Kent K C, Moscucci M, Gallagher S G, DiMattia S T, Skillman J J
Department of Surgery, Beth Israel Hospital, Boston, MA 02215.
J Vasc Surg. 1994 Jun;19(6):1008-13; discussion 1013-4. doi: 10.1016/s0741-5214(94)70212-8.
Neuropathy is a rare, but potentially morbid, complication of cardiac catheterization. In this study, we report the incidence of this complication and describe its clinical presentation, cause, and natural history.
Between 1988 and 1993, 9585 cardiac catheterizations were performed at this institution. Patients in whom femoral neuropathy developed were identified through a cardiology registry. Hospital and outpatient records and personal interviews were used to determine the presentation and clinical course of each of these patients.
Peripheral neuropathy developed in 20 patients (incidence = 0.21%). Two clinical patterns emerged. In 16 patients, large retroperitoneal hematomas were documented by either computed tomography scanning or by physical examination. These patients were admitted with a lumbar plexopathy involving the femoral, obturator, or lateral femoral cutaneous nerves. Long-term follow-up revealed persistent mild sensory neuropathy in five patients and a mild motor deficit in one. In four patients a groin hematoma or false aneurysm developed which resulted, in paresthesias involving the medial and intermediate cutaneous branches of the femoral nerve. Symptoms completely resolved in all four patients, although false aneurysms were surgically repaired in two.
Neuropathy after cardiac catheterization can be initially disabling, but it is usually completely reversible. Operation is recommended only for coexisting complications.
神经病变是心脏导管插入术一种罕见但可能致病的并发症。在本研究中，我们报告了这种并发症的发生率，并描述了其临床表现、病因及自然病程。
1988年至1993年间，本机构共进行了9585例心脏导管插入术。通过心脏病学登记系统确定发生股神经病变的患者。利用医院和门诊记录以及个人访谈来确定每位患者的表现和临床病程。
20例患者发生周围神经病变（发生率=0.21%）。出现了两种临床模式。16例患者经计算机断层扫描或体格检查证实有巨大腹膜后血肿。这些患者因涉及股神经、闭孔神经或股外侧皮神经的腰丛病变入院。长期随访显示，5例患者存在持续性轻度感觉神经病变，1例有轻度运动功能障碍。4例患者出现腹股沟血肿或假性动脉瘤，导致股神经内侧和中间皮支感觉异常。所有4例患者症状均完全缓解，尽管其中2例假性动脉瘤接受了手术修复。
心脏导管插入术后的神经病变起初可能导致功能障碍，但通常完全可逆。仅对并存的并发症建议进行手术治疗。
