Giurazza Francesco, Corvino Fabio, Silvestre Mattia, Corvino Antonio, Niola Raffaella
Cardarelli Hospital, Naples, Italy.
Department of Motor Science and Wellness, Parthenope University of Naples, Naples, Italy.
Pol J Radiol. 2019 Dec 2;84:e504-e510. doi: 10.5114/pjr.2019.91204. eCollection 2019.
This paper focuses on the role of interventional radiology embolisations in a series of patients presenting with iatrogenic vascular injuries of the lower limbs following orthopaedic interventions.
Fourteen patients (mean age: 64 years, range 23-90 years) were retrospectively analysed. Clinical presentation consisted of palpable pulsatile mass, pain, reduced lower limb motion, or visible haematoma; 11 patients had also anaemia (haemoglobin < 7 g/dl).
The time between orthopaedic surgery and embolisation ranged between 0 and 67 days (mean: 15 days). Injured arterial vessels were as follows: inferior gluteal artery (2), superficial external pudendal artery (2), deep femoral artery (1), lateral circumflex femoral artery (3), medial circumflex femoral artery (2), articular branch of descending genicular artery (1), perforating femoral arteries (3), posterior tibial recurrent artery (1), and anterior tibial artery (1). The typologies of vascular lesion were: pseudoaneurysm 57%, bleeding with extraluminal contrast agent blush of the terminal arterial segment 36%, and laceration and bleeding with extraluminal contrast agent blush of the arterial main trunk 7%. Embolising agents adopted were microcoils 57%, glue 14%, microplug 7%, particles 14%, and covered stent 7%. In all cases clinical and procedural technical successes were obtained (100%).
For the management of vascular injuries occurring after different orthopaedic interventions of the lower limbs, endovascular embolisations have proven to be safe and effective; orthopaedic surgeons should be aware of the support that interventional radiology could provide in the case of iatrogenic vascular complications.
本文聚焦于介入放射栓塞术在一系列因骨科干预导致下肢医源性血管损伤患者中的作用。
对14例患者（平均年龄：64岁，范围23 - 90岁）进行回顾性分析。临床表现包括可触及的搏动性肿块、疼痛、下肢活动减少或可见血肿；11例患者还伴有贫血（血红蛋白<7 g/dl）。
骨科手术与栓塞术之间的时间间隔为0至67天（平均：15天）。受损动脉血管如下：臀下动脉（2例）、阴部外浅动脉（2例）、股深动脉（1例）、旋股外侧动脉（3例）、旋股内侧动脉（2例）、膝降动脉关节支（1例）、股穿动脉（3例）、胫后返动脉（1例）和胫前动脉（1例）。血管病变类型为：假性动脉瘤57%，终末动脉段腔内造影剂外渗伴出血36%，动脉主干撕裂伴腔内造影剂外渗出血7%。采用的栓塞剂为微线圈57%、胶水14%、微栓7%、颗粒14%和覆膜支架7%。所有病例均获得临床和操作技术成功（100%）。
对于下肢不同骨科干预后发生的血管损伤的处理，血管内栓塞术已被证明是安全有效的；骨科医生应意识到介入放射学在医源性血管并发症情况下所能提供的支持。
