Hirota S, Sako M, Fujita Y, Hasegawa Y, Sugimoto K, Suzuki Y, Kono M
Department of Radiology, Kobe University School of Medicine.
Nihon Igaku Hoshasen Gakkai Zasshi. 1992 Jul 25;52(7):942-8.
We performed transcatheter embolization in two cases with huge pulmonary arteriovenous fistula (AVF) using a metallic "spider" and spring embolus. Conventional spring embolus or detachable balloon could not be used in these cases. Metallic spider was indicated for pulmonary AVF with a feeding artery diameter of more than 16 mm to prevent embolus passing through the AVF. In the first case, we used large handmade metallic spiders of 25 mm in diameter followed by embolization by numerous spring coils. At that time, a partial monorail technique was newly devised to carry the large metallic spider into the feeding artery, otherwise the spider could not pass into a 9F catheter. After embolization, symptoms and PaO2 in arterial blood improved remarkably in both cases. In the second case, a spring coil migrated into the normal pulmonary artery, but no infarction resulted. In conclusion, the metallic spider was very useful for embolization of hugee pulmonary AVF to avoid the embolus passing through and to tangle spring coils together with it. If commercially available "spiders" are too small, ones can be made easily.
我们使用金属“蜘蛛”和弹簧栓子对两例巨大肺动静脉瘘（AVF）患者进行了经导管栓塞治疗。在这些病例中无法使用传统的弹簧栓子或可脱性球囊。对于供血动脉直径超过16毫米的肺动静脉瘘，使用金属“蜘蛛”以防止栓子通过动静脉瘘。在第一例中，我们使用了直径为25毫米的大型手工制作金属“蜘蛛”，随后用大量弹簧圈进行栓塞。当时，新设计了一种部分单轨技术将大型金属“蜘蛛”送入供血动脉，否则“蜘蛛”无法通过9F导管。栓塞后，两例患者的症状和动脉血氧分压（PaO2）均有显著改善。在第二例中，一个弹簧圈迁移至正常肺动脉，但未导致梗死。总之，金属“蜘蛛”对于巨大肺动静脉瘘的栓塞非常有用，可避免栓子通过，并使其与弹簧圈缠绕在一起。如果市售的“蜘蛛”太小，可以很容易地自制。
