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Objective:To investigate the diagnostic value of bronchial arteriography CT (BA-ACT) combined with bronchoscopy (BS) in bronchial Dieulafoy′s disease (BDD), and the role of bronchial artery embolization (BAE) in the treatment of BDD.Methods:Retrospective analysis was made on the clinical data of 5 patients suspected of being BDD treated by BS in Guangzhou First People′s Hospital or Guangzhou Thoracic Hospital from January 2008 to January 2018 due to hemoptysis. Bronchial arteriography (BAG) and BA-ACT were performed during the operation of interventional embolization. BAG rotary acquisition data were post-processed according to BS findings, and BA-ACT reconstruction images of the diseased bronchi and bronchial arteries were obtained. BS reexamination and clinical follow-up observation were carried out after embolization to analyze the effect of embolization.Results:There were one BDD lesion for the five patients respectively, and the BAG lacked characteristic manifestations. Bronchoscopy revealed BDD foci to present as papillary (case 1-case 3), nodular (case 4), or lirellate (case 5) subbronchial submucosal protrusion lesions. On the BA-ACT reconstruction plot, the BDD lesions of papillary, nodular and carination manifested correspondingly as a bronchial artery branches locally " pointed arch" shaped (cases 1-case 4) or " bead-like" (case 5) fold and protruding toward the bronchial lumen. The BDD lesions of the cases 1-case 4 retraction and disappearance after one BAE were observed by BS examination, and no hemoptysis recurrence during the follow-up period (54-91 months). The ridge like BDD lesion of the case 5 remained unchanged after BAE, and hemoptysis recurred at 71 months after the first BAE; the uncollapsed foci were supplied by two collateral vessels that confirmed by second BAG and BA-ACT, and no hemoptysis for 71 months followed up after second BAE.Conclusions:BA-ACT combined with BS enables a locative and qualitative diagnosis of BDD, and BAE is a very effective treatment method for BDD.
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Objective:To investigate the clinical characteristics of cerebral hemorrhage caused by tentorial dural arteriovenous fistula (TDAVF).Methods:An unusual TDAVF case admitted to the Department of Neurology, Qilu Hospital, Shandong University in March 2020, complicated with hypertension with successive bilateral basal ganglia hemorrhage in short term was reported. The characteristics of cerebral hemorrhage caused by TDAVF reported in the literature were summarized and analyzed.Results:Digital subtraction angiography (DSA) revealed that there was arteriovenous fistula in the tentorial foramen area of this patient (male, 33 years old), and the TDAVF was fed by the right meningohypophyseal trunk, bilateral middle meningeal artery and posterior cerebral artery. A shunted pouch was present in the tentorial foramen area, and retrograde reflux drainage was seen in the deep venous system, from the meningeal vein to superior sagittal sinus or sigmoid sinus. Transarterial embolization was performed and subsequently DSA showed obliteration of the fistula. This patient experienced no clinical decline or rehemorrhage during the 12 months follow-up period. Forty-one cases of TDAVF with hemorrhage of cerebral parenchyma which were reported before March 30, 2021 with detailed clinical and imaging data were summarized. The average age of onset of this group of patients was 57.2 years, and the ratio of male to female was about 3∶1. The hemorrhage was located in superior of the tentorium in 17 cases (41%), while in inferior of the tentorium in 24 cases (59%). Supratentorial intracerebral hemorrhage mainly occurred in occipital lobe and thalamus. DSA showed that the arteriovenous fistula was classified as Borden type Ⅲ or Cognard type Ⅳ in 36 cases (88%). Twenty-nine patients (71%) underwent a single surgical procedure, while 12 cases (29%) underwent combined surgical or other treatments. Overall, 37 patients (90%) achieved angiographically documented obliteration of the fistula and 39 patients (95%) experienced good or excellent outcomes.Conclusions:TDAVF often presents as cerebral parenchymal hemorrhage which is common in supratentorial region, but rare in basal ganglia region. The cause of cerebral hemorrhage in patients with hypertension may not be attributed to hypertension. Early diagnosis and intervention are of great significance to improve the prognosis of patients.
