目的：探讨腔内血管修复技术治疗创伤性腋动脉损伤的可行性及其疗效。资料与方法：回顾性分析2008年2月—2016年8月14例接受血管腔内治疗的创伤性腋动脉损伤患者资料，血管造影表现为对比剂外溢、假性动脉瘤和血管狭窄/闭塞。对比剂外溢和假性动脉瘤行覆膜支架治疗，对血管狭窄、闭塞行血管成形术或裸支架治疗。结果：14例患者手术均获成功，平均手术时间为45 min（30～80 min），其中置入覆膜支架、裸支架各6例，单纯球囊扩张2例。腔内治疗后腋动脉血流恢复通畅，无对比剂外溢，无严重并发症发生。随访14例，2～36月（平均19.5月），1例患者因支架内血栓形成给予溶栓治疗后血流恢复通畅，其余患者上肢动脉血流保持通畅。结论：腔内治疗创伤性腋动脉损伤，能快速修复损伤血管，恢复肢体血流，临床疗效满意，具有创伤小、操作简单等优点，是一种安全、有效的方法。
Abstract
Objective: To explore the feasibility and efficacy of endovascular repair for traumatic axillary artery injury. Methods: The clinical data of 14 patients with traumatic axillary artery injury undergoing endovascular intervention from February 2008 to August 2016 were retrospectively analyzed, the angiography showed that contrast extravasation, pseudoaneurysms, vascular stenosis or occlusion. Contrast extravasation and pseudoaneurysms were treated with stent grafts, vascular stenosis or occlusion were treated with bare stents or angioplasty. Results: Operation was performed successfully in all 14 patients, The mean operation time was 45 minutes(30～80 minutes). The interventions included balloon angioplasty(n=2), covered stent implantation(n=6) and bare stent implantation(n=6). After endoluminal treatment, axillary artery blood flow recovered, no contrast extravasation or severe complications occurred. Fourteen patients were followed up for 2~36 months(mean of 19.5 months), one stent-graft occlusion occurred, which was treated with intraarterial pharmacologic thrombolysis, blood flow patency was kept in the rest of the upper limb artery. Conclusion: For traumatic axillary artery injury, percutaneous interventional treatment can rapidly repair vascular injury and restore the blood flow, the clinical effect is significant, with less invasive performance and easy to operate, and it is a safe and effective method.
关键词
腋动脉；创伤和损伤；血管成形术 /
气囊
Key words
Axillary artery /
Wounds and injuries /
Angioplasty, balloon
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参考文献
[1]Carli A, De JC, Martineau PA. Isolated axillary artery injury due to blunt trauma in ice hockey[J]. Clin J Sport Med, 2012, 22(5): 446-447.
[2]肖嵩华，刘芙进，宋守礼，等. 锁骨下及腋动脉损伤合并臂丛神经损伤的急救与外科治疗（附10例报告）[J]. 中国矫形外科杂志，2003，11（13）：898-900.
[3]陆清声，沈毓. 血管损伤的诊治进展[J]. 临床外科杂志，2015，23（8）：624-626.
[4]蒋国民，李绍钦，赵进委，等. 创伤性动脉损伤的血管内介入治疗[J]． 临床放射学杂志，2010，29（7）：947-950.
[5]Carrafiello G, Laganà D, Mangini M. Percutaneous treatment of traumatic upper-extremity arterial injuries: a single-center experience[J]. J Vasc Interv Radiol, 2011, 22(1): 34-39.
[6]Danetz JS, Cassano AD, Stoner MC, et al. Feasibility of endovascular repair in penetrating axillosubclavian injuries: a retrospective review[J]. J Vasc Surg, 2005, 41(2): 246-254.
[7]Canaud L, Marty-Ané C, Ziza V, et al. Minimum 10-year follow-up of endovascular repair for acute traumatic transection of the thoracic aorta[J]. J Thorac Cardiovasc Surg, 2014, 149(3): 825-829.
[8]Branco BC, DuBose JJ, Zhan LX, et al. Trends and outcomes of endovascular therapy in the management of civilian vascular injuries[J]. J Vasc Surg, 2014, 60(5): 1297-1307.
[9]Kouvelos GN, Papas NK, Arnaoutoglou EM, et al. Endovascular repair of profunda femoral artery false aneurysms using covered stents[J]. Vascular, 2011, 19(1): 51-54.
[10]Hershberger RC, Aulivola B, Murphy M, et al. Endovascular grafts for treatment of traumatic injury to the aortic arch and great vessels[J]. J Trauma, 2009, 67(3): 660-671.
[11]Lee BK, Jeung KW, Min YI, et al． A case of iatrogenic ilio—iliac arteriovenous fistula after percutaneons cardiopulmonary support in a patient with a tortuous iliac artery[J]. J Artif Organs, 2011, 14(2): 151-154.
[12]周兴立，尹存平，郭曙光，等. 动脉血管损伤患者的腔内治疗[J]． 中华医学杂志，2013，93（9）：656-658.
[13]葛世堂，张希全，潘晓琳，等. 经皮腔内介入治疗急性肱动脉损伤26例[J]． 介入放射学杂志，2017，26 （1）：69-72.
[14]Rohlffs F, Larena-Avellaneda AA, Petersen JP, et al. Through-and-through wire technique for endovascular damage control in traumatic proximal axillary artery transection[J]. Vascular, 2015, 23(1): 99-101.
[15] Zhong S, Zhang XQ, Chen Z, et al. Endovascular Repair of Blunt Popliteal Arterial Injuries[J]. Korean J Radiol, 2016, 17(5): 789-796.
[16]Shalhub S, Starnes BW, Tran NT. Endovascular treatment of axillosubclavian arterial transection in patients with blunt traumatic injury[J]. J Vasc Surg, 2011, 53(4): 1141-1144.
[17]Xenos ES, Freeman M, Stevens S, et al. Covered stents for injuries of subclavian and axillary arteries[J]. J Vasc Surg, 2003, 38(3): 451-454.
基金
军队后勤科研计划资助项目（CJN14J010）。
