Yonemitsu Takafumi, Shibata Naoaki, Shima Nozomu, Fuchigami Junya, Miyake Yuichi, Ikoma Akira, Minamiguchi Hiroki, Sonomura Tetsuo, Kato Seiya
Department of Emergency and Critical Care Medicine Wakayama Medical University Wakayama City Japan.
Department of Radiology Wakayama Medical University Wakayama City Japan.
Acute Med Surg. 2023 Feb 23;10(1):e823. doi: 10.1002/ams2.823. eCollection 2023 Jan-Dec.
Angioembolization for traumatic pancreaticoduodenal artery injury with unstable circulation, which characteristically requires a prolonged procedure time, does not yet have a standardized strategy for damage control interventional radiology.
We encountered two cases of rare traumatic pancreaticoduodenal artery injury wherein the patients were saved by a multidisciplinary team with a shared goal of clinical success, rather than the procedural success of angioembolization. Both patients treated with angioembolization had residual pseudoaneurysm or faint extravasation in the pancreaticoduodenal artery arcade. We prioritized critical care with preemptive plasma transfusion and aggressive blood pressure control, and planned repeat angiography. The patients showed no clinical signs of rebleeding or pseudoaneurysm based on computed tomography during follow-up.
Our findings suggest that the permissive untreated pseudoaneurysm concept can be useful in developing damage control interventional radiology strategies for trauma cases with challenging time limitations, such as traumatic pancreaticoduodenal artery injury with circulatory collapse.
对于循环不稳定的创伤性胰十二指肠动脉损伤进行血管栓塞治疗，其特点是手术时间较长，目前尚未有损伤控制介入放射学的标准化策略。
我们遇到了两例罕见的创伤性胰十二指肠动脉损伤病例，通过多学科团队共同实现临床成功而非血管栓塞手术成功的目标，挽救了患者生命。接受血管栓塞治疗的两名患者在胰十二指肠动脉弓处均有残留假性动脉瘤或轻微渗漏。我们优先进行了抢先输血和积极控制血压的重症监护，并计划重复血管造影。随访期间，根据计算机断层扫描，患者未出现再出血或假性动脉瘤的临床迹象。
我们的研究结果表明，允许未治疗的假性动脉瘤概念可能有助于为具有挑战性时间限制的创伤病例制定损伤控制介入放射学策略，例如伴有循环衰竭的创伤性胰十二指肠动脉损伤。