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Objective:To evaluate the application value of three-dimension digital subtraction angiography (3D-DSA) in the diagnosis and treatment of iliac vein compression syndrome (IVCS).Methods:A retrospective analysis was made on 171 patients with a tentative diagnosis of IVCS based on signs, symptoms, and finding of CTV or MRV, and iliac vein angiography. The diagnostic efficacy of MRV, 2D-DSA and 3D-DSA were analyzed. The imaging advantages of 3D-DSA in the diagnosis and treatment of IVCS were evaluated.Results:Ninty-three patients underwent MRV and 3D-DSA simultaneously, 101 patients had 2D-DSA and 3D-DSA simultaneously. 3D-DSA was taken as gold standard, the diagonotic sensitivity, specificity, Youden index of MRV was 75.61%, 72.73% and 0.48 respectively. The sensitivity, specificity, Youden index of 2D-DSA was 90.22%, 100% and 0.90 respectively. There are significant differences in the diagonotic sensitivity between MRV and 3D-DSA, 2D-DSA and 3D-DSA ( P<0.05). There is no significant difference in the diagonotic specificity between MRV and 3D-DSA, 2D-DSA and 3D-DSA ( P=1.000). In this study, we found that 3D-DSA has greater imaging evaluation advantages in preoperative evaluation, intraoperative guidance and immediate postoperative reexamination in the diagnosis and treatment of iliac vein disease. Conclusions:3D-DSA can improve the detection rate of IVCS, and has its advantage in imaging evaluation.
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Objective:To evaluate the safety, feasibility and efficacy of drug-coated balloon (DCB) in the treatment of in-stent restenosis (ISR) of the vertebrobasilar artery.Methods:Twenty-one patients with ISR of the vertebrobasilar artery treated with DCB at the Zhengzhou University People′s Hospital from January 2018 to December 2020 were retrospectively included. There were 22 lesions with ISR, of which 8 were located in the initial segments of vertebral artery, 12 were located in the V4 segment of the vertebral artery, and 2 were located in the basilar artery. The clinical prognosis was evaluated by modified Rankin Scale (mRS), and the target vessel restenosis was evaluated by DSA, CTA or MRA. The safety, feasibility and effectiveness of DCB in the treatment of vertebrobasilar artery ISR were analyzed by perioperative complications, technical success rate and follow-up.Results:All 21 patients with ISR underwent successful interventional surgery. No stroke, TIA and death occurred in perioperative period. During the operation, two cases (9.5%) were treated with Apollo stent due to the residual stenosis>50% after DCB dilation. The technical success rate was 90.5%. The mean stenosis of the target vessel was improved immediately from preoperative (78.1±11.3)% to postoperative (22.1±8.3)%. All the 21 patients were followed up. As of the last follow-up in September 2021, the median clinical follow-up period was 19 (12, 33.5) months, and there were no stroke, TIA and death caused by the corresponding artery. The mRS score was 0 in 18 patients 1 in 2 patients and 2 in 1 patient. Imaging follow-up was available in 13 cases (61.9%) with a median follow-up time of 7(5.5, 19) months, and the target vessel restenosis rate was 7.7% (1/13).Conclusions:This preliminary study has shown that DCB in the treatment of ISR of the vertebrobasilar artery is safe and feasible, with a high technical success rate and low restenosis rate, which provides clinical application evidence, but the long-term effect needs further follow-up observation.
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Objective:To investigate the efficacy of digital subtraction angiography combined with wire guidance versus gastroscopy in enteral nutrition catheterization in patients with special diseases of the upper gastrointestinal tract. Methods:We recruited 120 patients with special diseases of the upper gastrointestinal tract who underwent enteral nutrition catheterization in Yuyao People's Hospital from January 2016 to July 2020. These patients had gastric outlet obstruction ( n = 40), esophageal obstruction ( n = 39), tracheoesophageal fistula and mediastinal-esophageal fistula ( n = 26), or anastomotic fistula or anastomotic stenosis ( n = 15) after esophageal and gastric surgery. They were randomly allocated into the control and study groups ( n = 60/group). The control group was subject to enteral nutrition catheterization under the guidance of gastroscopy. The study group was subject to enteral nutrition catheterization using digital subtraction angiography combined with wire guidance. We compared the success rate of enteral nutrition catheterization, the time to successful enteral nutrition catheterization, changes in vital signs (such as heart rate, respiratory rate, mean arterial pressure, and blood oxygen saturation) after catheterization relative to before catheterization, and the incidence of adverse reactions between the two groups. Results:The success rate of enteral nutrition catheterization was significantly higher in the study group than in the control group (86.67% vs. 65.00%, χ2 = 7.68, P = 0.006). The time to successful enteral nutrition catheterization in the study group was significantly shorter than that in the control group [(28.61 ± 3.37) minutes vs. (39.75 ± 4.61) minutes, t = -8.92, P < 0.001]. During enteral nutrition catheterization, heart rate, respiratory rate, and mean arterial pressure in the control group were significantly increased compared with before enteral nutrition catheterization ( t = 5.07, 6.85, 4.96, all P < 0.001). During enteral nutrition catheterization, the heart rate and respiratory rate were significantly higher in the control group than in the study group ( t = 3.45, 3.29, both P < 0.001). After enteral nutrition catheterization, the incidence of adverse reactions was significantly lower in the study group than in the control group (13.33% vs. 33.33%, χ2 = 6.70, P = 0.010). Conclusion:Digital subtraction angiography combined with wire guidance can increase the success rate of enteral nutrition catheterization in patients with special diseases of the upper gastrointestinal tract, shorten the time to successful enteral nutrition catheterization, increase patient tolerance to catheterization, and reduce adverse reactions.
