ObjectiveTo explore the application value of digital subtraction angiography (DSA) in repairing foot and ankle wounds with posterior tibial arterial perforator flaps. MethodsBetween January 2010 and May 2014, 12 cases of foot and ankle wounds were repaired using posterior tibial arterial perforator flaps. There were 7 males and 5 females with an average age of 36 years (range, 22-54 years). The causes were machine injury in 2 cases, falling injury in 3 cases, and traffic accident injury in 7 cases. The disease duration ranged from 7 to 45 days (mean, 16 days). The size of wound ranged from 6 cm×4 cm to 10 cm×5 cm. Preoperative DSA was performed to observe the orientation and distribution of the posterior tibial arterial perforator and the relationship between perforator vessels. Correspondently, the flaps were designed and harvested. The size of flap ranged from 7 cm×5 cm to 11 cm×6 cm. The donor sites were repaired with skin grafts. ResultsPosterior tibial arterial perforator vessels send out ascending branches and descending branches while going down in the superficial layer. All branches were connected to form vertical chain-form anastamosis, and its orientation was consistent with limb vertical axis. According to DSA results, the flaps were designed and harvested easily. All flaps survived after operation. Meanwhile, wounds healed by first intention. All skin grafts at donor site survived. All patients were followed up 6 months. The flaps had good appearance, color, and texture. No ulcer was found. Affected feet had normal walking function. ConclusionThe size, distribution, and chain-form anastamosis condition of the posterior tibial arterial perforator vessels can be accurately observed by DSA, which provides imaging evidence for harvesting posterior tibial arterial perforator flaps and improves the success rate for repairing foot and ankle wounds.
ObjectiveTo observe the influence of three postoperative analgesia methods on the survival rate of replanted finger by flat digital subtraction angiography (DSA) medical imaging detection system. MethodFrom July 2014 to July 2015, 342 patients were classified into gradeⅠ and gradeⅡ replantation in accordance with their physical condition and they were randomly divided into routine oral group, muscle injection group and analgesia group with 144 patients in each. Flat DSA was used to dynamically observe replantation after revascularization. Then we compared the three different analgesia methods in terms of psychological status of the patients, incidence of vascular crisis, occlusion rate, survival rate of replanted fingers. The function score of replanted fingers was evaluated for clinical efficacy. ResultsCompared with the conventional oral group and muscle injection group, the incidence of vascular crisis in replanted fingers and thrombosis rate were significantly lower in the analgesia group which had a replanted finger survival rate of 96.69% and a normal mental condition rate of 78.07%. Six months after surgery, the rate of excellent and good follow-up was significantly higher than the conventional oral group and muscle injection group (P<0.017) . ConclusionsThe 3-D technology of flat DSA can provide clear and reliable pictures of vessel revascularization status for replanted fingers. The use of continuous brachial plexus analgesia performs better than other methods of analgesia. Good analgesia can stabilize patients' anxiety and negative emotions, which is helpful to avoid excessive fluctuations in blood pressure induced by small artery spasm caused by blood clots and vascular crisis, thereby increasing the survival rate of replanted fingers and facilitating early rehabilitation of their function.
Objective To observe the complication after embolizing the bilateral internal il iac arteries and the median sacral artery of dogs by different combinations and embolization levels with gelfoam particle, and to provide a reference for safety appl ication of gelfoam in cl inic. Methods Sixteen common grade adult healthy dogs (weighing 10-13 kg, 14 males and 2females) were randomly divided into 5 groups. Under the monitoring of digital subtraction angiography (DSA), the embolization was performed with gelfoam particle (diameter, 50-150 μm) in bilateral internal il iac arteries and the main branch of the median sacral artery (group A, n=3), in bilateral internal il iac arteries and the first branch of the median sacral artery (group B, n=3), in the main branch of bilateral internal il iac arteries (group C, n=3), in the unilateral internal il iac artery and the main branch of the median sacral artery (group D, n=4), and in the main branch of unilateral internal il iac artery (group E, n=3). Under the DSA, the anatomic relationships of the abdominal aorta, bilateral external il iac arteries, bilateral internal il iac arteries, and median sacral artery were observed before embol ization. The survival dogs were observed and the specimens of bladder, rectum, sciatic nerve, and gluteal muscles were harvested for the general and histological observations at 3 days after embolization. Results In dogs, there was no common il iac artery; bilateral external il iac arteries originated from the abdominal aorta and the starting of the median sacral artery had variation. Seven dogs (3 in group A, 3 in group C, and 1 in group D) died within 2 days after embolization, and the others survived to the end of the experiment. In the dead dogs of groups A, C, and D, the darkening and necrosis of the rectum were observed; the bladder presented lamellar obfuscation and focal hemorrhage and edema; and the median urinary volume in bladder was 270.6 mL. In survival dogs, no obvious change was observed in the rectum; the bladder only manifested l ight edema; and the median urinary volume in bladder was 137.0, 220.5, and 28.0 mL, respectively in groups B, D, and E.The rectum and bladder of dead dogs in groups A, C, and D manifested the disrupted cells, generous inflammatory cells infiltration, and desquamation of epithel ial cells; the rectum and bladder of survival dogs in groups B, D, and E manifested l ight inflammatory cells infiltration and edema; the embol ized artery mainly focused on the arterioles whose diameter was 100-200 μm. The sciatic nerve and gluteal muscles of each group had no obvious change except for l ight edema. Conclusion When the internal il iac artery and median sacral artery are embol ized with gelfoam particle with a diameter of 50-150 μm, to ensure the safeness of pelvic organs, the embol ized artery can not exceed the first branch when the 3 arteries are embol ized at the same time, or reserve at least unilateral internal il iac artery when embol ized to the trunk , or it will result in pelvic organ necrosis and perforation.
