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Objective:To evaluate the efficacy and safety in the treatment of the visceral artery aneurysms (VAAs) by Viabahn stent graft and the detachable coils combined with Onyx embolization.Methods:A retrospective study on clinical and follow up results of 46 patients in the treatment of visceral aneurysms (VAAs) from Jun 2012 to Jun 2018 was carried out.Result:In 18 patients of VAAs treated with Vabahn endovascular stent grafting, the aneurysm cavity was completely isolated after injection of contrast and the technical success rate was 100% (18/18). In 28 patients of VAAs treated with the detachable coils combined with Onyx embolization, the aneurysm cavities of 26 patients among the 28 cases were filled tightly. In 2 patients the aneurysm neck was still visible. The average follow-up period was (36.5±2.3) months by CTA. After treating VAAs with the Viabahn stent graft, the complete isolation rate and the patency of aneurysm bearing artery were respectively 100% (18/18) and 94.4% (17/18). When VAAs was treated with the detachable coils combined with Onyx embolization, the complete isolation rate and the patency of aneurysm bearing artery were respectively 85.7% (24/28) and 92.9% (26/28) (χ 2=3.915, P=0.048), the difference of the patency of aneurysm bearing artery between the two groups was no significant difference (χ 2=0.074, P=0.786). Conclusion:VAAs treated with Viabahn endovascular stent grafting or detachable coils combined with Onyx embolization are both safe and effective.
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Objective To assess the feasibility and effectiveness of percutaneous transluminal angioplasty (PTA)for the salvage of immature arteriovenous fistula (AVF) and to identify the incidence of arterial and venous puncture site spasm.Methods The medical records and radiological data of 88 patients with 112 interventional procedures for immature AVFs were retrospectively reviewed.Results The stenosis lesions were (2.0 ± 1.4) cm long.Technical success rate and clinical success rate were 80.4％ (78/97) and 92.8％ (90/97) for PTA via brachial artery,85.7％ (6/7) and 100％ (7/7) for PTA via vein,25％ (2/8) and 50％ (4/8) for PTA via both brachial artery and vein,respectively.Spasm of pure arterial PTA occurred in 2 patients (2.1％) and was mild and moderate.Spasm of pure venous PTA occurred in 2 patients (28.6％) and was both moderate.Spasm of combined arterial and venous PTA occurred in 3 patients (37.5％) and from being severe to completely occluded.By comparison,there were statistical differences of technical and clinical success rate (P =0.000,0.019 ; P =0.000,0.029),fistulas spasm rate was statistically significant different (P =0.000).Conclusions Endovascular therapy was effective in restoring the dysfunctional native AVFs,it was safer and more effective and with less sideeffects especially in selecting coronary balloon to treat patients without large phlebangioma and round fistulas.
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Objective To summarize the experience of the nursing care of indwelling catheter thrombolysis for acute thrombosis in the arteriovenous fistula in eight hemodialysis patients.Methods After breaking thrombus through indwelling catheter,both bolus injection and micro-pump continuous infusion of urokinase was employed in eight hemodialysis patients with acute thrombosis in the arteriovenous fistula.The necessary nursing measures were carried out to assist the whole therapeutic procedure.Results All the patients could well cooperate with the procedure of indwelling catheter thrombolysis and urokinase infusion.The reopening rate of the obstructed fistula was 100%.Conclusion Indwelling catheter thrombolysis with urokinase infusion is a simple,effective and safe treatment for acute thrombosis in the arteriovenous fistula in hemodialysis patients.In order to obtain optimal results,necessary nursing measures must be carried out.
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Objective To study the locations, types and causes of different pseudoaneurysms in order to find out the optimal individualized treatment for different pseudoaneurysms. Methods Different methods were applied in treating 21 patients with pseudoaneurysm, which were located at limb (n = 11 ), spleen (n =3), kidney (n = 2) , common lilac artery (n = 1), internal iliac artery (n = 1), gallbladder (n = 1) and penis (n = 1 ). Different managements were employed in treating these pseudoaneurysms. Temporary obstruction of blood circulation with balloon together with arterial anastomosis or direct incision neoplasty was performed in 9 cases with pseudoaneurysms at limb arteries close to the larger joints. Endovascular stent graft was used to isolate the trunk type of pseudoaneurysm in 4 cases, in 2 of them branch arterial embolism and stent graft endovascular exclusion were applied as they had common iliae artery trunk type of pseudoaneurysm at the opening of internal iliac artery. Gelfoam together with metallic coils embolization was employed in 6 cases with terminal type of pseudoaneurysms. Results After different treatments, tumor cavities disappeared in the 21 cases with pseudoaneurysms. Distal arterial pulse returned to normal and no nerve damage occurred in 11 cases with limb pseudoaneurysms. No internal hemorrhage was observed and distal blood circulation returned to normal after graft endovascular exclusion in 2 eases with pseudoaneurysms at spleen artery trunk and in 2 cases with pseudoaneurysms at iliac artery trunk. In 6 cases with terminal type of pseudoaneurysms,the tumor cavity disappeared, hemorrhage stopped and no ischemic necrosis of organ occurred. But one of them with multiple traumatic pseudoaneurysms located at the second grade branch died one week after embolism due to a serious pelvic trauma accompanied with serious infection. Conclusion Based on the locations, types and causes of pseudoaneurysms, different individualized treatment should be adopted in order to obtain optimal results with least damages.