Background Vascular access （VA） dysfunction is a major clinical complication in the hemodialysis population and has a direct effect on dialysis outcome. This study was conducted to explore the role of microinflammat...Background Vascular access （VA） dysfunction is a major clinical complication in the hemodialysis population and has a direct effect on dialysis outcome. This study was conducted to explore the role of microinflammation in the VA dysfunction in maintenance hemodialysis patients. Methods Forty-seven patients （male 35 and female 12） receiving maintenance hemodialysis were included for this study. They were divided into three groups： group 1 （n=15）, patients with initial hemodialysis and new arteriovenous fistula （AVF）; group 2 （n=18）, patients treated with hemodialysis for long term with well-functional VA; group 3 （n=14）, maintenance hemodialysis patients with VA dysfunction. Biochemical parameters and serum tumor necrosis factor-α （TNF-α）, interleukin 6 （IL-6） and monocyte chemoattractant protein-1 （MCP-1） were determined. High-sensitivity C-reactive protein （hs-CRP） was determined by latex-enhanced immuno-nephelometric method. Tissues of radial artery were taken from group 1 and group 3 for the histological study. Expression of CD68 and MCP-1 in the radial artery was determined by immunohistochemistry. Results Serum hs-CRP in group 3 was significantly higher than those in group 1 and group 2 （（7.40±2.42） mg/L vs （4.21±1.62） mg/L and （5.04±3.65） mg/L, P 〈0.01 and P 〈0.05, respectively）. Serum TNF-α in group 3 was significantly higher than those in group 1 and group 2 （（64.03±9.29） pg/ml vs （54.69±12.39） pg/ml and （54.05±7.68） pg/ml, P 〈0.05 and P 〈0.01, respectively）. Serum IL-6 in group 3 was also significantly higher than those in group 1 and group 2 （（70.09±14.53） pg/ml vs （56.43±10.11） pg/ml and （60.77±9.70） pg/ml, P 〈0.01 and P 〈0.05, respectively）. Patients in group 3 had a thicker internal layer of vessels than in group 1 （（0.356±0.056） mm vs （0.111±0.021） mm, P 〈0.01）. Expression of CD68 and MCP-1 in the fistula vessel walls in group 3 were much higher than those in group 1 （P展开更多
Obejctive To assess the value of noninvasive three dimensional computed tomographic angiography (3D CTA) in preoperative detection of intracranial arteriovenous malformations (AVMs) Methods A prospective eval...Obejctive To assess the value of noninvasive three dimensional computed tomographic angiography (3D CTA) in preoperative detection of intracranial arteriovenous malformations (AVMs) Methods A prospective evaluation at a single institute over a 2 year period included 23 patients suspected of intracranial AVMs All patients underwent 3D CTA and digital subtraction angiography (DSA) Results from both procedures were compared Results 3D CTA imaging provided excellent visualization of intracranial AVMs The false positive error and false negative error were zero in our sample The details of arterial supply (numerical measure, orientation, caliber and routing) and vascular nidus (size, morphosis and location) provided by 3D CTA images were the same as DSA and the details of venous drainage were an approximate match Additionally, 3D CTA can depict tridimensional anatomical information for AVMs and their relationship to adjacent structures, a function not possible with DSA This assisted the surgeons in making better surgical planning and reduced trauma As a non invasive course, there were no related complications in the course of 3D CTA processing Conclusions DSA is still regarded as the gold standard for intracranial AVMs detection The modality of 3D CTA is accurate, noninvasive, nearly risk free and low price; we could routinely use it instead of or as a supplement to DSA, in the preoperative detection of suspected intracranial AVMs and postoperative radiological follow up 3D CTA adds tridimensional aspect and assists the surgeon in a the more accurate therapeutic scheme Preliminary data suggest that 3D CTA is playing a favorable role in the assessment of patients with intracranial AVMs展开更多
Background：Nontraumatic spontaneous subarachnoid hemorrhage （SAH） is associated with a high mortality.This study was conducted to investigate the epidemiological features of nontraumatic spontaneous SAH in China.Me...Background：Nontraumatic spontaneous subarachnoid hemorrhage （SAH） is associated with a high mortality.This study was conducted to investigate the epidemiological features of nontraumatic spontaneous SAH in China.Methods：From January 2006 to December 2008,the clinical data of patients with nontraumatic SAH from 32 major neurosurgical centers of China were evaluated.Emergent digital subtraction angiography （DSA） was performed for the diagnosis of SAH sources in the acute stage of SAH （≤3 days）.The results and complications of emergent DSA were analyzed.Repeated DSA or computed tomography angiography （CTA） was suggested 2 weeks later if initial angiographic result was negative.Results：A total of 2562 patients were enrolled,including 81.4% of aneurysmal SAH and 18.6% of nonaneurysmal SAH.The total complication rate of emergent DSA was 3.9% without any mortality.Among the patients with aneurysmal SAH,321 cases （15.4%） had multiple aneurysms,and a total of 2435 aneurysms were detected.The aneurysms mostly originated from the anterior communicating artery （30.1%）,posterior commtmicating artery （28.7%）,and middle cerebral artery （15.9%）.Among the nonaneurysmal SAH cases,76.5% （n =365） had negative initial DSA,including 62 cases with peri-mesencephalic nonaneurysmal SAH （PNSAH）.Repeated DSA or CTA was performed in 252 patients with negative initial DSA,including 45 PNSAH cases.Among them,the repeated angiographic results remained negative in 45 PNSAH cases,but 28 （13.5%） intracranial aneurysms were detected in the remaining 207 cases.In addition,brain arteriovenous malformation （AVM,7.5%）,Moyamoya disease （7.3%）,stenosis or sclerosis of the cerebral artery （2.7%）,and dural arteriovenous fistula or carotid cavernous fistula （2.3%） were the major causes of nonaneurysmal SAH.Conclusions：DSA can be performed safely for pathological diagnosis in the acute stage of SAH.Ruptured intracranial aneurysms,AVM,and Moyamoya disease are the major causes of SAH detect展开更多
