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[血管穿刺、置管及具有诊断或治疗目的的放射学检查的法医学意义]

[Forensic medical implications of vascular punctures and catheterization and radiologic procedures with diagnostic or therapeutic purpose].

作者信息

Natali J, Picard J D, Melki J P

机构信息

Clinique Bizet, Paris.

出版信息

J Mal Vasc. 1996 Nov;21(4):238-47.

PMID:9005244
Abstract

Whatever the aim of the procedure, puncture of a vessel can lead to local complications. Access to the artery carries a risk of hemorrhage, occlusion, stenosis, arteriovenous fistulization or pseudo-aneurysm. The same types of complications can occur in veins. Other complications include skin necrosis due to extravasation of the contrast medium, perforation of the superior vena cava after insertion of an infusion catheter and the risk of pericardial effusion. General complications occur immediately, usually caused by contrast media, or late. There are different examples of secondary legal procedures following punctures involving, with the exception of radiology cases, intraarterial injection at the elbow, perforation of the right atrium by a jugular catheter and acute ischemia of the foot after catheterization of the pedial artery. Legal procedures after radiological procedures were discussed in more detail. The personal experience of the authors and others concerns accidents occurring after arteriography, angioplasty or embolization. Finally, two legal cases after treatment for impotency are analyzed. We focus on a certain number of rules on patient information, preangiography consultation, participation of an anesthetist, careful post-operative follow-up and operation report. Finally, the possibility of radiation-induced arteriopathy is demonstrated by one case reported here.

摘要

无论该操作的目的为何,血管穿刺都可能导致局部并发症。动脉穿刺存在出血、闭塞、狭窄、动静脉瘘形成或假性动脉瘤的风险。静脉穿刺也可能出现相同类型的并发症。其他并发症包括造影剂外渗导致的皮肤坏死、输液导管插入后上腔静脉穿孔以及心包积液的风险。一般并发症可立即出现,通常由造影剂引起,也可延迟出现。除放射学病例外,穿刺后涉及的二级法律程序有不同实例,如肘部动脉内注射、颈静脉导管穿破右心房以及足背动脉插管后足部急性缺血。放射学操作后的法律程序进行了更详细的讨论。作者及其他人的个人经历涉及动脉造影、血管成形术或栓塞术后发生的事故。最后,分析了两例阳痿治疗后的法律案例。我们重点关注一些关于患者信息、血管造影术前咨询、麻醉师参与、术后仔细随访及手术报告的规则。最后,本文报告的一例病例证明了放射性动脉病的可能性。

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