Schönholz Claudio, Krajcer Zvonimir, Carlos Parodi Juan, Mendaro Esteban, Hannegan Christopher, D'Agostino Horacio, Selby Bayne, Guimaraes Marcelo, Uflacker Renan
Heart and Vascular Center, Medical University of South Carolina, Charleston, SC, USA.
Vascular. 2006 May-Jun;14(3):123-9. doi: 10.2310/6670.2006.00034.
The purpose of this study was to assess the safety and efficacy of stent-graft placement in the management of arteriovenous fistulae (AVF) and pseudoaneurysms (PAs) involving the carotid artery (CA). Twenty-two patients (16 men, 6 women) with a CA AVF (n = 5) or PA (n = 17) owing to a gunshot or stab wound, carotid endarterectomy, blunt trauma, a tumor, spontaneous dissection, or a central venous catheter were treated with percutaneous placement of stent grafts. The patients presented with tumor, bruit, headache, mouth and tracheostomy bleeding, transitory hemiparesis, seizure, or stroke. Diagnoses were made by using computed tomographic angiography (CTA) and digital subtraction angiography. Fourteen lesions were in the common CA; eight were in the internal CA. Homemade devices and stent grafts from a variety of manufacturers were employed. Follow-up evaluations included clinical, CTA, and Doppler ultrasound assessments. All patients had resolution of the PA or AVF. In one patient with a large petrous PA, acute occlusion of the CA developed after placement of three balloon-expandable stent grafts, but there were no neurologic complications because the circle of Willis was functional. During follow-up ranging from 2 months to 13 years, asymptomatic 90% stenosis owing to stent compression was observed on Doppler ultrasound and angiographic examinations in a patient with an autologous vein-covered stent graft in the internal CA. Three other patients died of causes unrelated to stent-graft placement. In all other patients, the stent graft remained patent. Our results indicate that stent grafting is an acceptable alternative to surgery in the treatment of AVF and PAs in the CA.
本研究的目的是评估支架移植物置入术在治疗累及颈动脉（CA）的动静脉瘘（AVF）和假性动脉瘤（PA）中的安全性和有效性。22例患者（16例男性，6例女性）因枪伤或刺伤、颈动脉内膜切除术、钝性创伤、肿瘤、自发性夹层分离或中心静脉导管置入导致CA AVF（n = 5）或PA（n = 17），接受了经皮支架移植物置入治疗。患者表现为肿瘤、杂音、头痛、口腔和气管造口出血、短暂性偏瘫、癫痫发作或中风。通过计算机断层血管造影（CTA）和数字减影血管造影进行诊断。14处病变位于颈总动脉；8处位于颈内动脉。使用了自制装置和来自多家制造商的支架移植物。随访评估包括临床、CTA和多普勒超声评估。所有患者的PA或AVF均得到解决。1例患有巨大岩骨PA的患者在置入3个球囊扩张式支架移植物后出现CA急性闭塞，但由于Willis环功能正常，未出现神经并发症。在2个月至13年的随访期间，1例颈内动脉置入自体静脉覆盖支架移植物的患者在多普勒超声和血管造影检查中发现因支架压迫导致无症状性90%狭窄。另外3例患者死于与支架移植物置入无关的原因。在所有其他患者中，支架移植物保持通畅。我们的结果表明，在治疗CA的AVF和PA方面，支架移植物置入术是一种可接受的手术替代方法。