INTRODUCTIONIntervention therapy has become one of the maintherapies of hepatic cancer.Theintroduction of hepatic arterial perfusion andembolization has provided opportunities for asecondary operation on patients with...INTRODUCTIONIntervention therapy has become one of the maintherapies of hepatic cancer.Theintroduction of hepatic arterial perfusion andembolization has provided opportunities for asecondary operation on patients with intermediateand advanced cancer,thus展开更多
Autogenous arteriovenous fistula(AVF)is a lifeline for maintenance hemodialysis patients.In 2006,the vascular access guidelines issued by the Kidney Disease Outcomes Quality Initiative(KDOQI)introduced the concept of...Autogenous arteriovenous fistula(AVF)is a lifeline for maintenance hemodialysis patients.In 2006,the vascular access guidelines issued by the Kidney Disease Outcomes Quality Initiative(KDOQI)introduced the concept of“Fistula first”.1 In 2019,the same organization updated these vascular access guidelines and proposed the concept of“Patient first”,2 sparking a wide range of controversy and discussion on whether to abandon the“Fistula first”principle.Given this context,experts from across China mainland conducted a comprehensive and systematic evaluation of the relevant literature,evidence-based medical guidelines,and international guidelines.展开更多
Background The major consequence of pulmonary arteriovenous malformations （PAVMs） is the direct inflow of blood from the pulmonary artery to the pulmonary vein which induces hypoxemia. Severe complications include t...Background The major consequence of pulmonary arteriovenous malformations （PAVMs） is the direct inflow of blood from the pulmonary artery to the pulmonary vein which induces hypoxemia. Severe complications include transient ischemic attacks, paradoxical embolization in the central nervous system, massive hemoptysis or hemothorax, etc. The conventional treatment is surgical intervention. However, this can be very traumatic and dangerous. Endovascular embolization has advantages over surgery such as a faithful therapeutic effect, a low complication rate, repeatability, etc. Methods Patients （n=-23） with symptomatic PAVMs underwent endovascular embolization; 11 were males and 12 were females, with ages ranging from 6 months to 58 years. During the embolization, microcoils were applied in 6 cases and standard steel coils were used in 17 cases. Results Multiple PAVMs lesions were found in 16 cases and single PAVMs lesion was found in 7 cases. Embolotherapy was carried out 28 times for 23 patients. The success rate was 100%. The results of pulmonary arteriography after treatment showed that single lesion disappeared completely while the main abnormal vessels in multiple lesions also disappeared. The mean blood oxygen saturation increased from （78.04＋8.22）% to （95.13＋3.67）% after the procedure. A correlated groups t test showed changes in blood oxygen saturation before and after embolization （t=9.101, P 〈0.001）. Symptoms of cardiac insufficiency disappeared in 5 cases and vascular murmur in the chest disappeared in 13 cases. After embolization, mild chest pain occurred in 11 cases, small amounts of pleural effusion occurred in 5 cases, and 1 patient died 2 months later because of a pyogenic infection secondary to the pulmonary infarction. Among the 22 remaining cases, with overall follow-up ranging from 18 months to 12 years, general conditions were fine, daily lives were normal and there were no neurologic symptoms or signs, except for 3 patients with diffused PAVMs who had persistent blood ox展开更多
Background Treatment of cavernous dural arteriovenous fistulas （DAVF） is usually made by a transarterial approach. However, in many complicated patients, treatments via transarterial approaches can not be achieved, ...Background Treatment of cavernous dural arteriovenous fistulas （DAVF） is usually made by a transarterial approach. However, in many complicated patients, treatments via transarterial approaches can not be achieved, and only an operation via a transvenous approach is feasible. We aimed to study the feasibility of transarterial embolization of cavernous dural arteriovenous fistulas with a combination detachable coils and Onyx to embolize a complicated cavernous DAVF via a transvenous approach. Methods From August 2006 to August 2007, six cases of complicated cavernous DAVF were embolized with a combination of detachable coils and Onyx via a transvenous approach. Three cases were male and the other three were female. Their ages ranged from 36 to 69 years old. The fistula was in the right lateral cavernous sinus in one case, in the left lateral cavernous sinus in another, and in the bilateral cavernous sinus in 4 cases. One fistula was fed by the right internal carotid artery and its meningohypophyseal trunk; one was fed by the branches of the left internal carotid artery and left external carotid artery; four were fed by the