Kinkori Takeshi, Watanabe Kenichi, Kato Naoki
Department of Neurosurgery, Okazaki City Hospital, Okazaki, Aichi, Japan.
Department of Radiology, Okazaki City Hospital, Okazaki, Aichi, Japan.
J Neuroendovasc Ther. 2020;14(3):108-111. doi: 10.5797/jnet.cr.2019-0085. Epub 2020 Feb 12.
We experienced a case of difficult catheterization to the left brachiocephalic vein (LBCV) during transfemoral transvenous embolization for traumatic carotid-cavernous fistula. We discussed the cause of this phenomenon.
A 78-year-old woman with a traumatic carotid-cavernous fistula was treated with combined transarterial and transvenous embolization; however, catheterization to the LBCV was very difficult. A balloon guiding catheter (BGC) already placed in the left common carotid artery (LCCA) caused displacement of the LCCA and further compression of the originally stenotic LBCV.A CT investigation of 104 cases of neuroendovascular treatment in our hospital revealed that the distance between the ventral bones and the dorsal arteries sandwiching the LBCV was significantly negatively correlated with age (r = -0.41, p = 0.000020). Aging and arteriosclerotic change are possibly related to the LBCV stenosis.
When catheterization to the LBCV is difficult during transfemoral transvenous embolization, not only the presence of anatomical variations and stenosis or occlusion of LBCV itself but also compression from surrounding structures should be considered, especially in elderly patients. In rare cases, a catheter inserted in an adjacent artery may cause further compression of the LBCV.
我们在经股静脉栓塞治疗外伤性颈内动脉海绵窦瘘的过程中遇到了一例难以将导管插入左头臂静脉（LBCV）的情况。我们对这一现象的原因进行了讨论。
一名78岁患有外伤性颈内动脉海绵窦瘘的女性接受了经动脉和经静脉联合栓塞治疗；然而，将导管插入LBCV非常困难。已置于左颈总动脉（LCCA）的球囊引导导管（BGC）导致LCCA移位，并进一步压迫原本就狭窄的LBCV。对我院104例神经血管内治疗病例的CT研究显示，夹着LBCV的腹侧骨骼与背侧动脉之间的距离与年龄呈显著负相关（r = -0.41，p = 0.000020）。衰老和动脉硬化改变可能与LBCV狭窄有关。
在经股静脉栓塞过程中，当难以将导管插入LBCV时，不仅应考虑LBCV本身存在解剖变异、狭窄或闭塞的情况，还应考虑周围结构的压迫，尤其是在老年患者中。在罕见情况下，插入相邻动脉的导管可能会导致LBCV进一步受压。
