腹部常規素片診斷獨發性內腸骨動脈瘤並循靜脈以導管栓塞治療－病例報告

Isolated Iliac Aneurysm Diagnosed by Plain Film and Occluded by Transvenous Embolization

陳昭安(Chao-An Chen) ； 蔣咸嘉(Hsein-Jar Chiang) ； 沈戊忠(Wu-Chung Shen) ； 劉崇祥(Chung-Hsiang Liu) ； 陳永芳(Yung-Fang Chen) ； 陳瑞芬(Ren-Fan Chen)

《中華放射線醫學雜誌》 24卷5期 (1999/10) Pp. 207-210

摘要

獨發性內腸骨動脈瘤是一種罕見的血管疾患，因為其位於骨盆的深部一般難直接用手觸及或者有明顯的病人自覺症狀，除非合併有其他的併發症而引起臨床症狀，例如：神經的壓迫、腸胃道出血、或泌尿道出血以及阻塞。需要依靠影像學儀器之探索，以揭發其病灶。而影像醫學在診斷及治療上，均扮演了一個重要角色。
本文的目的就是報告1個病例，病人因為嚴重之右腳無力麻木疼痛而到醫院治療。病人患有腦中風，脊椎有明顯的退化性病變。例行腹部X光攝影發現他的骨盆腔右側有一囊狀鈣化的病灶，推斷與右腿症狀有關，在電腦斷層以及血管攝影檢查上，證實了獨發性之內腸骨動脈瘤合併內腸骨動靜脈瘦管。病人先是接受外科結紮手術將內腸骨動脈與予結紮，但是在手術後4個月，症狀復發，再度的血管攝影發現外腸骨動脈及股骨動脈之側枝循環供應到此血管瘤管。所以當下也實施了血管栓塞術，由左邊的股總靜脈，將導管放到右內腸骨靜脈然後再進到右內腸骨動脈瘤內，在裹面總共放置了六支15亳米以及兩支8毫米的線圈(coil)，終於將此動脈瘤及動靜脈瘧管完全封閉。

關鍵字

動脈，腸骨 ； 動脈瘤，腸骨動脈 ； 動脈，治療性栓塞

並列摘要

The isolated iliac aneurysm is a rare vascular abnormality. It is located deep in the pelvic cavity, and is barely palpable. There is a potential for compression or erosion of adjacent organs, and complications with vascular-enteric fistula or arterio-venous fistula. Imaging studies play an important role in both diagnosis and treatment.
We report a 65 year old woman, who complained of right lower limb weakness, numbness, and tenderness. Because she had a history of stroke and marked degenerative disease of the lumbar spine, the clinical physician searched for cerebral and spinal problems. However, a plain film of the pelvis disclosed a ring calcification lesion over the right pelvic sidewall. CT of the pelvis confirmed the diagnosis of an aneurysm over the right pelvic sidewall just near the sciatic foramen. A pelvic angiogram showed an isolated internal iliac aneurysm with an arterio-venous fistula. The patient had surgical ligation at the proximal internal iliac artery. Unfortunately, the aneurysm recurred 4 months later. Collateral circulation was supplied from both the external iliac and femoral arteries, and recanalization of the arterio-venous fistula was also noted. Transvenous embolization of the aneurysm through the arterio-venous fistula was done and 8 pieces of coil were inserted. The aneurysm was successfully occluded and subsequently the arterio-venous fistula was obliterated.

並列關鍵字

Arteries, iliac ； Aneurysm, iliac ； Arteries, therapeutic blockade