branches of the bilateral internal carotid artery and/or the bilateral external carotid artery. One case was drained via one lateral inferior petrosal sinus; three were drained via bilateral inferior petrosal sinuses; one was drained via one lateral ophthalmic and facial veins; one was drained via the inferior petrosal sinus and the ophthalmic and facial veins. Four were embolized via the inferior petrosal sinus, and two were embolized via the ophthalmic and facial veins. Results Among six cases of complicated cavernous DAVF, four were fully embolized with Onyx by a single operation, and two cases were fully embolized with Onyx following two operations. Transient headache was found after operation in all patients, but was cured after several days by the symptomatic treatments. In one case, the first operation via the inferior petrosal sinus was a failure; the feeding branches of the external展开更多
A male patient underwent conventional transcatheter chemoembolization for advanced recurrent hepatocellular carcinoma(HCC). Even after the injection of 7 m L of lipiodol followed by gelatin sponge particles, the flow ...A male patient underwent conventional transcatheter chemoembolization for advanced recurrent hepatocellular carcinoma(HCC). Even after the injection of 7 m L of lipiodol followed by gelatin sponge particles, the flow of feeding arteries did not slow down. A repeat angiography revealed a newly developed vascular lake draining into systemic veins; however, embolization was continued without taking noticing of the vascular lake. The patient's level of consciousness deteriorated immediately after the procedure, and non-contrast computed tomography revealed pulmonary and cerebral lipiodol embolisms. The patient's level of consciousness gradually improved after 8 wk in intensive care. In this case, a vascular lake emerged during chemoembolization and drained into systemic veins, offering a pathway carrying lipiodol to pulmonary vessels, the most likely cause of this serious complication. We should be aware that vascular lakes in HCC may drain into systemic veins and can cause intratumoral arteriovenous shunts.展开更多
BACKGROUND A hybrid operating room(hybrid-OR)is a surgical space that combines a conventional operating room with advanced medical imaging devices.AIM To explore and summarize the technical features and effectiveness ...BACKGROUND A hybrid operating room(hybrid-OR)is a surgical space that combines a conventional operating room with advanced medical imaging devices.AIM To explore and summarize the technical features and effectiveness of the application of a hybrid-OR in dealing with spinal dural arteriovenous fistulas(SDAVFs).METHODS Eleven patients with SDAVFs were treated with the use of a hybrid-OR at the Department of Neurosurgery of our hospital between January 2015 and December 2018.The dual-marker localization technique was used in the hybrid-OR to locate the SDAVFs and skin incision,and the interoperative digital subtraction angiography(DSA)technique was used before and after microsurgical ligation of the fistulae in the hybrid-OR to verify the accuracy of obliteration.The patients were followed for an average of 2 years after the operation,and the preoperative American Spinal Cord Injury Association(ASIA)score and postoperative ASIA score at 6 mo after the operation were compared.RESULTS The location and skin incision of the SDAVFs were accurately obtained by using the dual-marker localization technique in the hybrid-OR in all patients,and there were no cases that required expansion of the range of the bone window in order to expose the lesions.Intraoperative error obliteration occurred and was identified in two patients by using the intraoperative DSA technique;therefore,the findings provided by the intraoperative DSA system significantly changed the surgical procedure in these two patients.With the assistance of the hybrid-OR,the feeding artery was correctly ligated in all cases,and the intraoperative error obliteration rate decreased from 18.2%(2/11)to 0%.All 11 patients were followed for an average of 2 years.The ASIA score at 6 mo after the operation was significantly improved compared with the preoperative ASIA score,and there were no patients with late recurrence during the follow-up.CONCLUSION Compared with intra-arterial embolization for the treatment of SDAVFs,hybrid-ORs can solve the problem of a higher incide展开更多
Objective To investigate pre- and postoperative changes of regional cerebral cortical blood flow in patients with cerebral arteriovenous malformation. Method Twenty-two adult patients with arteriovenous malformatio...Objective To investigate pre- and postoperative changes of regional cerebral cortical blood flow in patients with cerebral arteriovenous malformation. Method Twenty-two adult patients with arteriovenous malformation(AVM) were recruited into this study at Beijing Tiantan Hospital from September 2001 to May 2002. Eight patients had giant cerebral AVM and the other 14 had a small one. Cortical cerebral blood flow (CBF) was measured by laser Doppler flowmetry (LDF) before and after AVM resections. After surgery,the probe of LDF was implanted adjacent to the area of AVM and monitored for 24 hours.Results CBF increased significantly after the resection in all patients regardless of AVM size. In patients with small AVM,CBF returned to the baseline level within 4 hours,but in patients with giant AVM,CBF remained high even after 24 hours.Conclusions Monitoring CBF is helpful to understand pre- and postoperative changes of regional cortical CBF in patients with cerebral AVM.展开更多
