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Objective To evaluate the clinical value of internal carotid artery occlusion in treatment of intractable epistaxis caused by carotid artery siphon traumatic lesions.Methods A total of 37 patients with intractable epistaxis caused by traumatic carotid artery siphon pseudoaneurysm or carotid cavernous fistula were retrospectively analyzed.All the patients underwent embolization from October 1998 to June 2010,including 34 men and 3 women with the age ranged from 25 to 65 years and a average of 40 years.Only lesions were occlued in 12 cases without involving the internal carotid artery,while occlusions of internal carotid artery were performed in the rest 25 cases.Results Thirty-six patients were cured without recurrent hemorrhage after embolization.Only 1 patient with carotid artery occlusion died 48 hours after operation.Conclusion For patients with carotid arterial intractable epistaxis,if the elimanation of the lesions is not applicable and the collateral circulation of Willis ring has a good compensation,the use of detachable balloon or coil occlusion of ipsilateral internal carotid artery is a quick and easy method to save patients' lives.
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Objective To explore the treatment and efficiency of high blood flow vascular malformations of oral maxillofacial region with super-selective arterial embolization. Methods 18 cases underwent angiography of the head and neck before treatment and then followed by super-selective catheterization with microcatheter to embolize the feeding vessels of the vascular malformations with PVA. 8 cases underwent surgical excision within 72 hours after the embolization and the other 10 cases passed through the arterial radical emboliztion treatment. Results Technical success ratio reached 100% with no complications causing skin necrosis or incorrect arterial embolization else where in the skull. All 8 cases undergone preoperative embolization showed obviously less bleeding, easier removal of the mass and reduction of operation time. 10 cases with radical arterial embolization manifested reduction of swelling and improvement of organ function within 1 to 24 months after the procedure. 5 patients were cured with only once operation, 4 cases with twice operation and 1 with the thrice. Conclusions Aterial embolization is a safe and effective method in the treatment of high blood flow vascular malformations of oral maxillofacial region.
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Objective To explore the feasibility and value of special carotid cavemous fistula(CCF). Metheds In 28 cases with traumatic history, cerebral angiographies were performed via percutaneous transfemoral route before endovascular embolization. Results Bilateral CCF in 6 cases,unilateral CCFs including mutileakage in 2 cases and small fistulae in 4 cases,CCF combined with fracture segment in 11 cases,traumatic aneurysms in 3 cases,NPPB after embolizationin 2 cases. The fistulas of 9 cases were occluded with patency of internal carotid artery(ICA),and ICA were occluded in 19cases.Conclusions Endovascular embolization of carotid cavernous fistula was safe and effective.This methed should be the first choice for the treatment.Different techniques of endovascular embolization should be undertaken for different CCF.
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Objective To investigate the hemorrhagic risk factors of cerebral arteriovenous malformations (AVM) on angioarchitecture. Methods 201 cases with AVM diagnosed by digtial subtraction angiography (DSA), including 60 cases by superselective DSA, were devided into two groups. The bleeding group consisted of 138 (68.66%) cases, with ages ranging from 7 to 60 years (average 26 years). The nonbleeding group had 63 (31.34%) cases, whose ages ranged from 11 to 68 years (average 37 years). 14 risk factors with 45 levels were studied by SAS Statistical package. Results The proportion of the total value of square of mean diameters was in partial distribution between the supplying arteries and drainage veins (∑D 2 A/∑D 2 v) in the two groups. Rank sum tests showed significant difference ( P
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Objective To study the technical feasibility and embolic effect of embolism with the national ethylene-vinyl alcohol copolymer(EVAL)embolic mixture in an animal model.Methods 6 swines,25~30 kg,no matter male or female were used in this study.Superselective catheterization of ascending pharyngeal artery or rete mirable(RMB) was performed under general anaesthesia,then EVAL embolic mixture was injected to make the vascular embolism until satisfaction under fluoroscopy.The swines after embolism were followed-up 1 day,1 week,4 weeks,8 weeks,12 weeks,24 weeks and DSA,histopathological examination were respectively done.Results The embolic programes were successful in all animals,but one because of over reflux,and the embolic blood vessels could not be showed on angiography.In gross pathology,black embolic EVAL inside the vessels could be seen,which were firm and easily dissected.In histopathology,in the acute phase,all of vessel walls were destroyed in different degree,there were many neutrophils and eosinophils around the EVAL embolic mixtures and out of the vessels,and a lot of red cells could be seen,in subacute and chronic phase,mild to moderate mixed inflammatory infiltrates with histoleucocytes and large foreign-body giant cells were seen in occluded vessels.Conclusion The national EVAL embolic mixture is a suitable and easy control vascular embolic material.
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The author described anatomical basis of areriovenous malformation model construction in swine with methods,applications and the existence of deficiency.
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Hereditary haemorrhagic telangiectasia(HHT) is a genetic autosomal-dominant disorder characterized by the presence of epistaxis,vascular telangiectasis in mucosal and cutaneous tissues,with visceral lesions and family history. However,many specialists or radiologists are still in lack of appreciation concerning the full range of consequences in diagnosis and their family relationship resulting the poor recognition of the disease. Understanding the diagnostic imaging and therapeutic measure for HHT will be critical,because of the continuous growth and risk existance of these arteriovenous malformations arousing early diagnosis,proper treatment,adequate follow-up and screening of the family.