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OBJECTIVE@#To explore the methods and efficacy of unilateral extra-pedicle precision puncture percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty(PKP) by digital subtraction angiography (DSA) for the treatment of osteoporotic vertebral compression fractures (OVCFs).@*METHODS@#The clinical data of 68 patients with osteoporotic vertebral compression fractures treated from August 2015 to December 2018 were retrospectively analyzed. There were 20 males and 48 females, aged 56 to 90(73.5±8.0) years, 40 cases of double segments, 28 cases of three segments, a total of 168 vertebrae. All the patients were performed PVP orPKP through unilateral extra pedicle precision puncture under the guidance of DSA. The vertebrae were distributed in T@*RESULTS@#All the punctures were successful in 68 patients. All the puncture needles reached the midline of vertebral body, and the bone cement was well dispersed in the vertebral body with symmetrical distribution. The operation time was 35 to 60 (41.6±3.2) minutes, and there was no puncture complications. The injection volume of bone cement was 3 to 5 (3.6±0.5) ml in each vertebra. There were 8 cases of bone cement leakage, with a leakage rate of 11.76%. All 68 patients were followed up from 12 to 27 (14.3±3.5) months in the study. VAS score and ODI at 3 days after surgery and at final follow-up time were significantly improved (@*CONCLUSION@#PVP or PKP under the guidance of DSA via a unilateral extrapedicular approach with precision puncture can effectively relieve pain, restore vertebral body height and spinal function, which is a safe, fast and effective method in the treatment of osteoporotic vertebral compression fractures.
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Angiography, Digital Subtraction , Female , Fractures, Compression/surgery , Humans , Kyphoplasty , Male , Osteoporotic Fractures/surgery , Retrospective Studies , Spinal Fractures/surgery , VertebroplastyABSTRACT
Objective:To investigate the imaging manifestations and diagnostic significance of multislice spiral CT angiography for aortic intramural hematoma.Methods:Forty-three patients with aortic intramural hematoma who received digital subtraction angiography or multislice spiral CT angiography in Yiwu Central Hospital from November 2017 to September 2018 were included in this study. The misdiagnosis rate and image quality were compared between the two imaging examination methods.Results:The misdiagnosis rate of digital subtraction angiography was 6.98% (3/43) and that of multislice spiral CT angiography was 4.65% (2/43). There was no significant difference in the misdiagnosis rate between the two methods ( P > 0.05). The numbers of patients receiving multislice spiral CT angiography with grade III image quality ( n = 4) and grade IV image quality ( n = 2) were lower than those of patients receiving digital subtraction angiography ( χ2 = 3.957 and 4.074, both P < 0.05). There were no significant difference in the numbers of patients with grade I and II image quality between the two methods (both P > 0.05). Multislice spiral CT angiography showed that among 43 patients, 18 patients had non-ulcerative aortic wall hematoma, 25 patients had ulcerative aortic wall hematoma. Among patients with aortic wall hematoma, 14 patients had moderate or more amount of pleural effusion, with the average thickness of hematoma tissue of 11.42 mm, the maximum diameter of the involved ascending aorta of 56 mm, and the maximum diameter of the involved descending aorta of 44 mm. Conclusion:Multislice spiral CT angiography is superior to digital subtraction angiography in the diagnosis of aortic wall hematoma because it provides clearer images, which can help better present lesion changes.