Background Usually, cavernous dural arteriovenous fistula can be treated via transarterial approaches. However, in many complicated patients, transvenous approaches are superior to the transarterial ones because of th...Background Usually, cavernous dural arteriovenous fistula can be treated via transarterial approaches. However, in many complicated patients, transvenous approaches are superior to the transarterial ones because of the difficulties during a transarterial operation. In this study, we retrospectively analyzed the outcomes of 28 patients with cavernous dural arteriovenous fistula treated by transvenous embolization. Methods From September 2001 to December 2005, 28 patients with 31 cavernous dural arteriovenous fistulae were treated with transvenous embolization in Beijing Tiantan Hospital. The involved cavernous sinuses were catheterized via the femoral vein-inferior petrosal sinus approach or the femoral-facial-superior ophthalmic vein approach, and embolized with coils （GDC, EDC, Matrix, Orbit or free coil） or coils plus silk. The patients were followed up for 3 to 26 months. Results All the 31 cavernous sinuses in the 28 patients were successfully embolized. Complete angiographic obliteration of the fistulae was achieved immediately in 25 patients. Residual shunting was observed in the other 3, who had drainage through the pterygoid plexus （2 patients） or the inferior petrosal sinus （1） after the operation. Headache and vomiting were the most common symptoms after the embolization. In 3 patients, who achieved complete angiographic obliteration immediately, the left oculomotor nerve palsy remained unchanged after the operation. Transient abducens nerve palsy was encountered in 1. In 1 patient, the occular symptoms were improved after the operation, but recurred 4 days later, and then disappeared spontaneously after 5 days. During the follow-up, no patient had recurrence. Three months after the operation, angiography was performed on the 3 patients with residual shunting. Two of them had angiographic cure, the other had residual drainage through the pterygoid plexus. Conclusions Transvenous catheterization and embolization of the cavernous sinus is a safe and efficient way to treat complicated cavernous展开更多
The number of patients with chronic kidney disease re-quiring renal replacement therapy has increased world-wide. The most common replacement therapy is hemo-dialysis （HD）. Vascular access （VA） has a key role for ...The number of patients with chronic kidney disease re-quiring renal replacement therapy has increased world-wide. The most common replacement therapy is hemo-dialysis （HD）. Vascular access （VA） has a key role for successful treatment. Despite the advances that have taken place in the feld of the HD procedure, few things have changed with regards to VA in recent years. Ar-teriovenous fstula （AVF）, polytetrafuoroethylene graft and the cuffed double lumen silicone catheter are the most common used for VA. In the long term, a number of complications may present and more than one VA is needed during the HD life. The most common com-plications for all of VA types are thrombosis, bleeding and infection, the most common cause of morbidity in these patients. It has been estimated that VA dysfunc-tion is responsible for 20% of all hospitalizations. The annual cost of placing and looking after dialysis VA in the United States exceeds 1 billion dollars per year. A good functional access is also vital in order to deliver adequate HD therapy. It seems that the native AVF that Brescia and Cimino described in 1966 still remains the frst choice for VA. The native forearm AVFs have the longest survival and require the fewest interventions. For this reason, the forearm AVF is the frst choice, fol-lowed by the upper-arm AVF, the arteriovenous graft and the cuffed central venous catheter is the final choice. In conclusion, VA remains the most importantissue for patients on HD and despite the technical im-provements, a number of problems and complications have to be resolved.展开更多
As a non-atherosclerotic chronic cerebral vasculopathy, moyamoya disease is characterized by progressivesteno-occlusion of the arteries of the circle of Willis with a developed collateral vascular network mainly at th...As a non-atherosclerotic chronic cerebral vasculopathy, moyamoya disease is characterized by progressivesteno-occlusion of the arteries of the circle of Willis with a developed collateral vascular network mainly at the cerebral base. And it is named moyamoya disease because of a characteristic ＂puff-of-smoke＂ angiographic appearance. The steno-occlusive process is typically seen involving bilateral internal carotid arteries at their clinoid portion and/or the proximal portion of the anterior cerebral arteries （ACAs） and/or the middle cerebral arteries （MCAs）. The coexistence of moyamoya disease and arteriovenous malformation （AVM） is thought to be very rare.展开更多
