Department of Vascular Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
J Endovasc Ther. 2013 Aug;20(4):568-70. doi: 10.1583/12-4200.1.
To report a rare case of acute intraoperative retroperitoneal hemorrhage secondary to aortic penetration by the suprarenal anchoring barb on a stent-graft.
A 75-year-old patient on dual antiplatelet therapy for coronary stents and low-molecular-weight heparin for atrial thrombus underwent elective endovascular repair of a 6.7-cm infrarenal abdominal aortic aneurysm. A device with suprarenal fixation and metal anchoring barbs was implanted, and a molding balloon was used that at no time covered the proximal bare metal stents or barbs. In recovery, the patient became tachycardic and hypotensive. After resuscitation, imaging identified an anterior barb penetrating the aortic wall, causing the acute retroperitoneal hemorrhage. A decision to treat conservatively rather than resort to open surgery was difficult but ultimately influenced by the patients' high risk for open surgery. The patient was treated by aggressive reversal of heparin and platelet transfusion, and the bleed settled spontaneously.
Major surgery and subsequent morbidity may be avoided by medical management of what would appear to be a surgical problem.
报告一例罕见的因支架移植物肾上固定锚定刺穿透主动脉而导致术中急性腹膜后出血的病例。
一名 75 岁患者因冠状动脉支架置入术后和心房血栓形成后接受低分子肝素双重抗血小板治疗，行选择性腹主动脉瘤腔内修复术。植入了一种具有肾上固定和金属锚定刺的装置，并使用了成型球囊，该球囊在任何时候都不会覆盖近端裸金属支架或刺。在恢复过程中，患者出现心动过速和低血压。复苏后，影像学检查发现前刺穿透主动脉壁，导致急性腹膜后出血。决定保守治疗而不是采用开放手术治疗非常困难，但最终受到患者开放手术高风险的影响。通过积极逆转肝素和血小板输注治疗，出血自发性停止。
对于看似需要手术治疗的问题，通过药物治疗可能可以避免大手术和随后的发病率。
