腔内技术治疗医源性血管损伤的临床应用

Application of endovascular technique in treatment of iatrogenic vascular injury

目的探讨腔内技术在医源性血管损伤(iatrogenic vascular injury,IVI)治疗中的应用价值。方法回顾性分析2018年12月至2022年6月期间因IVI于我院行腔内治疗11例患者资料,包括静脉性IVI 4例,动脉性IVI 5例,血管内异物2例。IVI治疗方法包括腔内压迫、血管破裂口填塞、经皮血管内支架植入(percutaneous intravascular stent implantation,PISI)及血管缝合器(vascular closure devices,VCDs)腔内缝合。血管内异物治疗方法为导管辅助抓捕器腔内套取。分析腔内治疗的手术方式,统计手术成功率及手术相关并发症。结果所有患者均顺利完成腔内治疗IVI,技术成功率100%。1例静脉性IVI患者行PISI术后3 d复查示支架内血栓形成;1例动脉性IVI患者予行股动脉腔内封堵联合假性动脉瘤腔内注射促凝血药物治疗后4 d股动脉假性动脉瘤复发,予行外科切开缝合;1例静脉性IVI患者行腔内压迫止血无效后予弹簧圈及明胶海绵栓塞治疗术后4 d死亡,但与腔内治疗髂静脉IVI未存在明确相关性。余所有病例均未出现明显手术相关并发症及围手术期死亡。手术临床成功率81.82%,手术相关并发症发病率9.09%。无手术相关严重并发症发生。结论腔内技术以微创方式治疗IVI,术中创伤小、术后恢复快,值得临床推广;同时,血管侵入性操作的术前评估及术后观察亦非常重要。

Objective To explore the endovascular technique in the treatment of iatrogenic vascular injury(IVI).Methods Medical records of 11 patients who suffered from IVI and underwent endovascular treatment at our institute from December 2018 to June 2022 were reviewed.There were 4 cases of venous IVI,5 cases of arterial IVI and 2 case of intravascular foreign body.The treatment of IVI included intravascular compression,embolism of the vascular rupture,percutaneous intravascular stent implantation(PISI)and intravascular suture with vascular closure devices(VCDs).The intravascular foreign body was captured by using a snarer assisted with a catheter.The methods of endovascular treatment were analyzed,and the operation success and complications related to the operation were concerned.Results Technical success was achieved in 11 patients(100%).One patient with venous IVI underwent PISI during the process,and was detected with in-stent thrombosis at post-operative 3 days.One patient with arterial IVI was treated with intravascular compression combined with injection of procoagulant drugs for pseudoaneurysm,and the femoral artery pseudoaneurysm recurred 4 days later,then underwent surgery.One patient died 4 days after endovascular compression combined with embolization,but there was no correlation between the endovascular treatment of IVI.All the other cases had no obvious complications related to the treatment,and no death was encountered.The clinical success rate of operation was 81.82%,and the incidence of complications was 9.09%.There were no serious complications related to the operation.Conclusions As a minimally invasive method to treat IVI with small trauma and rapid post-operative recovery,endovascular technique is worthy of clinical promotion.Meanwhile,pre-operative evaluation and post-operative observation should also be concerned.