Kupczyk Patrick, Meyer Carsten, Thomas Daniel, Schild Hans Heinz, Pieper Claus Christian
Radiologische Klinik, Universitätsklinikum Bonn, Bonn, Deutschland.
Zentralbl Chir. 2017 Aug;142(4):404-410. doi: 10.1055/s-0043-114733. Epub 2017 Aug 24.
Intercostal artery bleedings are potentially fatal injuries. Apart from conservative and surgical treatment options, emergency interventional radiological treatment can also be performed. We report our experience with emergency intercostal artery embolisation. Patients with acute arterial bleedings from the intercostal artery who were treated interventionally over a period of 7 years were identified retrospectively. Technical and clinical success, clinical and procedural parameters as well as overall survival were analysed. Between 2010 and 2017, a total of 27 embolisation procedures was performed in 24 patients (14 male, mean age 65.7 ± 13.9 years). The majority of patients suffered from iatrogenic intercostal artery bleedings (n = 17; 70.1%; especially after thoracocentesis). In five cases, thoracoscopic surgery was attempted prior to intervention but was unsuccessful. Primary technical success was obtained in 25/27 interventions. In two cases, there was re-bleeding via collateral arteries so that re-intervention became necessary (secondary technical success). In 15 cases, secondary surgery after successful interventional treatment was necessary to evacuate the haematoma/haemothorax. Intercostal artery embolisation was clinically successful in 23/24 patients. One patient died despite technically successful embolisation, due to extensive haemothorax. One case of spinal ischaemia was observed as a major complication. Intercostal artery embolisation is an effective interventional radiological emergency measure in patients with acute bleeding and is an alternative to surgical treatment even after attempted, unsuccessful surgery. Because of potentially severe complications, the interventional procedure should be performed by an experienced interventionalist.
肋间动脉出血是有潜在致命风险的损伤。除了保守治疗和手术治疗方案外，还可以进行紧急介入放射治疗。我们报告了我们在紧急肋间动脉栓塞方面的经验。回顾性确定了在7年期间接受介入治疗的急性肋间动脉出血患者。分析了技术和临床成功率、临床和手术参数以及总体生存率。2010年至2017年期间，共对24例患者（14例男性，平均年龄65.7±13.9岁）进行了27次栓塞手术。大多数患者患有医源性肋间动脉出血（n = 17；70.1%；尤其是在胸腔穿刺术后）。有5例在介入治疗前尝试了胸腔镜手术，但未成功。27次干预中有25次取得了初次技术成功。有2例通过侧支动脉再次出血，因此需要再次干预（二次技术成功）。在15例中，成功的介入治疗后需要进行二次手术以清除血肿/血胸。肋间动脉栓塞在24例患者中有23例临床成功。1例患者尽管栓塞技术成功，但因广泛血胸死亡。观察到1例脊髓缺血为主要并发症。肋间动脉栓塞是急性出血患者有效的介入放射学急救措施，即使在尝试手术但未成功后也是手术治疗的一种替代方法。由于可能出现严重并发症，介入手术应由经验丰富的介入专家进行。