Background In the past 5 years, new treatment materials and techniques offering a different concept in endovascular treatment have been described for cerebral arteriovenous malformations （CAVMs）. The aim of this stu...Background In the past 5 years, new treatment materials and techniques offering a different concept in endovascular treatment have been described for cerebral arteriovenous malformations （CAVMs）. The aim of this study was to assess the endovascular treatment of CAVMs by using a liquid embolic material, Onyx （ Micro Therapeutics. Inc. , Irvine, CA, USA）. Methods From September 2003 to September 2004, Onyx was used to treat 22 patients with CAVMs. Ten AVMS were located in functional areas, 8 in deep cerebral areas, and 4 in the cerebellar hemisphere. The size of CAVMs was about 3 cm in diameter in 5 patients, 3 -6 cm in 11, and more than 6 cm in 6. Results In the 22 patients, Onyx embolization was successful. Nidus occlusion was complete in 3 patients, 〉 90% in 8, 〉 80% and 〈 90% in 6, and 〉 50% and 〈 80% in 5. Complications included transient neurological deficits in 2 patients, and adherence of microcatheter to the site of injection in 2. Conclusions Being non-adhesiveness, Onyx is a safe and satisfactory embolic material in the treatment of CAVMs. But its long-term efficacy awaits further follow-up.展开更多
[Objective] To explore the effect of clinical care pathways in perioperative patients with autologous arteriovenous fistula balloon expansion. [Method] 202 patients undergoing autologous arteriovenous fistula from Jul...[Objective] To explore the effect of clinical care pathways in perioperative patients with autologous arteriovenous fistula balloon expansion. [Method] 202 patients undergoing autologous arteriovenous fistula from July 2021 to June 2022 were randomly divided into a control group (101 cases) and an observation group (101 cases) to compare the incidence rates of postoperative complications, hospitalization days, hospitalization expenses, knowledge of self-management of arteriovenous fistula and nursing satisfaction. [Results] In the observation group, the incidence of arteriovenous fistula was higher than that of the control group, and the hospitalization days and hospitalization costs were lower than that of the control group. The difference between the two groups was statistically significant (P < 0.05). [Conclusion] The application of the clinical nursing path to intervene in patients with autologous arteriovenous fistula balloon dilation can reduce the incidence of postoperative complications, shorten the hospital length of time, reduce hospitalization costs and improve patient satisfaction, which is clinical promotion significance.展开更多
文摘Background Vascular access （VA） dysfunction is a major clinical complication in the hemodialysis population and has a direct effect on dialysis outcome. This study was conducted to explore the role of microinflammation in the VA dysfunction in maintenance hemodialysis patients. Methods Forty-seven patients （male 35 and female 12） receiving maintenance hemodialysis were included for this study. They were divided into three groups： group 1 （n=15）, patients with initial hemodialysis and new arteriovenous fistula （AVF）; group 2 （n=18）, patients treated with hemodialysis for long term with well-functional VA; group 3 （n=14）, maintenance hemodialysis patients with VA dysfunction. Biochemical parameters and serum tumor necrosis factor-α （TNF-α）, interleukin 6 （IL-6） and monocyte chemoattractant protein-1 （MCP-1） were determined. High-sensitivity C-reactive protein （hs-CRP） was determined by latex-enhanced immuno-nephelometric method. Tissues of radial artery were taken from group 1 and group 3 for the histological study. Expression of CD68 and MCP-1 in the radial artery was determined by immunohistochemistry. Results Serum hs-CRP in group 3 was significantly higher than those in group 1 and group 2 （（7.40±2.42） mg/L vs （4.21±1.62） mg/L and （5.04±3.65） mg/L, P 〈0.01 and P 〈0.05, respectively）. Serum TNF-α in group 3 was significantly higher than those in group 1 and group 2 （（64.03±9.29） pg/ml vs （54.69±12.39） pg/ml and （54.05±7.68） pg/ml, P 〈0.05 and P 〈0.01, respectively）. Serum IL-6 in group 3 was also significantly higher than those in group 1 and group 2 （（70.09±14.53） pg/ml vs （56.43±10.11） pg/ml and （60.77±9.70） pg/ml, P 〈0.01 and P 〈0.05, respectively）. Patients in group 3 had a thicker internal layer of vessels than in group 1 （（0.356±0.056） mm vs （0.111±0.021） mm, P 〈0.01）. Expression of CD68 and MCP-1 in the fistula vessel walls in group 3 were much higher than those in group 1 （P
文摘Obejctive To assess the value of noninvasive three dimensional computed tomographic angiography (3D CTA) in preoperative detection of intracranial arteriovenous malformations (AVMs) Methods A prospective evaluation at a single institute over a 2 year period included 23 patients suspected of intracranial AVMs All patients underwent 3D CTA and digital subtraction angiography (DSA) Results from both procedures were compared Results 3D CTA imaging provided excellent visualization of intracranial AVMs The false positive error and false negative error were zero in our sample The details of arterial supply (numerical measure, orientation, caliber and routing) and vascular nidus (size, morphosis and location) provided by 3D CTA images were the same as DSA and the details of venous drainage were an approximate match Additionally, 3D CTA can depict tridimensional anatomical information for AVMs and their relationship to adjacent structures, a function not possible with DSA This assisted the surgeons in making better surgical planning and reduced trauma As a non invasive course, there were no related complications in the course of 3D CTA processing Conclusions DSA is still regarded as the gold standard for intracranial AVMs detection The modality of 3D CTA is accurate, noninvasive, nearly risk free and low price; we could routinely use it instead of or as a supplement to DSA, in the preoperative detection of suspected intracranial AVMs and postoperative radiological follow up 3D CTA adds tridimensional aspect and assists the surgeon in a the more accurate therapeutic scheme Preliminary data suggest that 3D CTA is playing a favorable role in the assessment of patients with intracranial AVMs
