目的探讨复杂的创伤性动脉瘤（TAA）和动静脉瘘（TAVF）的手术方法和疗效。方法对我院1963年6月至2000年12月经手术治疗的TAA和TAVF 121例进行回顾性分析。结果TAA ７１例含９１个动脉瘤，TAVF ５０例含５４个动静脉瘘。手术方式包括瘤体切除和端端吻合或血管移植或上下结扎，瘤体上下结扎加血管旁路移植，直接修补或补片。瘘管切除加四头结扎或动静脉移植或动静脉修补，介入栓塞治疗。死亡１例。TAA、TAVF随访率分别为６５.７%和６０.0%。远期效果好。结论不同部位复杂的TAA和TAVF应根据其不同分型采用不同的手术方式，对选择性病例可考虑做介入治疗。
ObjectiveTo explore the clinical characteristics and improve the knowledge of diagnosis and treatment of complex pulmonary arteriovenous fistula (PAVF) as well as enrich the experience of diagnosis and treatment of the disease.MethodsA retrospective analysis of pathogenetic process clinical manifestations, imaging features and diagnosis and treatment was conducted on one case of complex PAVF. The literature review was carried out with " complex pulmonary arteryovenous fistula (malformation)” as the research terms in English and Chinese respectively in CNKI, WanFang and PubMed database. Search time ranged from January 1997 to April 2018, and the literature was screened and reviewed.ResultsThe patient was a 47-year-old female complained of recurrent epistaxis for 40 years, intermittent hemoptysis for 20 years, headache, dizziness, chest pain, chest tightness for 4 years and the symptoms were aggravated by 3 months, visiting this hospital on January 23, 2018. Pulmonary CT angiography revealed multiple nodules in internal and external segment and outer basal segment of right lung, anterior basal segment and outer basal segment of left lung. CT enhanced scan showed that the thickened pulmonary artery was connected with the above lesion, and the edge was accompanied by large draining veins. Pulmonary artery revascularization showed complex PAVF abnormal branches. The diagnosis was complex PAVF, and interventional embolization therapy was carried out and curative effect was satisfactory during the follow-up. A total of 6 literatures were reviewed in above-mentioned databases, including 4 Chinese literatures and 2 English literatures, containing 10 patients, including 8 males and 2 females, with an average age of (9.7±7.0) years. Most of the clinical manifestations were shortness of breath after exercise, cyanosis and hemoptysis and all patients were cured and discharged after interventional embolization treatment except for 1 patient refused treatment.ConclusionsComplex PAVF is a very rare pulmonary vascular malformation. The clinical manifestations mainly include hypoxemia, dyspnea, hemoptysis, and the preferred treatment is interventional embolization, which has a satisfactory clinical effect at a short-term follow-up.
ObjectiveTo summarize the diagnosis and treatment experience of one case of abdominal aortic aneurysm with iliac arteriovenous fistula.MethodsA case of abdominal aortic aneurysm with left iliac arteriovenous fistula admitted to Nanchong Central Hospital in December 2019 was retrospectively analyzed. The diagnosis and treatment of the patient and the MDT discussion results were summarized.ResultsThe clinical manifestations of this patient was refractory heart failure, and he received heart medicine treatment in Nanchong Center Hospital. The patient diagnosed as abdominal aortic aneurysm with left iliac arteriovenous fistula after computed tomography angiography (CTA), abdominal aorta lumen coated stents isolation (EVAR) during operation was performed after the MDT discussion. Postoperative imaging revealed a tumor cavity abdominal aortic aneurysm and left iliac arteriovenous fistula completely closed, then the heart failure symptoms of the patient was quickly relieved. The whole operation went smoothly, with a duration of about 120 min and intraoperative blood loss of about 100 mL. The patient was discharged from hospital on the 7th day after the operation. CTA and color doppler ultrasound were rechecked in 3 months after the operation, and the stent was found to have unobtrusional blood flow and no internal leakage, and the pseudoaneurysm of the left iliac artery disappeared.ConclusionsFor patients with refractory heart failure, if accompanied by lower limb swelling, the possibility of arteriovenous fistula of the great vessels should be taken into account, and the medical history and physical examination should be collected comprehensively, and necessary examinations should be carried out timely to avoid missed diagnosis or misdiagnosis. Meanwhile, compared with traditional surgery, EVAR is a more reliable, minimally invasive, and safe treatment for abdominal aortic aneurysm with iliac arteriovenous fistula.
【摘要】 目的 探讨外周血管动静脉瘘的超声特征及其鉴别诊断。 方法 回顾性分析2003年1月-2010年3月间收治的36例先天性及后天性动静脉瘘患者的临床资料，使用彩色超声诊断仪观察受累血管的内径、血管壁的连续性，根据血流动力学变化寻找瘘口；对受累血管血流频谱进行分析，并与健侧对照。 结果 18例先天性动静脉瘘查见纡曲扩张的血管网，无法辨认瘘口；18例后天性动静脉瘘全部可显示瘘口，2例合并静脉破裂的为囊瘤型，其余后天性动静脉瘘均为洞口型。受累动脉近心端血流为高速低阻型，全部患者受累静脉出现动脉样血流，近心端静脉呈高速低阻型频谱；10例患者远心端静脉内出现逆向离心血流。 结论 引流静脉出现高速、动脉样血流频谱是动静脉瘘的特征性表现；先天性动静脉瘘可见异常血管网，不能辨认瘘口；后天性动静脉瘘均可显示瘘口。彩色超声多普勒检查对动静脉瘘能够正确诊断及鉴别诊断。【Abstract】 Objective To observe characteristic imaging of arteriovenous fistulas (AVF) of periphery vessel, and to evaluate the differential diagnosis of AVF by ultrasonography. Methods Thirty-six patients suffering from congenital and acquired AVF in this hospital from January 2003 to March 2010 were selected to undergo Doppler ultrasonography. The blood flow of arteriovenous fistulas, diameter, morphology and blood flow characters of affected vessels were observed. Spectral of fistula and affected vessels were analyzed and compared with the healthy side. Results Deformed vascular net was observed, and the localization of arteriovenous fistulas was not observed directly in 18 congenital AVF patients.Inversely the localization of arteriovenous fistulas was observed directly in 18 acquired AVF patients.Two acquired AVF patients with venous rupture belonged to kystoma form, and others acquired AVF patients belonged to orifice form.Spectral analysis of proximal arteries of the fistula revealed high velocity and low resistance.Arterialized flow pattern was observed in affected veins.Proximal veins of the fistula revealed arterialized spectral with high velocity and low resistance.Reversed blood flow was observed in the distal veins of the fistulas in 10 patients. Conclusion Arterialized flow with high velocity in veins are characteristic signs of AVF.Deformed vascular net is observed, and the localization of arteriovenous fistulas in not observed directly in congenital AVF patients, but the localization of arteriovenous fistulas is observed directly in acquired AVF patients.Color Doppler ultrasonography has great value in confirming diagnosis and differential diagnosis of AVF.
目的 提高对创伤性假性动脉瘤并动静脉瘘的影像诊断水平。 方法 报告1例腰椎间盘手术所致的创伤性假性动脉瘤并动静脉瘘，比较分析MRA和DSA对该病的诊断价值。 结果 MRA能够明确创伤性假性动脉瘤及动静脉瘘的诊断，与DSA有良好的相关性。 结论 MRA对创伤性假性动脉瘤并动静脉瘘的确诊有重要价值，在一定程度上能够代替常规血管造影。