Department of Kinesiology, Université Laval, Quebec, QC, Canada.
CISSS Chaudière-Appalaches (CHAU-Hôtel-Dieu de Lévis), Hyperbaric Medicine Unit, Emergency Department, Lévis, QC, Canada.
Diving Hyperb Med. 2024 Sep 30;54(3):188-195. doi: 10.28920/dhm54.3.188-195.
Aortic dissections and dissections of cervical, cerebral, and coronary arteries have been previously reported in scuba divers. These incidents may be the consequence of a variety of physiological effects. We review the reported cases of arterial dissection in scuba divers and discuss potential contributing factors related to immersion and diving.
Medline, CINAHL Plus, and SPORTDiscus were searched for published reports of arterial dissection and the Australasian Diving Safety Foundation fatality database was searched for additional cases from Australia. Identified cases were recorded and scrutinised for possible contributing factors.
Nineteen cases of arterial dissection, both fatal and non-fatal, were identified. These included cervical or intracranial artery dissection (n = 14), aortic dissection (n = 4), and coronary artery dissection (n = 1). There were 14 male and five female victims; mean age 44 years (SD 14, range 18-65). Contributing factors may include a combination of vasoconstriction and blood redistribution, untreated hypertension, increased pulse pressure, abnormal neck movement or positioning, constrictive and burdensome equipment, exercise, increased gas density and circuit resistance with concomitant elevated work of breathing, atheroma, and possibly the mammalian dive response.
Dissecting aneurysms of the aorta or cervical, cerebral, and coronary arteries should be considered as a potential complication of scuba diving. The development of aneurysms associated with scuba diving is likely multifactorial in pathogenesis. Detailed reporting is important in the evaluation of cases. The potential role of the mammalian dive response as a contributing factor requires further evaluation.
在水肺潜水员中，先前曾报道过主动脉夹层和颈、脑、冠状动脉夹层。这些事件可能是多种生理效应的结果。我们回顾了潜水员动脉夹层的报告病例，并讨论了与浸入和潜水相关的潜在促成因素。
在 Medline、CINAHL Plus 和 SPORTDiscus 上搜索动脉夹层的已发表报告，并在澳大利亚潜水安全基金会的死亡数据库中搜索澳大利亚的其他病例。记录并仔细检查已确定的病例，以寻找可能的促成因素。
共确定了 19 例动脉夹层，包括致命和非致命病例，包括颈内或颅内动脉夹层（n = 14）、主动脉夹层（n = 4）和冠状动脉夹层（n = 1）。有 14 名男性和 5 名女性受害者；平均年龄 44 岁（标准差 14，范围 18-65）。促成因素可能包括血管收缩和血液再分配、未治疗的高血压、脉搏压增加、异常颈部运动或姿势、紧身和负担过重的设备、运动、增加的气体密度和回路阻力以及随之而来的呼吸功增加、动脉粥样硬化，以及哺乳动物潜水反应。
应将主动脉或颈、脑、冠状动脉的夹层动脉瘤视为水肺潜水的潜在并发症。与水肺潜水相关的动脉瘤的发生机制可能是多因素的。详细报告对于评估病例很重要。哺乳动物潜水反应作为促成因素的潜在作用需要进一步评估。
