Parker P M, Vinocur C D, Smergel E, Faerber E N, Dunn S P, Weintraub W H
Department of Surgery and Radiology, St Christopher's Hospital for Children, Temple University School of Medicine, Philadelphia, PA 19133.
J Pediatr Surg. 1989 May;24(5):423-7. doi: 10.1016/s0022-3468(89)80393-8.
Angiography is often essential in the evaluation of patients with suspected vascular injuries. However, arterial cannulation has a significant inherent complication rate, especially in small patients. Therefore, a less invasive method of evaluating children with such injuries is desirable. We report nine children (age range, 9 months to 16 years; median, 7 years) in whom intravenous digital subtraction angiography (IV-DSA) was used to evaluate suspected vascular injuries. IV-DSA showed a false aneurysm in two children, one managed by ligation alone and the other by resection with primary anastomosis. One child was found to have an arteriovenous fistula, which was treated by ligation. An iliac occlusion, following an arteriogram to evaluate a liver tumor, was documented by IV-DSA and successfully managed with aggressive anticoagulant therapy. Demonstration of a normal vascular tree avoided exploration in four children. A planned skin flap was abandoned in a child who suffered an electrical injury when IV-DSA showed lack of adequate vascular supply. In all nine cases, the IV-DSA obviated the need for intraarterial angiography. In addition to avoiding arterial cannulation, IV-DSA required significantly less radiation and less time to perform than conventional arteriography. Motion artifact, vessel overlap, and some loss of minute detail are some of its potential shortcomings. IV-DSA is an effective method of screening children with suspected vascular injuries. In addition, our experience has shown that IV-DSA can be the definitive diagnostic procedure, although intraarterial angiography may be necessary in selected cases.
血管造影术在评估疑似血管损伤的患者时往往至关重要。然而，动脉插管具有显著的固有并发症发生率，尤其是在小儿患者中。因此，需要一种侵入性较小的方法来评估此类损伤的儿童。我们报告了9名儿童（年龄范围为9个月至16岁；中位数为7岁），他们接受了静脉数字减影血管造影术（IV-DSA）以评估疑似血管损伤。IV-DSA显示2名儿童存在假性动脉瘤，其中1名仅通过结扎治疗，另1名通过切除并一期吻合治疗。发现1名儿童患有动静脉瘘，通过结扎进行治疗。IV-DSA记录了1名在进行肝脏肿瘤动脉造影后出现的髂动脉闭塞，并通过积极的抗凝治疗成功处理。血管树正常的显示避免了4名儿童进行探查。1名遭受电击伤的儿童，当IV-DSA显示血管供应不足时，放弃了计划中的皮瓣。在所有9例病例中，IV-DSA避免了动脉造影的需要。除了避免动脉插管外，IV-DSA所需的辐射明显较少，且操作时间比传统动脉造影短。运动伪影、血管重叠以及一些细微细节的丢失是其潜在的缺点。IV-DSA是筛查疑似血管损伤儿童的有效方法。此外，我们的经验表明，IV-DSA可以作为确定性的诊断方法，尽管在某些特定情况下可能需要动脉造影。
