Embolization of the branches of the external carotid artery]

Authors present their own experience with the embolization of the external carotid artery branches. The main indications to embolization included well vascularized and hemorrhagic brain tumors in facial part of the skull, mainly meningiomas, juvenile angiofibromas, and angioneuromyomas. Embolization of external carotid artery was performed in 15 patients. Complete impatience of blood vessel supplying the tumor was achieved in 12 cases, but it was incomplete in 3 cases. Single serious complication in the form of hemiplegia was noted. There were also mild complications in 5 patients, which did not require any intervention.     

Uterine artery embolization for the treatment of uterine fibroids

Uterine artery embolization can be regarded as a less invasive procedure for the treatment of fibroids compared with myomectomy, hysterectomy, and laparoscopic myolysis. The aim of this study was the evaluation of safety and efficacy of uterine artery embolization and of womens' opinion about this treatment. After gynecological examination sixty-nine premenopausal women underwent uterine artery embolization. All procedures but four were technically successful; three women underwent unilateral embolization because of vascular malformation and one of them had an allergic reaction to contrast medium. Of the 69 patients: 58 went home the day after embolization, and 11 within first week. The follow-up examinations after 3, 6 and 12 month showed a significant reduction of uterine and fibroid volume with significant improvement of bleeding. Therefore, according to this report, uterine artery embolization is a successful, minimal invasive treatment of myoma that preserves the uterus and requires shorter hospitalization and recovery times than surgery.     

介入栓塞术在急诊难治性医源性肾出血中的临床应用价值

摘要 目的：探讨介入栓塞术在急诊难治性医源性肾出血中的临床应用价值。方法：收集2012年6月至2021年6月南京医院大学第一附属医院收治的72例急诊难治性医源性肾出血的患者。所有患者在保守治疗无效的情况下,行介入下肾动脉血管造影,根据造影表现确定出血责任动脉,并行栓塞治疗,术后观察临床止血的有效性及安全性。结果：72例患者,介入血管造影呈阳性结果64例,包括血管出现单纯造影剂外溢12例,单纯假性动脉瘤19例,单纯动静脉瘘8例,9例患者合并两种造影表现,以及16例患者呈现动脉出血的一些间接征象。阳性出血患者介入栓塞技术成功率及临床止血率为100%。72例患者介入术后3 d血白细胞、血中性粒细胞比率、血红蛋白、血细胞比容及血小板较术前明显升高（均P＜0.05）,血肌酐及尿素氮较介入术前轻度升高（均P＞0.05）;其中30例患者介入术后7 d再次检测血肌酐及尿素氮,较介入术前基本恢复正常（均P＞0.05）。住院期间所有患者未出现肾衰等严重的术后并发症。结论：介入栓塞术治疗急诊难治性医源性肾出血患者,具有安全、高效、并发症少等优点,临床上值得推广应用。     

Pulmonary embolization causes hypoxemia by redistributing regional blood flow without changing ventilation

To explore mechanisms of hypoxemia after acutepulmonary embolism, we measured regional pulmonary blood flow andalveolar ventilation before and after embolization with 780-µm beadsin five anesthetized, mechanically ventilated pigs. Regionalventilation and perfusion were determined in~2.0-cm³ lung volumes by using1-µm-diameter aerosolized and 15-µm-diameter injected fluorescentmicrospheres. Hypoxemia after embolization resulted from increasedperfusion to regions with low ventilation-to-perfusion ratios.Embolization caused an increase in perfusion heterogeneity and a fallin the correlation between ventilation and perfusion. Correlationbetween regional ventilation pre- and postembolization was greater thancorrelation between regional perfusion pre- and postembolization. Themajority of regional ventilation-to-perfusion ratio heterogeneity wasattributable to changes in regional perfusion. Regional perfusionredistribution without compensatory changes in regional ventilation isresponsible for hypoxemia after pulmonary vascular embolization in pigs.