文摘Background：Nontraumatic spontaneous subarachnoid hemorrhage （SAH） is associated with a high mortality.This study was conducted to investigate the epidemiological features of nontraumatic spontaneous SAH in China.Methods：From January 2006 to December 2008,the clinical data of patients with nontraumatic SAH from 32 major neurosurgical centers of China were evaluated.Emergent digital subtraction angiography （DSA） was performed for the diagnosis of SAH sources in the acute stage of SAH （≤3 days）.The results and complications of emergent DSA were analyzed.Repeated DSA or computed tomography angiography （CTA） was suggested 2 weeks later if initial angiographic result was negative.Results：A total of 2562 patients were enrolled,including 81.4% of aneurysmal SAH and 18.6% of nonaneurysmal SAH.The total complication rate of emergent DSA was 3.9% without any mortality.Among the patients with aneurysmal SAH,321 cases （15.4%） had multiple aneurysms,and a total of 2435 aneurysms were detected.The aneurysms mostly originated from the anterior communicating artery （30.1%）,posterior commtmicating artery （28.7%）,and middle cerebral artery （15.9%）.Among the nonaneurysmal SAH cases,76.5% （n =365） had negative initial DSA,including 62 cases with peri-mesencephalic nonaneurysmal SAH （PNSAH）.Repeated DSA or CTA was performed in 252 patients with negative initial DSA,including 45 PNSAH cases.Among them,the repeated angiographic results remained negative in 45 PNSAH cases,but 28 （13.5%） intracranial aneurysms were detected in the remaining 207 cases.In addition,brain arteriovenous malformation （AVM,7.5%）,Moyamoya disease （7.3%）,stenosis or sclerosis of the cerebral artery （2.7%）,and dural arteriovenous fistula or carotid cavernous fistula （2.3%） were the major causes of nonaneurysmal SAH.Conclusions：DSA can be performed safely for pathological diagnosis in the acute stage of SAH.Ruptured intracranial aneurysms,AVM,and Moyamoya disease are the major causes of SAH detect
文摘INTRODUCTIONIntervention therapy has become one of the maintherapies of hepatic cancer.Theintroduction of hepatic arterial perfusion andembolization has provided opportunities for asecondary operation on patients with intermediateand advanced cancer,thus
文摘Autogenous arteriovenous fistula(AVF)is a lifeline for maintenance hemodialysis patients.In 2006,the vascular access guidelines issued by the Kidney Disease Outcomes Quality Initiative(KDOQI)introduced the concept of“Fistula first”.1 In 2019,the same organization updated these vascular access guidelines and proposed the concept of“Patient first”,2 sparking a wide range of controversy and discussion on whether to abandon the“Fistula first”principle.Given this context,experts from across China mainland conducted a comprehensive and systematic evaluation of the relevant literature,evidence-based medical guidelines,and international guidelines.
文摘Background The major consequence of pulmonary arteriovenous malformations （PAVMs） is the direct inflow of blood from the pulmonary artery to the pulmonary vein which induces hypoxemia. Severe complications include transient ischemic attacks, paradoxical embolization in the central nervous system, massive hemoptysis or hemothorax, etc. The conventional treatment is surgical intervention. However, this can be very traumatic and dangerous. Endovascular embolization has advantages over surgery such as a faithful therapeutic effect, a low complication rate, repeatability, etc. Methods Patients （n=-23） with symptomatic PAVMs underwent endovascular embolization; 11 were males and 12 were females, with ages ranging from 6 months to 58 years. During the embolization, microcoils were applied in 6 cases and standard steel coils were used in 17 cases. Results Multiple PAVMs lesions were found in 16 cases and single PAVMs lesion was found in 7 cases. Embolotherapy was carried out 28 times for 23 patients. The success rate was 100%. The results of pulmonary arteriography after treatment showed that single lesion disappeared completely while the main abnormal vessels in multiple lesions also disappeared. The mean blood oxygen saturation increased from （78.04＋8.22）% to （95.13＋3.67）% after the procedure. A correlated groups t test showed changes in blood oxygen saturation before and after embolization （t=9.101, P 〈0.001）. Symptoms of cardiac insufficiency disappeared in 5 cases and vascular murmur in the chest disappeared in 13 cases. After embolization, mild chest pain occurred in 11 cases, small amounts of pleural effusion occurred in 5 cases, and 1 patient died 2 months later because of a pyogenic infection secondary to the pulmonary infarction. Among the 22 remaining cases, with overall follow-up ranging from 18 months to 12 years, general conditions were fine, daily lives were normal and there were no neurologic symptoms or signs, except for 3 patients with diffused PAVMs who had persistent blood ox
