凝血功能障碍患者中心静脉置管所致意外椎动脉损伤的处理
Management of inadvertent vertebral artery injury due to central venous catheterization in a coagulopathic patient.
作者信息
Yamamoto Akitaka, Suzuki Kei, Sakaida Hiroshi, Suzuki Hidenori, Imai Hiroshi
机构信息
Emergency and Critical Care Center Mie University Hospital Tsu Mie Japan.
Department of Neurosurgery Mie University Graduate School of Medicine Tsu Mie Japan.
出版信息
Acute Med Surg. 2015 Nov 29;3(3):265-267. doi: 10.1002/ams2.177. eCollection 2016 Jul.
CASE
A 72-year-old man was admitted to the intensive care unit for severe pancreatitis with coagulopathy. He underwent hemodialysis catheter insertion into the internal jugular vein that subsequently leaked arterial blood; vertebral artery cannulation was suspected following a computed tomography scan.
OUTCOME
Under angiographic guidance, the catheter was removed, and an arteriovenous fistula was identified. The patient was successfully treated with endovascular embolization of the affected vertebral artery with detachable coils and N-butyl-2-cyanoacrylate.
CONCLUSION
Despite ultrasound guidance, vertebral cannulation can occur, which can result in serious complications. Prompt management is needed to prevent further sequelae. Endovascular embolization with detachable coils and N-butyl-2-cyanoacrylate appears to be an effective option for vertebral artery injury in patients with coagulopathy.
病例
一名72岁男性因重症胰腺炎合并凝血功能障碍入住重症监护病房。他接受了颈内静脉血液透析导管插入术，随后导管出现动脉血渗漏；计算机断层扫描后怀疑发生了椎动脉插管。
结果
在血管造影引导下，移除了导管，并发现了动静脉瘘。患者通过使用可脱卸弹簧圈和N-丁基-2-氰基丙烯酸酯对受影响的椎动脉进行血管内栓塞治疗而成功治愈。
结论
尽管有超声引导，仍可能发生椎动脉插管，这可能导致严重并发症。需要及时处理以防止进一步的后遗症。对于合并凝血功能障碍的患者，使用可脱卸弹簧圈和N-丁基-2-氰基丙烯酸酯进行血管内栓塞似乎是治疗椎动脉损伤的有效选择。
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