     

儿童颈髓区巨大动静脉畸形1例(英文)

脑动静脉畸形(AVM)是复杂的血管病变,是由于没有毛细血管床的脑动脉和静脉之间的异常连接引起的病灶[1]。脑动静脉畸形的临床表现有大出血、癫痫、神经功能障碍或头痛,但大部分患者无特异性症状,因此容易漏诊、误诊。手术切除、血管内治疗和放射治疗是动静脉畸形的选择疗法。血管内治疗可以作为其他难以治愈的脑动静脉畸形,或者作为手术切除或放射治疗前的辅助治疗,以减少脑动静脉畸形的血供或促进其收缩,进而促进手术切除或消融[2]。该病引起的颈部疼痛在儿科未见报道。我们收治1例颈髓区巨大动静脉畸形患儿,表现为持续性颈部疼痛并出现癫痫和呕吐症状,经采取分段外科胶栓塞术(第一次部分栓塞术后观察1年再行第二次栓塞),达到动静脉畸形的治愈。     

Effects of arterial ligation and embolization on pulmonary vascular pressure distribution

The effects of embolization on the longitudinal distribution of pulmonary vascular pressures with respect to vascular compliance were determined by the vascular inflow and outflow occlusion technique in isolated blood-perfused pig lungs treated with papaverine to prevent vasomotor responses. Embolization with microspheres having mean diameters of 75, 200, and 550 microns and with barrier beads (2 X 3 X 3.5 mm) significantly increased the pressure gradient across the relatively compliant middle region (delta Pm) without increasing the gradients across the relatively noncompliant regions on the arterial (delta Pa) or venous (delta Pv) ends of the vasculature. In contrast ligation of several lobar arteries caused delta Pa to increase from 0.9 +/- 0.3 to 5.9 +/- 1.1 mmHg but did not change delta Pm or delta Pv. Assuming that delta Pa and delta Pv measured by vascular occlusion result from cessation of flow through resistances, these data suggest that in isolated pig lungs the vessels at the boundary between the arterial and middle regions defined by the occlusion technique are arteries greater than 2-3 mm diam and smaller than lobar arteries.     

综合手术救治方舱内采用不同栓塞材料救治脾破裂的对比研究

目的：探讨在战争或自然灾害等野战条件下,使用综合手术介入方舱,现场对脾脏实施快速微创介入栓塞的可行性及效果,对比分析综合手术救治方舱内采用不同栓塞材料介入救治脾破裂的适应症及有效性、安全性。方法：采用Seldinger技术,经股动脉插管至脾动脉,行数字减影血管造影术（DSA）,显示出血动脉,然后超选择插管至该动脉,经导管注入不同类型栓塞剂以栓塞出血动脉。术后观察不同栓塞剂成功封堵受损血管所用时间,封堵时造影剂用量,封堵效果。结果：手术均成功,止血效果确切,无严重并发症。术后观察2周动物无死亡。结论：综合手术救治方舱具有良好的机动性和较强的自然环境适应能力,灾难现场应用综合手术救治方舱开展血管损伤应急介入救治具有可行性。根据血管损伤的不同类型,恰当选择不同类型的栓塞剂,可以取得很好的疗效。     

PVA颗粒与中药白芨栓塞犬子宫动脉的对比研究

目的:研究PVA微粒、中药白芨颗粒栓塞犬子宫动脉所引起的子宫病理变化,观察两者之间对子宫影响有无差别;探讨中药白芨作为血管栓塞剂的有效性、安全性及相关特性。方法:先结扎8例犬双侧子宫动脉,病理证实子宫组织无坏死。然后采用Seldinger技术,对16例犬进行选择性子宫动脉栓塞。分别向子宫动脉注入PVA微粒、中药白芨颗粒阻断供血,观察子宫病理变化。将病理结果予以定量,综合评价脏器损伤。结果:双侧子宫动脉栓塞后,各栓塞组之间样本均数两两比较,均为P>0.05,即三种处理对于子宫组织损伤无统计学差异。白芨主要栓塞末梢小动脉,栓塞牢靠,不易形成侧支循环,未出现细胞坏死。结论:选择上述栓塞剂,对子宫组织损伤效果一致,中药白芨颗粒具有良好的血管栓塞作用和载体特性,使用方便、安全,是一种较理想的末梢型血管栓塞剂。     