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Objective:To analyze the clinical presentation, potential pathogenesis, diagnosis, management and prognosis of dural arteriovenous fistula (DAVF) manifesting as bithalamic lesions.Methods:The clinical data of three patients with DAVF manifesting as bithalamic lesions from the First Affiliated Hospital of Xi'an Jiaotong University between August 2019 and August 2020 were analyzed retrospectively, and related literatures were reviewed.Results:Patient 1, a 56-year-old female, presented with a one-month aggressive clinical course of weakness, somnolence, nausea, vomiting, urine incontinence and sitting instability. Patient 2, a 53-year-old male, presented with a one-month aggressive clinical course of disturbance of consciousness, walking with difficulty and decreased higher cortex function. Patient 3, a 68-year-old male, presented with an eight-day aggressive clinical course of memory loss, disturbance of consciousness and mental symptoms. In these three patients, cranial computed tomography (CT) scans showed bilateral hypodensity shadow in thalamus while magnetic resonance imaging (MRI) demonstrated bithalamic edema. Magnetic resonance angiography (MRA) or computed tomography angiography (CTA) presented venous or venous sinus closely related with arteries. Digital substraction angiography (DSA) of the patient 1 demonstrated bilateral occipital artery-straight sinus DAVF treated with surgical excision. Four months later, the patient was consciousness with modified Rankin scale (mRS) score of 5. DSA of the patient 2 demonstrated DAVF supplied by the right external carotid artery and the symptoms were relieved after endovascular embolization. One year after operation, there was no recurrence and mRS score was 2. DSA of the patient 3 demonstrated occipital sinusional area DAVF treated with surgical excision. More than one year after surgery, the patient was conscious with mRS score of 5.Conclusions:DAVF-induced bithalamic lesions is a rare disorder in which clinical presentations are not specific.When cranial CT or MRI demonstrating bithalamic lesions, MRA or CTA showing venous or venous sinus closely related with arteries or presenting with disturbance of consciousness or cognitive decline, DAVF should be considered. DSA is the gold standard for diagnosis of DAVF. Endovascular embolization and surgical excision are the main treatments of DAVF.
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Objective:To investigate the diagnostic value of contrast-enhanced ultrasonography (CEUS) in evaluating the severity of renal artery stenosis.Methods:Eighty six patients with suspected renal artery stenosis admitted to Shanxi Provincial People′s Hospital from January 2018 to July 2021 were enrolled in the study. All patients underwent digital subtraction angiography (DSA), Doppler ultrasonography (DUS) and CEUS examinations. With DSA results as gold standard the sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of CEUS and DUS in the diagnosis of renal artery stenosis were analyzed. The consistency between CEUS and DSA in the diagnosis of renal artery stenosis was evaluated. The accuracy of DUS and CEUS in diagnosis of renal artery stenosis was assessed by the area under receiver operating characteristic (ROC) curve (AUC) and compared between groups.Results:Among 153 renal arteries from 86 patients examined by DSA, 101 showed the stenosis ≥30% (49 left and 52 right renal arteries), and there were 31, 45, 20 and 5 renal arteries with grade I, II, III and IV stenosis. The sensitivity and specificity of DUS in the diagnosis of renal artery stenosis were 74.3% (75/101) and 76.9% (40/52),respectively. DUS showed 21, 42, 20 and 4 renal arteries with grade Ⅰ, Ⅱ, Ⅲ and Ⅳ stenosis, respectively. The sensitivity and specificity of CEUS in the diagnosis of renal artery stenosis were 88.1% (89/101) and 86.5%(45/52), respectively. CEUS showed 26, 43, 23 and 4 renal arteries with grade Ⅰ, Ⅱ, Ⅲ and Ⅳ stenosis, respectively. There was a significant difference between DUS and DSA in grading of renal artery stenosis (χ2=4.447, P=0.03),and there was a moderate consistency between DUS and DSA ( Kappa=0.480). There was no significant difference between CEUS and DSA in grading renal artery stenosis (χ2=0.842, P=0.36) with a good consistency ( Kappa=0.730). The AUC of CEUS in diagnosis of renal artery stenosis was higher than that of DUS [0.873 (95% CI: 0.808-0.938) vs. 0.756 (95% CI:0.673-0.839); Z=4.361, P<0.01]. Conclusion:The study suggests that contrast-enhanced ultrasonography may be used as a diagnostic method for grading renal artery stenosis.
