Mussa Firas F, Towfigh Shirin, Rowe Vincent L, Major Kevin, Hood Douglas B, Weaver Fred A
Division of Vascular Surgery and Endovascular Therapy, Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.
Vasc Endovascular Surg. 2006 Oct-Nov;40(5):354-61. doi: 10.1177/1538574406290844.
This study was undertaken to elicit the opinion of experts regarding the management of iatrogenic injury to the carotid artery. A text questionnaire was transmitted by electronic mail to members of the Western Vascular Society concerning management of iatrogenic injury to the cervical carotid artery. Participants were asked to submit information regarding practice status and their preferred choices for the management of different clinical scenarios. The scenarios were: (1) large bore sheath (> 8.5F) cannulation of the carotid artery in anesthetized patients, (2) large bore sheath cannulation of the carotid artery in an awake patient, (3) delayed recognition of a misplaced sheath by > 4 hours, and (4) arterial puncture was recognized after only the entry needle (16-gauge) was introduced but before sheath insertion. Finally, the members were asked to comment on the management of abnormal findings on duplex scanning, such as intimal flap or pseudoaneurysm. A response rate of 42% was obtained (45/106 active members). Eighty-two percent of respondents had been in practice for longer than 10 years. Eighty-nine percent had seen this complication and 29% had cared for patients in whom subsequent neurologic deficit developed. The institutional incidence of such injury was 1-5 cases per year for 82% of respondents. Sixteen-gauge needle injury was managed by immediate removal and applied pressure by 98% of respondents. When large-bore sheath injury is recognized within 1 hour of insertion, 62% of respondents would remove the sheath and hold pressure, with or without obtaining a duplex ultrasound examination. However, if injury recognition was delayed for > 4 hours, 82% would proceed to surgery. Only 26% operated on asymptomatic carotid flap found on ultrasound, while the remaining 74% would base their decision on size and flow characteristics on ultrasound. The management of pseudoaneurysm differed significantly. Whereas 31% of respondents would manage this finding expectantly, 69% would proceed to surgery regardless of size or symptoms. Despite awareness of iatrogenic injury to the cervical carotid artery, the institutional incidence remains high. Two thirds of respondents would manage a misplaced sheath in the carotid artery nonoperatively if the injury was recognized immediately. However, if injury recognition was delayed for > 4 hours, the majority of respondents would remove the sheath surgically. While the management of intimal flap largely depended on size and flow characteristics, 69% of respondents would operate on a pseudoaneurysm regardless of size or symptoms. The results of this survey may serve as a guideline for the management of this potentially devastating injury.
本研究旨在征求专家对医源性颈动脉损伤处理的意见。通过电子邮件向西方血管外科学会成员发送了一份关于颈段颈动脉医源性损伤处理的文本问卷。参与者被要求提交有关实践情况以及他们对不同临床场景处理的首选方案的信息。这些场景包括：（1）在麻醉患者中使用大口径鞘管（>8.5F）穿刺颈动脉；（2）在清醒患者中使用大口径鞘管穿刺颈动脉；（3）鞘管位置不当延迟4小时以上才被发现；（4）仅在引入穿刺针（16号）后但在插入鞘管前就识别出动脉穿刺。最后，要求成员对双功超声扫描异常结果（如内膜瓣或假性动脉瘤）的处理发表意见。获得了42%的回复率（45/106名活跃成员）。82%的受访者从业时间超过10年。89%的受访者见过这种并发症，29%的受访者曾护理过随后出现神经功能缺损的患者。82%的受访者所在机构每年此类损伤的发生率为1 - 5例。98%的受访者对16号针损伤的处理是立即拔出并按压。当在插入大口径鞘管后1小时内识别出损伤时，62%的受访者会拔出鞘管并按压，无论是否进行双功超声检查。然而，如果损伤识别延迟超过
