Nehler M R, Taylor L M, Porter J M
Department of Surgery, University of Colorado Health Sciences Center, Denver, USA.
Semin Vasc Surg. 1998 Dec;11(4):283-93.
With the increasing performance of percutaneous transluminal angioplasty and insertion of an increasing number of intravascular devices, the size of arterial punctures has been increasing. A consistent minority of these procedures will result in vascular injuries requiring treatment. At the same time, the regionalized nature of trauma care in the United States has resulted in a large number of vascular surgeons who are exposed to vascular trauma only when iatrogenic. The most common injuries observed are caused by percutaneous vascular instrumentation and include hemorrhage and pseudoaneurysm that may compress adjacent structures, fistula, acute occlusion, and embolization. Injuries unique to balloon angioplasty/stenting include arterial rupture and dissection. Indwelling intravascular devices are another common source of iatrogenic vascular injury ranging from arterial rupture to thrombosis and embolization. Much less common injuries are observed in orthopedic and abdominal/laparoscopic operations but show reproducible causes/patterns. Finally, pediatric iatrogenic vascular trauma is relatively common because of the small size of the vasculature, but the natural history and management is markedly different from that in adults.
随着经皮腔内血管成形术的性能不断提高以及越来越多血管内装置的植入，动脉穿刺的尺寸一直在增大。这些操作中始终有一小部分会导致需要治疗的血管损伤。与此同时，美国创伤护理的区域化性质导致大量血管外科医生只有在医源性情况下才会接触到血管创伤。观察到的最常见损伤是由经皮血管器械操作引起的，包括可能压迫相邻结构的出血和假性动脉瘤、瘘管、急性闭塞和栓塞。球囊血管成形术/支架置入术特有的损伤包括动脉破裂和夹层。留置血管内装置是医源性血管损伤的另一个常见来源，范围从动脉破裂到血栓形成和栓塞。在骨科和腹部/腹腔镜手术中观察到的损伤要少见得多，但有可重复的原因/模式。最后，由于脉管系统较小，儿科医源性血管创伤相对常见，但其自然病程和处理方法与成人明显不同。