文摘Background Treatment of cavernous dural arteriovenous fistulas （DAVF） is usually made by a transarterial approach. However, in many complicated patients, treatments via transarterial approaches can not be achieved, and only an operation via a transvenous approach is feasible. We aimed to study the feasibility of transarterial embolization of cavernous dural arteriovenous fistulas with a combination detachable coils and Onyx to embolize a complicated cavernous DAVF via a transvenous approach. Methods From August 2006 to August 2007, six cases of complicated cavernous DAVF were embolized with a combination of detachable coils and Onyx via a transvenous approach. Three cases were male and the other three were female. Their ages ranged from 36 to 69 years old. The fistula was in the right lateral cavernous sinus in one case, in the left lateral cavernous sinus in another, and in the bilateral cavernous sinus in 4 cases. One fistula was fed by the right internal carotid artery and its meningohypophyseal trunk; one was fed by the branches of the left internal carotid artery and left external carotid artery; four were fed by the branches of the bilateral internal carotid artery and/or the bilateral external carotid artery. One case was drained via one lateral inferior petrosal sinus; three were drained via bilateral inferior petrosal sinuses; one was drained via one lateral ophthalmic and facial veins; one was drained via the inferior petrosal sinus and the ophthalmic and facial veins. Four were embolized via the inferior petrosal sinus, and two were embolized via the ophthalmic and facial veins. Results Among six cases of complicated cavernous DAVF, four were fully embolized with Onyx by a single operation, and two cases were fully embolized with Onyx following two operations. Transient headache was found after operation in all patients, but was cured after several days by the symptomatic treatments. In one case, the first operation via the inferior petrosal sinus was a failure; the feeding branches of the external
文摘A male patient underwent conventional transcatheter chemoembolization for advanced recurrent hepatocellular carcinoma(HCC). Even after the injection of 7 m L of lipiodol followed by gelatin sponge particles, the flow of feeding arteries did not slow down. A repeat angiography revealed a newly developed vascular lake draining into systemic veins; however, embolization was continued without taking noticing of the vascular lake. The patient's level of consciousness deteriorated immediately after the procedure, and non-contrast computed tomography revealed pulmonary and cerebral lipiodol embolisms. The patient's level of consciousness gradually improved after 8 wk in intensive care. In this case, a vascular lake emerged during chemoembolization and drained into systemic veins, offering a pathway carrying lipiodol to pulmonary vessels, the most likely cause of this serious complication. We should be aware that vascular lakes in HCC may drain into systemic veins and can cause intratumoral arteriovenous shunts.
基金the Tianjin Science and Technology Projects in Key Areas of Traditional Chinese Medicine,No.2018001.
文摘BACKGROUND A hybrid operating room(hybrid-OR)is a surgical space that combines a conventional operating room with advanced medical imaging devices.AIM To explore and summarize the technical features and effectiveness of the application of a hybrid-OR in dealing with spinal dural arteriovenous fistulas(SDAVFs).METHODS Eleven patients with SDAVFs were treated with the use of a hybrid-OR at the Department of Neurosurgery of our hospital between January 2015 and December 2018.The dual-marker localization technique was used in the hybrid-OR to locate the SDAVFs and skin incision,and the interoperative digital subtraction angiography(DSA)technique was used before and after microsurgical ligation of the fistulae in the hybrid-OR to verify the accuracy of obliteration.The patients were followed for an average of 2 years after the operation,and the preoperative American Spinal Cord Injury Association(ASIA)score and postoperative ASIA score at 6 mo after the operation were compared.RESULTS The location and skin incision of the SDAVFs were accurately obtained by using the dual-marker localization technique in the hybrid-OR in all patients,and there were no cases that required expansion of the range of the bone window in order to expose the lesions.Intraoperative error obliteration occurred and was identified in two patients by using the intraoperative DSA technique;therefore,the findings provided by the intraoperative DSA system significantly changed the surgical procedure in these two patients.With the assistance of the hybrid-OR,the feeding artery was correctly ligated in all cases,and the intraoperative error obliteration rate decreased from 18.2%(2/11)to 0%.All 11 patients were followed for an average of 2 years.The ASIA score at 6 mo after the operation was significantly improved compared with the preoperative ASIA score,and there were no patients with late recurrence during the follow-up.CONCLUSION Compared with intra-arterial embolization for the treatment of SDAVFs,hybrid-ORs can solve the problem of a higher incide
文摘Objective To investigate pre- and postoperative changes of regional cerebral cortical blood flow in patients with cerebral arteriovenous malformation. Method Twenty-two adult patients with arteriovenous malformation(AVM) were recruited into this study at Beijing Tiantan Hospital from September 2001 to May 2002. Eight patients had giant cerebral AVM and the other 14 had a small one. Cortical cerebral blood flow (CBF) was measured by laser Doppler flowmetry (LDF) before and after AVM resections. After surgery,the probe of LDF was implanted adjacent to the area of AVM and monitored for 24 hours.Results CBF increased significantly after the resection in all patients regardless of AVM size. In patients with small AVM,CBF returned to the baseline level within 4 hours,but in patients with giant AVM,CBF remained high even after 24 hours.Conclusions Monitoring CBF is helpful to understand pre- and postoperative changes of regional cortical CBF in patients with cerebral AVM.
