Dutmers Jennifer, Soule Erik, Bertran Mario Agrait, Andreou Sonia, Matteo Jerry
Department of Radiology, University of Florida College of Medicine, Jacksonville, FL, USA.
Vasc Endovascular Surg. 2020 Jul;54(5):406-412. doi: 10.1177/1538574420921014. Epub 2020 May 11.
The incidence and prevalence of iatrogenic vascular trauma in the United States is staggering. This has led to the advent and implementation of more efficient and effective vascular repair methods. Although open surgical repair may still be considered gold standard, new endovascular solutions have emerged as other viable options. When using an endovascular approach, proper stent sizing is vital to a successful repair.
We present a case of a traumatic injury and pseudoaneurysm formation at the confluence of the right internal jugular and right subclavian veins during a central line placement. This iatrogenic pseudoaneurysm was treated with endovascular placement of side-by-side stents. A mathematical formula, which we have designated "Matteo's law," was utilized to select properly sized stent grafts to reconstruct the confluence and prevent infolding and endoleaks.
After deployment of kissing stents at the confluence of the right internal jugular and right subclavian veins, a venogram was performed, which demonstrated successful exclusion of the pseudoaneurysm and no endoleaks. Clinical follow-up confirms continued wide open flow through the reconstructed venous confluence at 8 months post-procedure.
In reconstruction of a venous confluence, selection of properly sized stent grafts is paramount to preventing infolding and endoleaks. Matteo's law states that the circumference of the native receiving vessel must equal the sum of the circumferences of both kissing stent grafts, subtracting the redundant material where the 2 stents interface.
美国医源性血管创伤的发病率和患病率惊人。这促使了更高效有效的血管修复方法的出现和应用。尽管开放手术修复可能仍被视为金标准，但新的血管腔内治疗方案已成为其他可行选择。采用血管腔内治疗方法时，合适的支架尺寸对于成功修复至关重要。
我们报告一例在放置中心静脉导管过程中，右侧颈内静脉与右侧锁骨下静脉汇合处发生创伤性损伤并形成假性动脉瘤的病例。该医源性假性动脉瘤采用血管腔内并排放置支架进行治疗。我们使用一个数学公式（我们称之为“马泰奥定律”）来选择尺寸合适的支架移植物，以重建汇合处并防止内折和内漏。
在右侧颈内静脉与右侧锁骨下静脉汇合处植入对接支架后，进行了静脉造影，结果显示假性动脉瘤成功排除且无内漏。临床随访证实，术后8个月重建的静脉汇合处血流持续通畅。
在重建静脉汇合处时，选择尺寸合适的支架移植物对于防止内折和内漏至关重要。马泰奥定律指出，天然接收血管的周长必须等于两个对接支架移植物周长之和减去两个支架交接处的多余材料。
