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心血管异物取出及其处理流程

Cardiovascular foreign body retrieval and its management algorithm.

作者信息

Salimi Javad, Rasekhi Siahkalmahalleh Mohammad, Miratashi Yazdi Seyed Amir

机构信息

Vascular and Endovascular Surgery Department Sina hospital, Tehran University of Medical Sciences Tehran Iran.

School of Medicine Tehran University of Medical Sciences Tehran Iran.

出版信息

Clin Case Rep. 2023 Sep 8;11(9):e7911. doi: 10.1002/ccr3.7911. eCollection 2023 Sep.

Abstract

Application of central venous catheters become more common however a rare complication, embolization, can occur which lead to high mortality rate. Therefore, cardiovascular foreign bodies should be immediately remove with a safe and effective method and algorithm. So, we investigate the results of cardiovascular foreign body retrieval in our center based on a designed algorithm. In this case series study, patients who had cardiovascular foreign body embolization were managed by our algorithm. Our approach was based on the time duration of foreign body embolization in cardiovascular system and also its location. If the embolization time was less than 48 h, based on the location of foreign body, insertion site would be right femoral or jugular vein. If the time of foreign body embolization was more than 48 h, echocardiography should be done to assess thrombosis around foreign body. Retrieval was done with snare technique in all patients. Over 12 patients, 9 patient had port catheter foreign body in SVC and atrium, 1 patient had port catheter in atrium, 1 patient had port catheter in pulmonary artery and 1 patient had hemodialysis catheter in inferior vena cava (IVC) and atrium. Foreign body retrieval was successful in all 11 patient. The IVC and atrium were the common site of port catheter fragments. According to our experience, we organize a useful algorithm for retrieval of cardiovascular foreign body based on time of embolization and its location.

摘要

中心静脉导管的应用变得更加普遍,然而,一种罕见的并发症——栓塞可能会发生,这会导致高死亡率。因此,心血管异物应采用安全有效的方法和流程立即取出。所以,我们基于一种设计好的流程,研究了我们中心心血管异物取出的结果。在这个病例系列研究中,患有心血管异物栓塞的患者按照我们的流程进行处理。我们的方法基于异物在心血管系统中的栓塞时长及其位置。如果栓塞时间少于48小时,根据异物位置,插入部位将是右股静脉或颈静脉。如果异物栓塞时间超过48小时,应进行超声心动图检查以评估异物周围的血栓形成。所有患者均采用圈套技术进行取出。在12例患者中,9例患者的中心静脉导管异物位于上腔静脉和心房,1例患者的中心静脉导管位于心房,1例患者的中心静脉导管位于肺动脉,1例患者的血液透析导管位于下腔静脉和心房。11例患者的异物取出均成功。下腔静脉和心房是中心静脉导管碎片的常见部位。根据我们的经验,我们基于栓塞时间及其位置,组织了一种有用的心血管异物取出流程。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c99c/10491749/6705b1845523/CCR3-11-e7911-g003.jpg

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