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Objective: To explore the therapeutic effect of DSA-guided percutaneous radiological gastrostomy (PRG) in patients with esophageal cancer with dysphagia. Methods: Data of 194 patients with esophageal cancer with dysphagia were retrospectively analyzed. The patients were divided into PRG group (enteral nutrition support via DSA-guided PRG, n=80) and non-PRG group (nutritional support through oral feeding after esophageal stent insertion, n=114). Body mass index (BMI), the serum levels of albumin, prealbumin, hemoglobin before and 1 month after operation, and the incidence of adverse reactions were compared between 2 groups. Results: There was no significant difference of BMI, albumin, prealbumin nor hemoglobin between 2 groups preoperation (all P>0.05). Albumin, prealbumin and hemoglobin 1 month after operation were lower than those preoperation in both groups (all P<0.05),but in PRG group were significantly higher than those in non-PRG group (all P<0.05). During the follow-up period, the incidences of aspiration pneumonia and tracheoesophageal fistula in PRG group were significantly lower than in non-PRG group (both P<0.05). Conclusion: DSA-guided PRG can improve nutritional status and reduce the incidences of aspiration pneumonia and tracheoesophageal fistula in patients with esophageal cancer with dysphagia.
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Objective: To investigate the effect of DSA-guided transnasal ileus tube implantation for treatment of refractory adhesive ileus. Methods Totally 50 patients with refractory adhesive ileus were treated with transnasal ileus tube implantation under the guidance of DSA. The time of intubation, time of relieving abdominal pain and distention, the flow of negative pressure, the time of anal exhaust and defecation were counted. The length of tube entry was counted on the 3rd and 6th day after operation, and the position of tube head was observed with abdominal X-ray films. Results All 50 patients were successfully catheterized in one time, the average catheterization time was (22.57±6.93)min.The patients were well tolerated, no gastrointestinal bleeding nor perforation occurred. Forty-five patients (45/50, 90%) were relieved of abdominal pain and distention, and the average time was (9.64±8.33)h. The negative pressure drainage volume was (1 500±450)ml on the first day, (750±120)ml on the second day and (257±112)ml on the third day. On the third day after operation, the average length of the tube was (195.97±14.63)cm, and abdominal X-ray films showed that the head of the tube located in the distal jejunum (Group 3). On the sixth day after operation, the average length of the tube was (240.55±17.65)cm, and the head of the tube located in the distal ileum. The average time of anal exhaust was (2.80±1.01)d, and of defecation was (3.52±1.26)d. Conclusion: DSA-guided transnasal ileus tube implantation is effective for treatment of refractory adhesive ileus, which can significantly relieve clinical symptoms and restore the physiological function of intestinal tract.
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Objective: To evaluate the feasibility of color coding of DSA (CC-DSA) in assessment of hemodynamic changes before and after carotid artery stenting (CAS). Methods: Data of 16 patients with severe stenosis at the beginning of internal carotid artery who underwent CAS were analyzed retrospectively. DSA images before and after CAS were processed with CC-DSA software to get the corresponding color coded images. The points of interest (POI) were set up in common carotid artery, C1 segment of internal carotid artery, M1 segment of middle cerebral artery and transverse sinus, respectively, and the time to peak (TTP) as well as the relative time to peak (rTTP) of each POI were collected. Meanwhile, the peak systolic velocity (PSV) and end-diastolic velocity (EDV) of the anterior and posterior carotid artery stenosis segments and the distal end of the internal carotid artery C1 segment (normal lumen) were collected. Results: TTP and rTTP of C1 segment of internal carotid artery and M1 segment of middle cerebral artery after CAS were lower than those before CAS (all P0.05). Compared with those before CAS, PSV and EDV in carotid artery stenosis segment decreased, and PSV in the distal segment C1 of internal carotid artery increased after CAS (all P<0.05). The change value of TTP in C1 segment of internal carotid artery before and after CAS was positively correlated with the change values of PSV (rs=0.500, P=0.049) and EDV (rs=0.522, P=0.038) at the distal end. Conclusion: CC-DSA can quantitatively evaluate the hemodynamic changes before and after CAS in patients with internal carotid artery stenosis.
