Sasaki Ryota, Maruhashi Takaaki, Kim Muneyoshi, Kurihara Yutaro, Maruki Hideo, Suzuki Koyo, Oi Marina, Asari Yasushi
Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0375, Japan.
Trauma Case Rep. 2024 Jul 29;53:101086. doi: 10.1016/j.tcr.2024.101086. eCollection 2024 Oct.
Angiography using carbon dioxide (CO) has gained attention as a method of inducing active bleeding in patients for whom bleeding cannot be detected with iodine contrast medium (ICM). We experienced a case in which CO angiography was performed during transarterial embolization (TAE) for severe liver injury with active bleeding. A woman in her 40s was struck by a minitruck while crossing the road and rushed to our hospital. Upon admission, she was in shock vital with blood pressure of 75/38 mmHg and pulse rate of 130 bpm. Blood transfusion was promptly started after arrival and her blood pressure increased. Abdominal ultrasonography showed echo free space in Morrison's pouch. Contrast-enhanced CT showed deep liver laceration in the right lobe and intra-abdominal hemorrhage with active bleeding. We selected TAE for hemostasis. ICM angiography showed extravasation of contrast medium from the anterior and posterior segmental branches, which was embolized with a gelatin sponge. After embolization, CO angiography revealed new extravasation that could not be detected by ICM, which was additionally embolized. There was no rebleeding or pseudoaneurysm after embolization. In TAE for deep liver injury, ICM alone may underestimate active bleeding. CO angiography may lead to better outcomes when injured vessels are reliably identified and TAE is performed.
使用二氧化碳（CO）进行血管造影作为一种在无法用碘造影剂（ICM）检测到出血的患者中诱导活动性出血的方法已受到关注。我们遇到了一例在经动脉栓塞术（TAE）治疗伴有活动性出血的严重肝损伤过程中进行CO血管造影的病例。一名40多岁的女性在过马路时被一辆小型卡车撞倒，随后被紧急送往我院。入院时，她处于休克状态，生命体征为血压75/38 mmHg，脉搏率130次/分。到达后立即开始输血，她的血压有所上升。腹部超声检查显示莫里森袋内有无回声区。增强CT显示右叶肝深部裂伤并伴有腹腔内活动性出血。我们选择TAE进行止血。ICM血管造影显示造影剂从肝段前后支外渗，用明胶海绵进行了栓塞。栓塞后，CO血管造影显示出ICM未能检测到的新的外渗，对其进行了额外栓塞。栓塞后未出现再出血或假性动脉瘤。在TAE治疗深部肝损伤时，仅使用ICM可能会低估活动性出血。当可靠地识别出受损血管并进行TAE时，CO血管造影可能会带来更好的治疗效果。
