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经皮冠状动脉介入治疗期间医源性严重出血的介入放射学治疗

Interventional radiology treatments for iatrogenic severe bleeding during percutaneous coronary interventions.

作者信息

Pasecki Piotr, Narloch Jerzy, Tkaczewski Konrad, Wasek Wojciech, Ziecina Piotr, Brzozowski Krzysztof

机构信息

Department of Interventional Radiology, Military Institute of Medicine, Warsaw, Poland.

Department of Interventional Cardiology, Military Institute of Medicine, Warsaw, Poland.

出版信息

Pol J Radiol. 2018 Jun 24;83:e319-e325. doi: 10.5114/pjr.2018.77027. eCollection 2018.

Abstract

PURPOSE

Interventional cardiology and interventional radiology are separate medical disciplines in which intra-arterial contrast media are used. Interventional cardiology has resigned from many types of treatment techniques that are now used and developed in the field of interventional radiology. In the event of iatrogenic bleeding during coronary interventions, there is an urgent need to use safe and efficient rescue procedures that are as efficient as cardiosurgery but use simpler treatment options. Serious perforations require immediate endovascular interventions. Medical history may reveal risk factors for artery perforation. Medicines, location of artery perforation, and extent of bleeding are directly associated with the prognosis. Most often, arterial perforations are due to inappropriate wire manipulation or use of oversized balloons or cutting balloons. Prolonged, artery-occluding balloon inflation, covered stent implantation, and embolisation with different agents are among the available treatment options for artery ruptures.

MATERIAL AND METHODS

A retrospective analysis was carried out among selected patients with iatrogenic vascular complications during procedures involving either coronary or non-coronary arteries.

RESULTS

Only representative cases were selected and presented in the patient subsection.

CONCLUSIONS

Artery perforation during cardiac catheterisation can lead to dire consequences. To manage this complication, clinicians need pre-established procedures, adequate resources, and knowledge. Interventional radiology can be used as a salvage therapy in such cases.

摘要

目的

介入心脏病学和介入放射学是使用动脉内造影剂的独立医学学科。介入心脏病学已放弃了许多目前在介入放射学领域使用和发展的治疗技术。在冠状动脉介入治疗期间发生医源性出血时,迫切需要使用安全有效的抢救程序,这些程序要像心脏外科手术一样有效,但使用更简单的治疗选择。严重穿孔需要立即进行血管内介入治疗。病史可能揭示动脉穿孔的危险因素。药物、动脉穿孔的位置和出血程度与预后直接相关。动脉穿孔最常见的原因是不适当的导丝操作或使用过大的球囊或切割球囊。延长动脉闭塞球囊充气时间、植入覆膜支架以及用不同药物进行栓塞是动脉破裂可用的治疗选择。

材料与方法

对在涉及冠状动脉或非冠状动脉的手术中发生医源性血管并发症的选定患者进行回顾性分析。

结果

仅选择了具有代表性的病例并在患者部分呈现。

结论

心导管检查期间的动脉穿孔可能导致严重后果。为了处理这种并发症,临床医生需要预先制定的程序、足够的资源和知识。在这种情况下,介入放射学可作为挽救疗法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2790/6323580/6de85b60c862/PJR-83-77027-g001.jpg

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