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Objective: To observe the effect of interventional embolization in treatment of benign prostatic hyperplasia (BPH) patients with common trunk of prostatic artery (PA) and dorsal penile artery. Methods: Data of 29 BPH patients with common trunk of PA and dorsal penis artery treated with interventional embolization were retrospectively analyzed. Results: Among 29 patients, superselective embolization of PA with small PVA particles (diameter 150-300 μm) was successfully performed in 12 cases. Postembolization angiography showed that the prostatic parenchyma staining disappeared, while the dorsal penis artery existed. Clinical symptoms were significantly improved in these 12 patients, and no penis-related complications occurred. However, microcatheter could not enter into PA in the rest 17 cases, among them conventional embolization with small PVA particles was performed in 2 cases, the symptoms such as dysuria were significantly improved after operation, but penile ischemia and necrosis occurred. Embolization with large PVA particles (350-560 μm in diameter) was performed in 3 cases, no complication of penile occurred after operation, but the improvement of symptoms was limited. The other 12 cases were embolized with small PVA particles after temporary ligation on the root of penis with rubber strips, the symptoms were obviously improved after operation, and no complication of penis ischemia nor necrosis occurred. Conclusion: Interventional embolization is effective for BPH patients with common trunk of prostate artery and dorsal penis artery. The details of embolization should be individually adjusted according to vascular anatomy and the possibility of superselection.
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Objective: To observe movement of catheter tip of chest wall access port implanted via the internal jugular vein and impact factors when changing from supine to vertical positions. Methods: Data of 171 patients underwent implantation of chest wall access port via the internal jugular vein and chest X-ray films on supine and vertical position postoperatively were retrospectively analyzed, and the distance from the tracheal protuberance to catheter tip was measured. Pearson correlation analysis and multivariate regression analysis were performed to observe the impact factors of moving distance of catheter tip. Results: Changing from supine to vertical position, the catheter tip was inclined to cephalad movement, and the mean moving distance was (15.82±16.87)mm. The distance of catheter tip movement was positively correlated with gender (P=0.039) and sebum thickness (P=0.011) and negatively correlated with indwelling length of catheter (P=0.039). Conclusion: The catheter tip of chest wall access port implanted via the internal jugular vein tends to shift cephalad when changing from supine to vertical position, and the distance of movement is related to patient's gender, sebaceous thickness and the length of indwelling catheter.
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Objective: To explore the feasibility of 3D DSA in guidance of uterine artery catheterization (UAE). Methods: A total of 20 patients, including symptomatic uterine leiomyoma (n=8), postpartum hemorrhage (n=5), scar pregnancy (n=3), adenomyosis (n=1) and advanced cervical cancer (n=3) underwent UAE guided by 3D DSA (3D group, n=10) or 2D DSA (2D group, n=10). The relevant clinical indexes of 2 groups were compared. Results: UAE was successfully performed in all 20 patients (40 uterine arteries).No blood supply from ovarian artery was found. The operation time, catheterization time and fluoroscopy time were both shorter, and the dosage of contrast agent and radiation doses were all lower in 3D group than those in 2D group (all P<0.05). Conclusion: 3D DSA can be used to guid UAE, with shorter operation time and lower radiation dose than traditional 2D DSA.
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Objective; To evaluate the effect of percutaneous mechanical aspiration thrombectomy (PMT) with AngioJet for treatment of acute deep venous thrombosis (DVT) after surgical operation. Methods: Data of 103 patients with acute lower extremity DVT after surgical operation who underwent AngioJet PMT were retrospectively analyzed. The affected-healthy side diameter differences of thigh and leg, as well as peripheral blood D-dimer levels were compared before and 7 days after AngioJet PMT. The clearance rate of thrombosis for each segment of lower limb veins was detected, the intraoperative and postoperative adverse reactions were counted. Results: Seven days after AngioJet PMT, both the affected-healthy side diameter difference of thigh and leg decreased, so did the peripheral blood D-dimer value (all P<0.05). Effective thrombosis clearance rate (grade Ⅱ, III) of iliac vein, femoral vein and popliteal vein was 97.37% (74/76), 98.06% (101/103) and 94.83% (55/58), respectively, while grade III clearance rate of the above segments was 77.63% (59/76), 70.87% (73/103) and 55.17% (32/58), respectively, of iliac vein and femoral vein were all higher than that of popliteal vein (both P<0.01). Transient arrhythmia occurred in 11 cases (11/103, 10. 68%) during thrombectomy, and returned to normal within 2 min after stopping thrombectomy. Hemorrhage at the puncture site occurred in 3 cases, while 38 cases were found with transient hemoglobinuria, 2 cases with transient creatinine elevation and 3 cases with limb pain. No new pulmonary embolism nor acute renal failure occurred. The filters were failed to be removed in 2 cases, while removed filters were found with obvious thrombi in 6 cases. Conclusion: Percutaneous mechanical aspiration thrombectomy with AngioJet was effective and safe for treatment of acute lower extremity DVT.