Radiolabeled polyvinyl alcohol particles: A potential agent to monitor embolization procedures

Polyvinyl alcohol sponge (PVA) is a widely used angiographic embolic agent. The radiolabeling of PVA can accurately identify particle localization and may decrease the possibility of patient morbidity from embolization to distal sites. We incorporated ^99mTc sulfur colloid (SC) into PVA by heating. Animal experiments demonstrated the in vivo stability of the ^99mTc SC-PVA complex and the efficacy of external imaging. ^99mTc SC-PVA biodistribution data and external NaI(Tl) scintillation probe counts were performed, to assess anatomic localization. Embolization with this complex was performed in a patient.     

Transcatheter embolization of brain arteriovenous malformations and meningiomas. Evoked responses correlations

Transcatheter embolization of selective arteries of the carotid and vertebral systems were performed in several patients with brain arteriovenous malformations, angiomas and chemodectomas. All patients were submitted to angiography and electrophysiological examination consisting of a conventional EEG and of visual, auditory and somatosensory evoked responses before and after embolization. Patients with tumors showed a marked decrease of blood flow and tumoral necrosis after embolization, facilitating subsequent surgical procedures. Most patients showed an electrophysiological improvement after embolization, in those regions in which angiography revealed brain decompression resulting from the size reduction of the abnormal tissue. Transcatheter embolization can be very useful in the treatment of brain arteriovenous malformations and intracranial tumors, often facilitating surgical procedures.     

Superselective embolization of arterial bleeding as a late complication 3 months after nephron sparing surgery for renal cell carcinoma

To our knowledge, this is the first case of an arterial bleeding as a late complication 3 months after nephron sparing surgery of renal cell cancer, presumably originating from an arteriocalyceal fistula. Superselective embolization of the feeding arterial branch was chosen for treatment of the hemorrhage and proved successful. The high efficacy of superselective embolization as a minimally invasive procedure in this and other cases of bleeding Vessels should be the preferred method instead of open surgery.     

Embolization of uterine arteries in gynecological patients with uterine bleeding of various etiology

Embolization of internal iliac and uterine arteries is one of the surgical treatments for hemorrhages that complicate the course of uterine myoma, cancer diseases and medical treatment-unresponsive conditions. Endovascular hemostasis was performed in 24 patients. The causes of hemorrhage were uterine myoma with intramural or submucous nodal location in 15 patients, cancer of the uterus corpus in 6 patients, cancer of the uterus cervix in 2, and uterine sarcoma with tumor grown in the adjacent organs in 1. In all cases, free Gianturco-type spirals were used for embolization of internal iliac and ulterine arteries. For better visualization and superselective catheterization of uterine arteries, a study was performed in the right or light oblique projections at an angle of 20-25 degrees. After embolization of iliac and uterine arteries, hemostasis was attained in all patients. At the same time there were no complications. Thus, embolization of uterine arteries is a safe and highly effective alternative to radical surgical intervention in patients with acute gynecological disease complicated by bleeding, which provides effective hemostasis and permits either avoidance of surgical intervention or a significant reduction in the volume of intraoperative blood loss.     

Clinical results of TRAM flap delay by selective embolization of the deep inferior epigastric arteries

