Department of Neurosurgery, Tokushima Red Cross Hospital, 103 Irinoguchi, Komatsushima-cho, Komatsushima-shi, Tokushima 773-8502, Japan.
World J Emerg Surg. 2009 Nov 12;4:39. doi: 10.1186/1749-7922-4-39.
Abdominal wall hematoma is a rare and life-threatening complication after carotid artery stenting (CAS), but it can occur when activated clotting time is prolonged. We report a right lateral abdominal wall hematoma caused by rupture of the superficial circumflex iliac artery after CAS in a 72-year-old man with severe stenosis of the origin of the right internal carotid artery. We performed CAS for the targeted lesion while activated clotting time exceeded 300 seconds. After 2 hours, he complained of right lateral abdominal pain. Abdominal computed tomography revealed an extensive hematoma in the right lateral abdominal wall. Activated clotting time was 180 seconds at this point. Seven hours later, he developed hypotension and hemoglobin level dropped to 11.3 g/dl. Subsequent computed tomography showed enlargement of the hematoma. Emergent selective angiography of the external iliac artery revealed active bleeding from the right superficial circumflex iliac artery. Transcatheter arterial embolization with Gelfoam and microcoils was performed successfully. With more CAS procedures being performed, it is important for endovascular surgeons and radiologists to consider the possibility of abdominal wall hematoma in this situation.
腹壁血肿是颈动脉支架置入术（CAS）后罕见且危及生命的并发症，但在凝血酶时间延长时可能会发生。我们报告了一例 72 岁男性，因右侧颈内动脉起始处严重狭窄行 CAS 后，因旋髂浅动脉破裂导致右侧侧腹壁血肿。我们对目标病变进行了 CAS，此时凝血酶时间超过 300 秒。2 小时后，他诉右侧侧腹部疼痛。腹部 CT 显示右侧侧腹壁广泛血肿。此时凝血酶时间为 180 秒。7 小时后，他出现低血压，血红蛋白降至 11.3 g/dl。随后的 CT 显示血肿增大。髂外动脉选择性血管造影显示右侧旋髂浅动脉有活动性出血。用明胶海绵和微弹簧圈成功进行了经导管动脉栓塞治疗。随着越来越多的 CAS 手术的开展，血管外科医生和放射科医生在这种情况下应考虑腹壁血肿的可能性。