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Objective: To observe the clinical effect of transcatheter direct thrombolysis in treatment of acute upper extremity arterial embolism (AUEAE). Methods: Eighteen patients with AUEAE (18 limbs) were treated with transcatheter direct thrombolysis, and anticoagulation was performed regularly after operation. The treatment effect and complications were observed. Results: The technical successful rate of transcatheter direct thrombolysis was 100% (18/18). After thrombolytic therapy, the symptoms and signs improved, 15 patients (15/18, 83. 33%) were cured, 2 (2/18, 11.11%) became fine and 1 was generally accepted (1/18, 5.56%). The operation time of transcatheter direct thrombolysis was 36-84 (58.83±12.28)h. During the anticoagulation therapy, thrombocytopenia more than 50% occurred in 1 patient. After operation, puncture site hematoma and puncture site femoral artery pseudoaneurysm were observed in 3 cases and 1 case, respectively, and renal function decline occurred in 1 patient, all were alleviated or cured after corresponding treatment. Conclusion: The short-term efficacy and safety of transcatheter direct thrombolysis were both good for treating AUEAE.
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Objective To investigate the application of myelography including digital subtraction angiography myelogram (DSM) and computed tomography myelogram (CTM) in patients with spontaneous intracranial hypotension.Methods The myelography results including DSM and CTM of 10 patients with spontaneous intracranial hypotension form Guangzhou First People's Hospital between January 2013 and June 2018 were retrospectively analyzed.Some patients were treated with targeted epidural blood patch on the basis of myelography.Results Myelography (including DSM and CTM) showed cerebrospinal fluid leakages in all the 10 patients.There were one to 16 leak sites with an average of nine sites (totally 90 leak sites).Forty-two sites (47％) were located in cervical vertebra,19 sites (21％) in thoracic vertebra,22 sites (24％) in lumbar vertebra,and seven sites (8％) in sacral vertebra.On DSM and CTM,cerebrospinal fluid leakage was characterized by the diffusion of contrast agent along one side or the bilateral sides of nerve root,enlargement of the nerve sleeves and paraspinal collections of hyper-demity contrast medium.Two patients whose cerebrospinal fluid leakage occurred in long sections showed more cerebrospinal fluid leakage on CTM than on DSM.Two patients responded well to targeted epidural blood patch on the basis of myelography.The cerebrospinal fluid leakage was completely settled on myelography after the treatment of epidural blood patches.Conclusions Myelography has been shown to assist the diagnosis of spontaneous intracranial hypotension and accurately define the location and extent of cerebrospinal fluid leakages.Myelography can be used to guide targeted epidural blood patch and applied in the reexamination of cerebrospinal fluid leakages after treatment.More cerebrospinal fluid leakages are detected by CTM than by DSM.
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Objective To compare the effectiveness and safety of two different treatment methods for patients with polycystic liver disease using super selective hepatic arterial embolization. Methods This retrospective study enrolled 41 patients with polycystic liver disease treated from June 2008 to June 2016 in the First Medical Center of Chinese PLA General Hospital. The patients underwent transcatheter super-selective hepatic arterial embdization (TAE). There were 5 men and 36 women. The age ranged from 36 to 68 years. The patients were divided into the observation group (n=14) and the control group ( n=27). The observation group underwent treatment using an emulsion of iodized oil and bleomycin and N-butyl-2-cyanoacrylate. The control group underwent iodized oil and N-butyl-2-cyanoacrylate. The clinical symptoms, operative complications, volumes of intrahepatic cysts, hepatic parenchyma volumes of pre-TAE and post-TAE at 3, 6 months and every 6 monthly were compared. Results TAE was technically successful in all the patients. The follow-up periods ranged from 24 to 72 months. The clinical symptoms improved re-markably in the observation group at 3 month, 6 months, 12 months, and 24 months, being 92. 9% (13/14), 92. 9% (13/14), 92. 9% (13/14), 92. 3% (12/13), respectively. One patient was lost to follow-up 24 months after operation. The clinical symptoms improved remarkably in the control group at 3 month, 6 months, 12 months, and 24 months, being 88. 9% ( 24/27 ), 85. 2% (23/27), 84. 6% ( 22/26 ), 81. 8% (18/22), respectively. One patient was lost to follow-up 12 months after operation and five patients were lost to follow-up 24 months after operation. Compared with preoperative, the abdominal circumference of two groups had decreased, the total volume of intrahepatic cyst and liver decreased at 6 months, 12 months, and 24 months after surgery (P＜0. 05). Conclusions TAE was a safe and effective treatment for polycystic liver disease. Patients in the observation group had more effective treatment outcomes on follow-up.
