Iatrogenic Pseudoaneurysm Caused by Central Venous Cannulation-3 Case Reports

中心靜脈導管插入所引發的偽動脈瘤－病例報告三例

劉旭崇(Hsu-Chung Liu) ； 張開明(Ki-Ming Chang) ； 許正園(Jeng-Yuan Hsu)

《胸腔醫學》 22卷4期 (2007/08) Pp. 265-272

https://doi.org/10.29806/TM.200708.0007

摘要

偽動脈瘤是中心靜脈導管插入過程所引發的嚴重併發症之一。案例一是經由左側鎖骨下靜脈插管不慎所造成，案例二及案例三則是經由右側內頸靜脈插管所引發。在這些案例中我們分別採用不同的診斷檢查，包括傳統血管攝影及多層次電腦斷層血管攝影。治療部分，案例－乃是接受動脈導管栓塞術且成功，另外兩例則是接受傳統外科修復手術。總結來說，多層次電腦斷層血管攝影術有較非侵入性的優點，且已經漸漸取代傳統血管攝影術成為評估頭部血管損傷的首選檢查。另一方面，目前對於偽動脈瘤的治療已經有越來越多新的方式，在臨床應用上包括超音波引導下壓迫、動脈導管栓塞術、超音波引導凝血酶注射、以及外科修復手術等等，對於選擇那一種治療還是取決於臨床醫師對病人病情的考量以及各種治療的適用性。

關鍵字

偽動脈瘤 ； 中心靜脈導管 ； 血管攝影 ； 多層次電腦斷層血管攝影 ； 動脈導管栓塞術

並列摘要

Pseudoaneurysm of great vessels is 1 of the severe mechanical complications that can occur during central venous cannulation. Our first case developed a pseudoaneurysm after cannulation via the left subclavian route; the second and third cases developed a pseudoaneurysm after cannulation via the right internal jugular route. Different diagnostic examinations, including conventional angiography and Multi-Detector Computed Tomography (MDCT) angiography were used in these cases, respectively. Successful transcatheter embolization of the pseudoaneurysm was performed in case 1. Case 2 and case 3 received conventional surgical repair due to the different anatomical location. In conclusion, MDCT angiography is adequate for the initial evaluation of neck vessel injury, and has the advantage of less invasiveness compared with conventional angiography. The treatment options include ultrasound-guided compression, transcatheter interventions, percutaneous thrombin injection, and open surgical repair. The choice should always be based on the clinician's judgment and applicability to the clinical condition.

並列關鍵字

pseudoaneurysm ； central venous cannulation ； conventional angiography ； multi-detector computed tomography angiography ； transcatheter embolization