Preoperative selective embolization of the deep inferior epigastric arteries constitutes a new technique in TRAM flap delay. Whereas surgical ligation of these vessels has proved to be an effective delay procedure in experimental and clinical settings, it requires an additional operative step under general anesthesia. Despite the introduction of the free TRAM leading to improved flap perfusion, this microsurgical technique is not always available because of the requirements of specialized equipment and staff, longer operating hours, and subsequently higher expenses. The search for a minimally invasive, easy, and inexpensive technique to improve perfusion of the pedicled TRAM flap led us to selective embolization of the deep inferior epigastric arteries by an angiographic procedure. After 4 years of experience with this technique, we now present the first clinical results. Breast reconstruction by a delayed pedicled TRAM flap was performed in 40 patients with a mean age of 48.4 years (range, 31 to 66 years). The mean interval between embolization and surgery was 3.6 months. Postoperative data concerning flap survival and complications were available for all patients. Embolization of the deep inferior epigastric arteries was performed bilaterally in 35 patients (87.5 percent) and unilaterally in 5 patients (12.5 percent). Radiotherapy had been applied in 21 patients (52.5 percent) before surgery. Postoperative flap complications consisted of partial necrosis in three (7.5 percent), fat necrosis in one (2.5 percent), impaired wound healing in five (12.5 percent), and postoperative bleeding in two patients (5 percent). Abdominal wound healing complications occurred in six patients (15 percent), abdominal wall weakness in eight (20 percent), and hernia formation in four (10 percent). Surgical corrections were performed at the breast (TRAM flap) in 22 patients (55 percent) and at the abdomen (donor site) in 9 (22.5 percent). Preoperative selective embolization of the deep inferior epigastric arteries constitutes an alternative delay procedure for the pedicled TRAM flap. It is superior to the conventional procedure without delay, offers several advantages compared with surgical ligation of these vessels, and represents an alternative to the free TRAM flap in selected cases.     

Lung damage and pulmonary uptake of serotonin in intact dogs

We examined the influence of glass bead embolization and oleic acid, dextran, and imipramine infusion on the pulmonary uptake of trace doses of [3H]serotonin and the extravascular volume accessible to [14C]antipyrine in anesthetized dogs. Embolization and imipramine decreased serotonin uptake by 53 and 61%, respectively, but no change was observed with oleic acid or dextran infusion. The extravascular volume accessible to the antipyrine was reduced by 77% after embolization and increased by 177 and approximately 44% after oleic acid and dextran infusion, respectively. The results suggest that when the perfused endothelial surface is sufficiently reduced, as with embolization, the uptake of trace doses of serotonin will be depressed. In addition, decreases in serotonin uptake in response to imipramine in this study and in response to certain endothelial toxins in other studies suggest that serotonin uptake can reveal certain kinds of changes in endothelial function. However, the lack of a response to oleic acid-induced damage in the present study suggests that serotonin uptake is not sensitive to all forms of endothelial damage.     

院前明胶海绵栓塞治疗肾血管损伤的动物研究

目的：探讨在新型综合手术救治方舱中明胶海绵栓塞治疗肾血管损伤的可行性和疗效。方法：在新型综合手术救治方舱中构建3例动物肾腹（背）干动脉损伤模型、3例肾段动脉损伤模型,先用1mm×1mm×1mm明胶海绵颗粒对损伤血管进行栓塞治疗,若未能止血,改用2mm×2mm×2mm颗粒栓塞,观察栓塞后15分钟、1月后的肾动脉造影,栓塞后1月的组织病理表现。结果：3例肾段动脉和1例肾腹干动脉使用1mm×1mm×1mm明胶海绵颗粒一次栓塞成功;1例肾腹干动脉和1例肾背干动脉用1mm×1mm×1mm颗粒栓塞未能完全止血,改用2mm×2mm×2mm颗粒栓塞成功。6例动物术后生命体征平稳,全部存活,一个月后造影复查见栓塞动脉来再通,但其余分支动脉血供得到保留。大体标本观栓塞侧肾明显缩小,来见脓腔和脓性分泌物,病理切片示栓塞后局部肾组织有不同范围缺血性梗死。结论：野战方舱中明胶海绵栓塞治疗出血效果明确,对于一般肾血管损伤定位准确,止血迅速、彻底,有良好的可行性和疗效。     

Long-term results of endovascular treatment of metastatic renal cell cancer

The authors analyse the long-term results of treatment of 106 patients with advanced renal cell carcinoma. The patients were divided in two groups. Group 1 (42 patients) included cases with single metastatic lesion. Patients of group 2 (n = 64) had more than one site of metastases. All patients were treated by nephrectomy, embolization with chemotherapeutic agent or arterial occlusion without cytostatic drug except nine patient of group 2, who has undergone chemo and hormonal therapy. The survival according to method at treatment was studies. After occlusion satisfactory results were obtained in cases with single metastasis lesion and also in cases with many sites of metastases. Oily chemoembolization in renal cell carcinoma with distant metastases has given better results as compared with the embolization without chemodrugs. We conclude that endovascular method of treatment is an alternative to the traditional nephrectomy in palliation of renal cell carcinoma.     

