经静脉入路栓塞治疗难治性外伤性颈动脉海绵窦瘘

目的评价经静脉入路栓塞治疗难治性外伤性颈动脉海绵窦瘘(TCCF)的疗效,强调保留颈内动脉通畅的重要性。方法回顾性分析近3年经静脉入路弹簧圈联合Onyx胶栓塞的8例外伤性TCCF,所有病例经动脉入路球囊闭塞瘘口失败,后接受经静脉入路栓塞瘘口,术后3~18个月脑血管造影和临床随访评价其疗效。结果 5例单纯经静脉入路栓塞完全闭塞瘘口,2例经动脉入路植入可脱球囊联合经静脉入路栓塞完全闭塞瘘口,治愈率为87.5%;1例经静脉入路栓塞后遗留海绵窦内假性动脉瘤,3个月后复查动脉瘤消失;术中均未出现远端脑栓塞、脑出血症状,2例患者新发外展神经麻痹,术后2~6个月症状逐步改善并最终消失;术后3~18个月随访造影7例瘘口完全闭塞颈内动脉通畅,1例瘘口消失,同侧颈内动脉闭塞;同时所有病例眼部症状及颅内杂音均消失。结论经静脉入路栓塞治疗外伤性颈动脉海绵窦瘘安全有效,为保留颈内动脉,可作为难治性TCCF的一种重要的治疗方法。

Endovascular treatment of paravisceral mycotic aneurysm: Chimmeny endovascular sealing the end of de road

Open surgery is the elective treatment for mycotic aneurysms of the aorta. This surgery consists of resection of the aneurysm, debridement and revascularization with an in situ or extra-anatomic bypass. Even when surgery has been successful, the morbimortality is raised and the endovascular treatment has become an alternative for specific patients. When mycotic aneurysms involved the visceral arteries, more complex techniques are necessary such as fenestrated endovascular aortic repair or chimmeny endovascular aortic repair and the most frequent complications of this are endoleaks and oclussion the visceral arteries. We present a case of a pacient with a paravisceral abdominal mycotic aneurysms that was result with 2 chimney technique(in the right renal and superior mesenteric arteries) and a single Nellix EVAS(Endologix, Irvine, Calif) of 12 cm long without evidence of endoleaks in the follow-up.