Davies James, Metcalfe James, Ward Robert
Department of Vascular Surgery, Dorset County Hospital, Dorchester, UK.
Department of Clinical and Interventional Radiology, Dorset County Hospital, Dorchester, UK.
BJR Case Rep. 2016 Nov 2;2(1):20150335. doi: 10.1259/bjrcr.20150335. eCollection 2016.
A 70-year-old male presented with groin pain and swelling 11 days following a pulmonary vein isolation procedure via an unguided femoral venous puncture for atrial fibrillation. On the fourth visit, his haemoglobin level had dropped from 14.2 gl to 10.7g l. Repeat duplex imaging revealed a large haematoma with deep flow. A CT angiogram revealed a pseudoaneurysm of a right common femoral branch artery. A subsequent angiogram revealed active bleeding, and the feeding artery was coiled. Pseudoaneurysms are recognized complications of vascular intervention, but more commonly occur anteriorly in major vessels. This elusive presentation reminds us of several important points. First, with the increasing use of interventional techniques across all medical specialties, the use of image guidance to aid vessel access is paramount for safety; not all specialties currently practise this routinely. Furthermore, we should consider arterial injury in all patients, including those who have had venous puncture. Injuries may not necessarily occur at the anterior vessel wall, and may well be deeper. Finally, there should be a low threshold for alternative imaging if symptoms are out of context with clinical findings.
一名70岁男性在通过非引导股静脉穿刺进行肺静脉隔离治疗房颤11天后，出现腹股沟疼痛和肿胀。在第四次就诊时，他的血红蛋白水平从14.2g/l降至10.7g/l。重复双功成像显示有一个伴有深部血流的大血肿。CT血管造影显示右股总动脉分支假性动脉瘤。随后的血管造影显示有活动性出血，供血动脉被栓塞。假性动脉瘤是血管介入公认的并发症，但更常见于大血管的前方。这种难以捉摸的表现提醒我们几个要点。首先，随着所有医学专科介入技术的使用增加，使用图像引导辅助血管穿刺对于安全至关重要；目前并非所有专科都常规这样做。此外，我们应该考虑所有患者的动脉损伤，包括那些接受过静脉穿刺的患者。损伤不一定发生在前血管壁，可能更深。最后，如果症状与临床发现不符，应降低对替代成像的阈值。
