇介入栓塞治疗腮腺区先天性动静脉瘘(AVF)的临床效果。方法选择2015年1月至2019年12月上海交通大学医学院附属第九人民医院介入科收治的腮腺区先天性AVF患者,均采用Seldinger技术经股动脉穿刺行患侧颈总动脉和椎动脉造影证实AVF。经动脉途径使用同轴微导管到达瘘口或使用直接经皮穿刺到达扩张静脉,经穿刺针引入微导管至瘘口,使用可控弹簧圈与游离弹簧圈结合,联合使用无水乙醇闭塞瘘口。观察患者术后效果。结果本研究共纳入8例AVF患者,男7例,女1例,年龄3~58岁,平均28.5岁。8例患者均造影证实腮腺区AVF,5例右侧,3例左侧,所有患者面神经功能正常。供血动脉均为颈外动脉,回流静脉为颈外静脉。6例患者单纯采用经动脉途径使用弹簧圈栓塞,2例尝试经动脉途径失败后改为采用经皮穿刺静脉途径弹簧圈栓塞。8例患者均使用无水乙醇辅助栓塞,使用无水乙醇总量平均为17.4 ml,所有患者栓塞后复查颈外动脉造影显示瘘口完全闭塞,瘘口远端颈外动脉分支显影正常,未见明显回流静脉显影。1例患者出现术区同侧暂时性面神经麻痹,3 d后面神经麻痹症状消失,术后3个月出现弹簧圈外露,经过局部清创取出外露弹簧圈后,创口愈合。其余患者无明显并发症。8例患者随访6~12个月,未见AVF复发。结论腮腺区先天性AVF使用弹簧圈联合无水乙醇介入栓塞可获得满意的临床效果,可避免手术切除导致的AVF复发、面神经与腮腺损伤,面部无手术切口,对外观无影响。

Objective To evaluate the clinical effect of embolization of congenital parotid arteriovenous fistula(AVF)using coils and absolute ethanol.Methods From January 2015 to December 2019,8 patients with congenital AVF in parotid region were admitted to the Department of Interventional Radiology Shanghai Ninth People’s Hospital.AVF was confirmed by angiography of common carotid artery and vertebral artery through femoral artery puncture with Seldinger technique.Using coaxial microcatheter to reach the fistula via artery or using direct percutaneous puncture to reach the dilated vein and introduced microcatheter to the fistula via puncture needle.Combined detachable coils with fiber coils,and used absolute ethanol to occlude the fistula.Then the outcome was evaluated.Results There were 7 males and 1 female involved in this study.The average age was 28.5 years(3-58 years).All of the 8 patients were confirmed AVF in parotid region by angiography,five on the right and three on the left.The feeder artery was external carotid artery,and the outflow vein was external jugular vein.Among them,6 patients used coaxial microcatheter to reach the fistula via artery,2 patients used direct percutaneous puncture after failure via transarteral approach.All the 8 patients were treated with absolute ethanol,the total amount of which was 17.4 ml on average.After embolization,the external carotid angiography demonstrated that the fistula was completely occluded,the branches of the external carotid artery at the distal end of the fistula were normal,and there was no obvious reflux vein.After the operation,all the patients had no pulsation and tremor.The external jugular vein dilation disappeared in 4 patients.One patient had temporary facial paralysis on the same side of the operation area.The symptoms disappeared three days after treatment.This patient had undergone coils exposed three months after operation.After local debridement,the exposed coils were removed and the wound healed.The 8 patients were followed up for 6-12 months without recurrence.Conclusions Embolization with coils combined with absolute ethanol is safe and affective treatment for congenital parotid AVF.