Sternbergh W Charles, Conners Michael S, Ojeda Melissa A, Money Samuel R
Section of Vascular Surgery, Ochsner Clinc Foundation, New Orleans, LA 70121, USA.
J Vasc Surg. 2003 Sep;38(3):589-92. doi: 10.1016/s0741-5214(03)00295-7.
Endovascular treatment of blunt vascular trauma has been infrequently reported.
A 27-year-old man was crushed between a fork-lift truck and a concrete platform. The physical examination was remarkable for hemodynamic stability, significant lower abdominal ecchymosis and tenderness, obvious pelvic fracture, and gross hematuria. Vascular examination revealed no femoral pulses, no pedal signals bilaterally, and minimal left leg and no right leg motor function. Arteriograms revealed right common iliac artery and external iliac artery occlusion and a 2-cm near occlusion of the left external iliac artery.
In the operating room, bilateral common femoral artery access was obtained, and retrograde arteriogram on the right side demonstrated free extravasation of contrast material at the level of the proximal external iliac artery. An angled glide wire was successfully traversed over the vascular injury, and two covered stents (Wallgraft, 10 x 50 mm and 8 x 30 mm) were deployed. The left iliac injury was similarly treated with an 8 x 30-mm covered stent. After calf fasciotomy, exploratory laparotomy revealed a severe sigmoid colon degloving injury, requiring resection and colostomy. A suprapubic catheter was placed because of bladder rupture, and an open-book pelvic fracture was treated with external fixation. Postoperatively the patient regained palpable bilateral pedal pulses and normal left leg function, but right leg paralysis persisted secondary to severe lumbar plexus nerve injury.
Endovascular repair of blunt intra-abdominal arterial injuries is possible and should be particularly considered when fecal contamination, pelvic hematoma, or multiple associated injuries make conventional repair problematic.
钝性血管损伤的血管内治疗鲜有报道。
一名27岁男性被叉车和混凝土平台挤压。体格检查显示血流动力学稳定、下腹部有明显瘀斑和压痛、明显的骨盆骨折以及肉眼血尿。血管检查发现双侧股动脉搏动消失、双侧足部无血流信号，左腿运动功能轻微受限，右腿无运动功能。动脉造影显示右髂总动脉和外髂动脉闭塞，左外髂动脉近段有2厘米的近乎闭塞。
在手术室，通过双侧股总动脉进行穿刺，右侧逆行动脉造影显示造影剂在近端外髂动脉水平自由外渗。一根成角导丝成功穿过血管损伤部位，置入了两个覆膜支架（Wallgraft，10×50毫米和8×30毫米）。左髂动脉损伤同样用一个8×30毫米的覆膜支架进行治疗。小腿筋膜切开术后，剖腹探查发现乙状结肠严重脱套伤，需要切除并进行结肠造口术。因膀胱破裂放置了耻骨上导管，开放性骨盆骨折采用外固定治疗。术后患者双侧足部可触及搏动恢复，左腿功能正常，但由于严重的腰丛神经损伤，右腿麻痹持续存在。
钝性腹内动脉损伤的血管内修复是可行的，当存在粪便污染、盆腔血肿或多种合并伤使传统修复存在问题时，应特别考虑采用这种方法。
