联合Amplatzer血管封堵器与弹簧圈介入栓塞治疗多发性肺动静脉瘘的疗效评估

The efficacy evaluation of Amplatzer vascular plug combined with spring-coils interventional embolization in the treatment of multiple pulmonary arteriovenous fistula

目的探讨联合Amplatzer血管封堵器(AVP)与弹簧圈经导管供血动脉介入栓塞治疗多发性肺动静脉瘘(PAVF)的临床疗效。方法4例多发性PAVF患者术前均完善CT肺动脉造影(CTPA),初步评估主要供血血管大小、数目以及流入、流出道,在血管造影系统下使用AVP和弹簧圈对供血动脉行介入栓塞治疗。观察造影及栓塞表现,评估临床、技术成功率及并发症发生情况。结果4例多发性PAVF共21个病灶,其中19个病灶均获得成功栓塞,其中1例患者分两次介入手术完成,1例患者2个微小病灶未处理,对供血动脉最大径>5 mm者选用AVP栓塞,对供血动脉最大径<5 mm者采用弹簧圈栓塞,总计放置AVP 8个,弹簧圈25枚,4例患者手术顺利,紫绀和低氧血症的临床症状均明显改善,未出现严重并发症。结论联合AVP与弹簧圈介入栓塞治疗多发性PAVF具有安全、高效的优势。

Objective To investigate the clinical effect of multiple pulmonary arteriovenous fistula(PAVF)treated with Amplatzet vascular plug(AVP)and spring-coils transcatheter arterial embolization.Methods CT pulmonary angiography(CTPA)was performed in all the 4 patients with multiple PAVF before surgery,and the size,number,inflow and outflow channels of the main blood supply vessels were preliminarily evaluated.Interventional embolization of the blood supply arteries was performed using AVP and spring coils under angiography system.The manifestations of angiography and embolization were observed,and the clinical and technical success rates and complications were evaluated.Results Four patients with multiple PAVF had a total of 21 lesions,of which 19 lesions were successfully embolized,including 1 case completed by two interventional operations,and 1 case had 2 minimal PAVF lesions untreated.AVP was used for embolization of the largest diameter of the blood supply artery≥5 nim,and spring coils were used for embolization of the largest diameter blood supply artery<5 mm.A total of 8 AVP and 25 spring coils were placed.No serious complications were observed in 4 patients,and the clinical symptoms of cyanosis and hypoxemia were significantly improved.Conclusion Combined AVP and spring coil embolization in the treatment of multiple PAVF has the advantages of safety and efficiency.