Keymel Stefanie, Merx Marc W, Zeus Tobias, Kelm Malte, Steiner Stephan
Division of Cardiology, Pneumology and Angiology, Department of Medicine, Medical Faculty, University Hospital Duesseldorf, 40225 Düsseldorf, Germany.
Department of Cardiology, Angiology and Intensive Care Medicine, Robert Koch Hospital, 30989 Hannover, Germany.
Case Rep Pulmonol. 2014;2014:893647. doi: 10.1155/2014/893647. Epub 2014 Dec 28.
Pulmonary vascular injury is a rare but life-threatening complication of Swan-Ganz catheterization. We report an 82-year old patient who underwent right heart catheterization by a balloon-tipped catheter because of suspected pulmonary hypertension. After deflation of the catheter in the wedge position, hemoptoe appeared associated with acute respiratory insufficiency requiring respiratory support by intubation and mechanical ventilation. Pulmonary angiography showed the formation of a false aneurysm of a segment artery of the left lower lobe. Immediate interventional therapy was performed by the implantation of two coated coronary stent grafts into the injured pulmonary artery thereby excluding the false aneurysm. Bleeding was stopped by this interventional approach while antegrade blood flow was maintained. Long term follow-up after 3 months showed an effective treatment with a completely thrombotic false aneurysm. However, despite oral anticoagulation and dual antiplatelet therapy, graft patency could not be achieved after 3 months. In summary, implantation of coated stents is a feasible and safe approach for the acute and long term treatment of potentially life-threatening condition of a pulmonary artery false aneurysm while treatment to achieve long term patency of the affected vessel still remains an issue to be resolved.
肺血管损伤是Swan-Ganz导管插入术罕见但危及生命的并发症。我们报告了一名82岁患者，因疑似肺动脉高压接受了带球囊导管的右心导管插入术。在导管处于楔压位置放气后，患者出现咯血并伴有急性呼吸功能不全，需要通过插管和机械通气进行呼吸支持。肺血管造影显示左肺下叶一段动脉形成假性动脉瘤。立即通过将两枚带涂层冠状动脉支架移植物植入受伤的肺动脉进行介入治疗，从而排除假性动脉瘤。这种介入方法止住了出血，同时维持了顺行血流。3个月后的长期随访显示治疗有效，假性动脉瘤完全血栓形成。然而，尽管进行了口服抗凝和双联抗血小板治疗，但3个月后仍未实现移植物通畅。总之，植入带涂层支架是治疗肺动脉假性动脉瘤潜在危及生命状况的急性和长期治疗的一种可行且安全的方法，而实现受影响血管的长期通畅的治疗仍然是一个有待解决的问题。
