Shah Muhammad Usman, Poudyal Krishna, Goubran Ramy, Ahmed Adnan, Naqvi Yaseen Syed
Registrar.
Consultant Department of Cardiology, Hull University Teaching Hospitals NHS Trust, Castle Hill Hospital, Castle Road, Cottingham, HU16 5JQ.
Br J Cardiol. 2023 Nov 29;30(4):45. doi: 10.5837/bjc.2023.045. eCollection 2023.
Primary percutaneous coronary intervention (PPCI) remains the gold-standard treatment for ST- elevation myocardial infarction (STEMI). Femoral arterial access for the procedure may be an ideal option in patients who are haemodynamically unwell. However, it is associated with rare, but life- threatening, complications such as perforation, leading to retroperitoneal haemorrhage. We present the case of a man in his 50s, admitted with cardiac arrest secondary to inferolateral STEMI. Successful PPCI was performed via right femoral artery, with access gained under ultrasound guidance. However, the patient deteriorated and was diagnosed to have a retroperitoneal haematoma secondary to femoral artery perforation. Additional arterial access via left brachial artery was obtained, and a covered stent was deployed successfully in the right femoral artery with satisfactory haemostasis. The patient recovered successfully and was discharged two weeks later. Early recognition of such complications is imperative to adequate management and percutaneous treatment is a viable option for such situations, in comparison with open surgical repair.
直接经皮冠状动脉介入治疗（PPCI）仍然是ST段抬高型心肌梗死（STEMI）的金标准治疗方法。对于血流动力学不稳定的患者，该手术采用股动脉入路可能是理想选择。然而，它会伴发罕见但危及生命的并发症，如穿孔，进而导致腹膜后出血。我们报告了一例50多岁男性患者，因下外侧STEMI继发心脏骤停入院。通过右股动脉成功进行了PPCI，在超声引导下获得入路。然而，患者病情恶化，被诊断为股动脉穿孔继发腹膜后血肿。通过左肱动脉获得了额外的动脉入路，并在右股动脉成功植入了覆膜支架，止血效果满意。患者成功康复，两周后出院。早期识别此类并发症对于妥善处理至关重要，与开放手术修复相比，经皮治疗是此类情况的可行选择。