文摘Background Usually, cavernous dural arteriovenous fistula can be treated via transarterial approaches. However, in many complicated patients, transvenous approaches are superior to the transarterial ones because of the difficulties during a transarterial operation. In this study, we retrospectively analyzed the outcomes of 28 patients with cavernous dural arteriovenous fistula treated by transvenous embolization. Methods From September 2001 to December 2005, 28 patients with 31 cavernous dural arteriovenous fistulae were treated with transvenous embolization in Beijing Tiantan Hospital. The involved cavernous sinuses were catheterized via the femoral vein-inferior petrosal sinus approach or the femoral-facial-superior ophthalmic vein approach, and embolized with coils （GDC, EDC, Matrix, Orbit or free coil） or coils plus silk. The patients were followed up for 3 to 26 months. Results All the 31 cavernous sinuses in the 28 patients were successfully embolized. Complete angiographic obliteration of the fistulae was achieved immediately in 25 patients. Residual shunting was observed in the other 3, who had drainage through the pterygoid plexus （2 patients） or the inferior petrosal sinus （1） after the operation. Headache and vomiting were the most common symptoms after the embolization. In 3 patients, who achieved complete angiographic obliteration immediately, the left oculomotor nerve palsy remained unchanged after the operation. Transient abducens nerve palsy was encountered in 1. In 1 patient, the occular symptoms were improved after the operation, but recurred 4 days later, and then disappeared spontaneously after 5 days. During the follow-up, no patient had recurrence. Three months after the operation, angiography was performed on the 3 patients with residual shunting. Two of them had angiographic cure, the other had residual drainage through the pterygoid plexus. Conclusions Transvenous catheterization and embolization of the cavernous sinus is a safe and efficient way to treat complicated cavernous
文摘The number of patients with chronic kidney disease re-quiring renal replacement therapy has increased world-wide. The most common replacement therapy is hemo-dialysis （HD）. Vascular access （VA） has a key role for successful treatment. Despite the advances that have taken place in the feld of the HD procedure, few things have changed with regards to VA in recent years. Ar-teriovenous fstula （AVF）, polytetrafuoroethylene graft and the cuffed double lumen silicone catheter are the most common used for VA. In the long term, a number of complications may present and more than one VA is needed during the HD life. The most common com-plications for all of VA types are thrombosis, bleeding and infection, the most common cause of morbidity in these patients. It has been estimated that VA dysfunc-tion is responsible for 20% of all hospitalizations. The annual cost of placing and looking after dialysis VA in the United States exceeds 1 billion dollars per year. A good functional access is also vital in order to deliver adequate HD therapy. It seems that the native AVF that Brescia and Cimino described in 1966 still remains the frst choice for VA. The native forearm AVFs have the longest survival and require the fewest interventions. For this reason, the forearm AVF is the frst choice, fol-lowed by the upper-arm AVF, the arteriovenous graft and the cuffed central venous catheter is the final choice. In conclusion, VA remains the most importantissue for patients on HD and despite the technical im-provements, a number of problems and complications have to be resolved.
文摘As a non-atherosclerotic chronic cerebral vasculopathy, moyamoya disease is characterized by progressivesteno-occlusion of the arteries of the circle of Willis with a developed collateral vascular network mainly at the cerebral base. And it is named moyamoya disease because of a characteristic ＂puff-of-smoke＂ angiographic appearance. The steno-occlusive process is typically seen involving bilateral internal carotid arteries at their clinoid portion and/or the proximal portion of the anterior cerebral arteries （ACAs） and/or the middle cerebral arteries （MCAs）. The coexistence of moyamoya disease and arteriovenous malformation （AVM） is thought to be very rare.
文摘Background In the past 5 years, new treatment materials and techniques offering a different concept in endovascular treatment have been described for cerebral arteriovenous malformations （CAVMs）. The aim of this study was to assess the endovascular treatment of CAVMs by using a liquid embolic material, Onyx （ Micro Therapeutics. Inc. , Irvine, CA, USA）. Methods From September 2003 to September 2004, Onyx was used to treat 22 patients with CAVMs. Ten AVMS were located in functional areas, 8 in deep cerebral areas, and 4 in the cerebellar hemisphere. The size of CAVMs was about 3 cm in diameter in 5 patients, 3 -6 cm in 11, and more than 6 cm in 6. Results In the 22 patients, Onyx embolization was successful. Nidus occlusion was complete in 3 patients, 〉 90% in 8, 〉 80% and 〈 90% in 6, and 〉 50% and 〈 80% in 5. Complications included transient neurological deficits in 2 patients, and adherence of microcatheter to the site of injection in 2. Conclusions Being non-adhesiveness, Onyx is a safe and satisfactory embolic material in the treatment of CAVMs. But its long-term efficacy awaits further follow-up.
文摘[Objective] To explore the effect of clinical care pathways in perioperative patients with autologous arteriovenous fistula balloon expansion. [Method] 202 patients undergoing autologous arteriovenous fistula from July 2021 to June 2022 were randomly divided into a control group (101 cases) and an observation group (101 cases) to compare the incidence rates of postoperative complications, hospitalization days, hospitalization expenses, knowledge of self-management of arteriovenous fistula and nursing satisfaction. [Results] In the observation group, the incidence of arteriovenous fistula was higher than that of the control group, and the hospitalization days and hospitalization costs were lower than that of the control group. The difference between the two groups was statistically significant (P < 0.05). [Conclusion] The application of the clinical nursing path to intervene in patients with autologous arteriovenous fistula balloon dilation can reduce the incidence of postoperative complications, shorten the hospital length of time, reduce hospitalization costs and improve patient satisfaction, which is clinical promotion significance.