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Objective To explore the guiding role of double volume reconstruction (DVRT) in interventional embolization of intracranial aneurysms. Methods Ninety?six cases of subarachnoid hemorrhage with 115 aneurysms underwent total cerebrovascular angiography and interventional endovascular embolization of intracranial aneurysms in our hospital from January 2017 to December 2017 were retrospectively analyzed. They were randomly divided into observation group (n=48) and control group (n=48) according to random number method. In the control group, guided by the results of 2D?DSA and 3D?DSA 3D reconstruction, the aneurysm neck and tumor were fully exposed with the optimal position. the responsible aneurysms were performed with the interventional endovascular embolization. The operators finished the embolization According to the size and shape of aneurysms and the operative experience. In the observation group, the operators could speculate the embolization density of aneurysms by using the data of 3D reconstruction and digital subtraction reconstruction and adjusted the surgical plan to make the aneurysms had been completely embolized. The baseline data, treatment status, adverse cerebrovascular reaction and recurrence rate of aneurysms were compared between the two groups. All patients in the two groups were operated by Deputy chief surgeons or above of the neurosurgery department. The comparison of the counting data were tested by χ2. The measured data conformed to normal distribution were tested by independent sample t. Results Statistically, There was no significant differences in baseline data including sex, age, blood glucose, blood pressure and cerebral atherosclerosis between the two groups (P>0.05). Comparing the responsible aneurysms in different positions and sizes, the differences was not statistically significant (P>0.05).There was no statistically significant differences in the dosage of contrast media and the cost of operation between the two groups (P>0.05). The radiation dose and operation time in the observation group were smaller and shorter than those in the control group, but there was no statistical differences between the two groups (P<0.05). Statistically, The incidence of rerupture of aneurysm and thrombosis in the observation group was significantly lower than that in the control group (P<0.05). and The incidence of cerebral infarction and the recurrence rate of aneurysm in the observation group were significantly lower than those in the control group (P<0.05). There was no significant difference in sex, age, blood glucose, blood pressure and cerebral atherosclerosis between the two groups (P>0.05).There was no significant difference in the location and size of responsible arterial tumors (χ2=0.148, P=0.929).There was no significant difference in the dosage of contrast agent and the cost of operation between the two groups (t=-0.769, 0.225; P>0.05). The radiation dose and operation time were (479.81 ± 51.21)mGy, (103.52 ± 10.18) minin the observation group and (511.95 ± 53.26)mGy, (114.60 ± 9.51)min in the control group. The difference was statistically significant (t=-1.376,-2.516; P<0.05).There were 1 case of rerupture of aneurysm in the observation group, 4 cases in the control group;There were 0 cases of thrombus, respectively, 3 cases in the control group. The difference was statistically significant (χ2=11.748, 4.256; P<0.05).There were 0 cases postoperative cerebral infarction occurred in the observation group, and aneurysm recurrence in 1 case. Four cases postoperative cerebral infarction occurred in the control group, and aneurysm recurrence in 3 cases, respectively. The difference was statistically significant (χ2=5.719, 10.811; P<0.05). Conclusions The clinical effect of interventional embolization of intracranial aneurysms under the guidance of double volume reconstruction is remarkable, and the effect of interventional embolization and the relationship with the peripheral vessels can be clearly demonstrated. It can reduce the incidence of adverse cerebral vascular reactions and the recurrence rate of aneurysms and reduce the intraoperative risk. It is worthy to be popularized in interventional embolization of intracranial aneurysms and follow?up after operation.