目的 提高对创伤性假性动脉瘤并动静脉瘘的影像诊断水平。 方法 报告1例腰椎间盘手术所致的创伤性假性动脉瘤并动静脉瘘，比较分析MRA和DSA对该病的诊断价值。 结果 MRA能够明确创伤性假性动脉瘤及动静脉瘘的诊断，与DSA有良好的相关性。 结论 MRA对创伤性假性动脉瘤并动静脉瘘的确诊有重要价值，在一定程度上能够代替常规血管造影。
ObjectiveTo observe the effectiveness of digital subtraction angiography (DSA) assisted musculoskeletal flap transplantation in the treatment of osteonecrosis of the femoral head (ONFH).MethodsThe clinical data of 15 patients with 15 hips of ONFH admitted between January 2016 and December 2019 were retrospectively analyzed. All patients were male, aged 20-45 years, with an average age of 31.6 years. There were hormone type in 9 cases and alcohol type in 6 cases. The disease duration ranged from 15 days to 3 years, with an average of 8 months. The Association Research Circulation Osseous (ARCO) staging: 4 hips in stage Ⅱ, 11 hips in stage Ⅲ. The preoperative visual analogue scale (VAS) score was 6.2±0.2, and the Harris score of the hip joint was 57.3±1.3. Preoperative DSA examination of the femoral head was performed to determine the location of vascular lesions of the femoral head. According to the results of the angiography, the surgical selection of the musculoskeletal flap was guided. For the patients with both superior and inferior retinaculum vessels developed, simple core decompression was performed. For the patients with superior retinaculum vessels developed but inferior retinaculum vessels not developed, anterolateral tensor fasciae flap was used. For the patients whose superior retinaculum did not develop and the inferior retinaculum developed, posterolateral quadratus femoris flap was used. The fibular flap with anastomotic vessels was used in the patients whose superior and inferior retinaculum vessels were not developed.ResultsAll 15 cases of 15 hips were followed up 6-24 months, with an average of 14 months. During the follow-up, the patient’s ONFH did not worsen, the femoral head did not collapse, the joint space was normal, and the hip joint fextion and extension function was acceptable. At last follow-up, the VAS score was 1.9±0.2, and the hip Harris score was 92.1±0.8, both of which were significantly improved when compared with preoperative ones (t=14.85, P=0.00; t=23.22, P=0.00).ConclusionFor patients with ONFH who need musculoskeletal flap transplantation, preoperative DSA of femoral head can determine the location of vascular lesions of femoral head, so as to guide the selection of musculoskeletal flap transplantation, which is of great significance for hip-conserving surgery.
目的阐明数字减影血管造影（DSA）监控在区域性置管栓塞化疗治疗肝癌中的重要性。方法比较152例肝癌区域性置管中DSA监控置管与注射美蓝指导下置管的导管位置准确性； 并对术后发生与置管有关的并发症进行分析。结果DSA监控置管准确率肝动脉及门静脉均为100%，注射美蓝指导下置管肝动脉和门静脉的导管位置准确率分别为70.2%和76.1%，两组比较差异有显著性意义（P＜0.01)。术后有导管移位、肝动脉胆管瘘、导管阻塞、药液外漏、硬化性胆管炎等并发症。结论DSA指导下置管准确，又能保证血管内介入治疗的彻底性； 术后行DSA监控，以指导下一步的治疗，并可防止并发症的发生。
Both Dyna CT, a rotational faultage reconstructed technique, and digital subtraction angiography (DSA) play important roles in the diagnosis and treatment of arteriovenous malformations (AVM). Three-dimensional Dyna CT can provide the spatial information of AVM nidus, while two-dimensional DSA can provide the time information for distinguishing arteries and veins. To illustrate the location relationship of the nidus, arteries and veins at the same time, these two imaging modalities need to be fused. In this paper, a two-dimensional to three-dimensional back projection and growing method is proposed, which realizes the image fusion of two-dimensional DSA and three-dimensional Dyna CT and achieves the differentiation of arteries and veins in Dyna CT. The experimental results showed that the fusion image could present both the position information of AVM nidus and the dynamic information of the blood vessels. Therefore, the proposed method can help surgeons locate the AVM abnormality and make operation plan more accurately.