Lewis D R, Bullbulia R A, Murphy P, Jones A J, Smith F C, Baird R N, Lamont P M
Department of Surgery, Bristol Royal Infirmary.
Ann R Coll Surg Engl. 1999 Jan;81(1):23-6.
This study investigates incidence and outcome of iatrogenic vascular complications needing surgery in a single vascular unit serving interventional vascular radiology and interventional cardiology. Evolution of diagnostic and interventional cardiovascular radiology, along with the introduction of non-surgical therapies for such complications, may have influenced the number of vascular complications requiring emergency surgery. Vascular surgical data were collected from information prospectively entered on computerised database and case note review. Radiology data were collated from prospective entries in logbooks and computerised database. In all 24,033 cardiovascular radiological procedures were performed between 1984 and 1996 (61% cardiac), numbers increasing annually. During this period, 62 patients (40 peripheral; 22 cardiac) required emergency surgical intervention after radiological procedures. Mean age was 61.9 years (range 1-92 years), male to female ratio was 1:1. The absolute number of cases requiring surgical intervention peaked in 1989, subsequently reducing annually. Sites of vascular injury included common femoral artery (40), brachial artery (6), iliac artery (6), popliteal artery (5), other (5). A total of 87 vascular surgical operations was performed (range 1-6 operations per patient). Interventions included thrombectomy/embolectomy (29), bypass grafting (16), direct repair (27). Seven major amputations were performed (two bilateral). Mortality after surgery was 9.7%. Mean inpatient hospital stay was 11.3 days (range 0-75 days). A Poisson regression model indicates a 5% reduction in risk for each successive year of observation; however, this did not reach statistical significance (P = 0.16, 95% CI 12% decreased risk to 2% increased risk). The risk of surgical intervention after diagnostic or interventional cardiovascular radiology is diminishing but still requires vigilance. Necessity for surgical intervention is associated with a high risk of morbidity and mortality.
本研究调查了在一个同时服务于血管介入放射学和介入心脏病学的单一血管单元中，需要手术治疗的医源性血管并发症的发生率及治疗结果。诊断性和介入性心血管放射学的发展，以及针对此类并发症的非手术治疗方法的引入，可能影响了需要急诊手术的血管并发症数量。血管外科数据来自前瞻性录入计算机数据库的信息及病例记录回顾。放射学数据则从前瞻性登记的日志和计算机数据库中整理得出。1984年至1996年间共进行了24,033例心血管放射学检查（61%为心脏相关检查），数量逐年增加。在此期间，62例患者（40例为外周血管病变；22例为心脏相关病变）在放射学检查后需要急诊手术干预。平均年龄为61.9岁（范围1 - 92岁），男女比例为1:1。需要手术干预的病例绝对数在1989年达到峰值，随后逐年下降。血管损伤部位包括股总动脉（40例）、肱动脉（6例）、髂动脉（6例）、腘动脉（5例）、其他（5例）。共进行了87例血管外科手术（每位患者手术范围为1 - 6次）。干预措施包括血栓切除术/栓子切除术（29例）、旁路移植术（16例）、直接修复术（27例）。进行了7例大截肢手术（2例为双侧截肢）。手术后死亡率为9.7%。平均住院天数为11.3天（范围0 - 75天）。泊松回归模型表明，每连续观察一年风险降低5%；然而，这未达到统计学显著性（P = 0.16，95%可信区间为风险降低12%至风险增加2%）。诊断性或介入性心血管放射学检查后进行手术干预的风险正在降低，但仍需保持警惕。手术干预的必要性与高发病率和死亡率风险相关。
