Waller D A, Sivananthan U M, Diament R H, Kester R C, Rees M R
Vascular Surgical Unit, Seacroft Hospital, Leeds, UK.
Cardiovasc Surg. 1993 Jun;1(3):251-3.
Prospective data were collected over a 7-year period on patients undergoing repair of iatrogenic vascular injury following arterial cannulation. From 9375 procedures (7790 coronary angiograms, 835 coronary angioplasties, 445 other cardiac catheterizations, 155 femoral angiograms, 150 peripheral angioplasties) surgical repair was required in 26 patients. The overall incidence of significant injury was 0.28% and higher in therapeutic than diagnostic procedures. The mode of presentation included: critical limb ischaemia in 18 cases, false aneurysm in three, haematoma in three and claudication in two. The common femoral artery was the most common site of injury. No patient presenting with false aneurysm or haematoma suffered any deleterious sequelae. However, 50% of those presenting with critical ischaemia suffered permanent disability after operation. The median delay to surgery was significantly longer in this group (24 versus 4 h; P < 0.001) but there was no difference in age or incidence of underlying peripheral vascular disease. The physical, psychological and litigious sequelae of the complications of iatrogenic vascular injury cannot be overstated. It is strongly advocated that immediate surgical consultation be applied when limb ischaemia is suspected.
在7年时间里，收集了接受动脉插管后医源性血管损伤修复患者的前瞻性数据。在9375例手术（7790例冠状动脉造影、835例冠状动脉成形术、445例其他心脏导管插入术、155例股动脉造影、150例外周血管成形术）中，有26例患者需要进行手术修复。严重损伤的总体发生率为0.28%，治疗性手术中的发生率高于诊断性手术。临床表现形式包括：18例为严重肢体缺血、3例为假性动脉瘤、3例为血肿、2例为间歇性跛行。股总动脉是最常见的损伤部位。表现为假性动脉瘤或血肿的患者均未出现任何有害后遗症。然而，表现为严重缺血的患者中有50%术后出现永久性残疾。该组患者手术延迟的中位数明显更长（24小时对4小时；P<0.001），但年龄或潜在外周血管疾病的发生率无差异。医源性血管损伤并发症的身体、心理和诉讼后遗症再怎么强调都不为过。强烈建议当怀疑肢体缺血时立即进行外科会诊。
