Shen Yuchen, Han Qianyun, Wang Deming, Su Lixin, Wen Mingzhe, Fan Xindong, Yang Xitao
Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Front Cardiovasc Med. 2024 Sep 3;11:1449480. doi: 10.3389/fcvm.2024.1449480. eCollection 2024.
This study aimed to evaluate the efficacy and safety of ethanol embolization in treating traumatic arteriovenous fistulas (TAVFs).
From March 2012 to April 2020, 42 consecutive patients (29.9 ± 15.1 years, range: 3-68 years) with peripheral TAVFs underwent ethanol embolization. All patients underwent clinical and imaging follow-ups (40.0 ± 25.9 months, range: 3-90 months). The mean time to onset of symptoms after trauma was 5.4 ± 5.9 months (range: 0.5-30 months). Among the patients, 27 (64.3%) reported that the TAVFs occurred after blunt trauma, 10 (23.8%) presented after penetrating trauma (with 4 patients involving penetration by infusion indwelling needles), and 3 (7.1%) had a history of surgery. Treatment effects, devascularization rates, and complications were evaluated at follow-ups conducted at 1-3 month intervals.
Seventy-one embolization procedures were performed, with a mean of 1.6 ± 0.7 procedures per patient. Thirty-four patients received coil-assisted ethanol embolization. Absolute ethanol was used in all procedures, with an average volume of 7.1 ± 4.2 ml per procedure (range: 1-18 ml); 28 patients (28/42, 66.7%) received coil embolization in 36 procedures (36/71, 50.7%). Upon re-examination, 39 patients (92.9%) achieved 100% devascularization; of these, 29 patients (74.4%) with Schobinger stage II TAVFs improved to stage I or became asymptomatic. Overall, 30 cases (66.7%) achieved a complete response, while the other 12 cases (33.3%) showed a partial response. In addition, no major complications were observed postoperatively, apart from minor complications.
Coil-assisted ethanol embolization can effectively manage TAVFs with an acceptable risk of mild complications.
本研究旨在评估乙醇栓塞治疗创伤性动静脉瘘（TAVF）的疗效和安全性。
2012年3月至2020年4月，42例连续的外周TAVF患者（年龄29.9±15.1岁，范围：3 - 68岁）接受了乙醇栓塞治疗。所有患者均接受了临床和影像学随访（40.0±25.9个月，范围：3 - 90个月）。创伤后症状出现的平均时间为5.4±5.9个月（范围：0.5 - 30个月）。其中，27例（64.3%）报告TAVF发生于钝性创伤后，10例（23.8%）发生于穿透性创伤后（4例因输液留置针穿刺所致），3例（7.1%）有手术史。在每隔1 - 3个月进行的随访中评估治疗效果、去血管化率和并发症。
共进行了71次栓塞手术，每位患者平均进行1.6±0.7次手术。34例患者接受了弹簧圈辅助乙醇栓塞。所有手术均使用无水乙醇，每次手术平均用量为7.1±4.2 ml（范围：1 - 18 ml）；28例患者（28/42，66.7%）在36次手术（36/71，50.7%）中接受了弹簧圈栓塞。复查时，39例患者（92.9%）实现了100%去血管化；其中，29例（74.4%）Schobinger II期TAVF患者改善至I期或无症状。总体而言，30例（66.7%）达到完全缓解，其余12例（33.3%）为部分缓解。此外，术后除轻微并发症外，未观察到重大并发症。
弹簧圈辅助乙醇栓塞可有效治疗TAVF，且轻度并发症风险可接受。