Use of magnetic resonance imaging for the evaluation of vascular malformations of the lower extremity

Vascular malformations are anatomically subdivided according to the predominant channel anomaly into either capillary, arterial, venous, lymphatic, or combinations. They can be further subdivided into high- or low-flow malformations. Any lesion that has an arterial component is considered a high-flow malformation. Once the diagnosis of a vascular malformation is made, it is of paramount importance to define not only the flow characteristics but also the full range of extension, because the prognosis and appropriate treatment vary substantially for each type of anomaly. The two most useful noninvasive imaging techniques for assessing vascular malformations are magnetic resonance imaging (MRI) and ultrasonography. The aim of this review is to give surgeons involved in treating patients with vascular malformations an opportunity to gain some background on MRI scans when assessing vascular malformations. Although MRI is a powerful modality for assessing vascular malformations, we will also discuss some of the limitations of MRI. We further suggest a diagnostic flow chart developed on the basis of MRI features designed to help determine the composition of a vascular birthmark when intervention is anticipated.     

Pulmonary vascular pressure-flow characteristics in canine pulmonary embolism

We tested the hypothesis that, in canine embolic pulmonary hypertension, upstream transmission of increased left atrial pressure (LAP) is inversely related to the level of the pressure intercept (PI) obtained by extrapolation from the linear pulmonary vascular pressure-flow (P-Q) plot. P-Q coordinates were obtained by varying Q through systemic fistulas. Seven group 1 dogs were embolized with autologous blood clot to produce marked pulmonary hypertension and mean pulmonary arterial pressure (PAP), and PI increased from 15 to 41 mmHg (P less than 0.001) and from 8.8 to 31 mmHg (P less than 0.001), respectively. Before and after embolization we assessed effects of increased LAP, produced by inflation of a left atrial balloon, on PAP at constant Q. Embolization depressed the mean slope of this relationship from 0.78 to 0.16 (P less than 0.001). Subsequently, six group 2 dogs were embolized to produce moderate pulmonary hypertension with a mean PI of 22 mmHg. This value was significantly less than PI in group 1 (P less than 0.01). After embolization, the slope of the PAP-LAP relationship was greater in group 2 than group 1: 0.47 vs. 0.16 (P less than 0.01). We conclude that the upstream transmission of left atrial pressure is inversely related to PI and that marked embolic pulmonary hypertension produces an effective vascular waterfall.     

溶栓前后肺血栓栓塞症大鼠肺血管内皮细胞ICAM-1及Ps的表达

目的观察溶栓前后肺血栓栓塞症(pulmonarythromboembolism,PTE)大鼠肺血管内皮细胞上细胞间粘附分子-1(intercellularadhesion-1,ICAM-1),P-选择素(P-selectin,Ps)的变化,以此探讨溶栓治疗的影响。方法采用自体血栓回输法建立PTE模型,随机分为对照组、模型组、溶栓组。各组动物在栓塞后1、3、24、72、120h5个时间段分别处死,进行病理切片,免疫组化和原位杂交的方法检测肺血管内皮细胞上ICAM-1和Ps的蛋白及mRNA的变化。结果肺栓塞后病理可见肺动脉血栓形成,炎性反应明显。肺血管内皮上ICAM-1蛋白及mRNA表达在栓塞后3h开始增高(P<0·01),而Ps蛋白及mRNA表达在栓塞后1h开始增高(P<0·01)。溶栓治疗后,栓塞、出血、萎缩减轻,但炎性反应有所加重,肺血管内皮上ICAM-1和Ps的水平再次升高(P<0·01)。结论细胞间粘附分子-1与P-选择素均参与了大鼠肺血栓栓塞症的发病过程,溶栓治疗并未改善肺组织的炎性损伤。