导管相关的医源性主动脉夹层及主动脉壁间血肿临床治疗经验
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摘要
目的:导管相关的医源性主动脉夹层及主动脉壁间血肿发生率较低且相关报道有限,介绍和探讨我中心对此种并发症的临床治疗经验以及其临床效果。方法:在2016年5月至2018年1月期间,安贞医院共有8例因导管检查和治疗导致医源性主动脉夹层及主动脉壁间血肿患者,1例发生在心脏电生理检查和射频消融操作过程中,7例发生在冠状动脉造影检查及冠状动脉介入支架治疗操作过程中。3例为A型主动脉壁间血肿,1例为右冠状动脉窦局限性夹层,4例为A型主动脉夹层。4例(3例A型主动脉壁间血肿、1例局限性夹层)行保守治疗,4例A型主动脉夹层行急诊手术治疗。对8例患者均行定期随访及主动脉CTA复查。结果:1例保守治疗的A型主动脉壁间血肿患者1个月后再发胸痛,主动脉弓新发主动脉溃疡,行手术治疗。8例患者无住院死亡,且均无脑梗死、截瘫、心力衰竭等严重发症,远期随访结果均存活且恢复良好。结论:导管相关的医源性主动脉夹层及主动脉壁间血肿是一种发生率较低的并发症,但是出现此并发症可以导致严重的后果,通过对病情的综合判断采用合理的保守治疗和外科治疗方法都可以得到较理想的临床效果。
Objective: Transcather iatrogenic aortic dissection and aortic hematoma is rare and the literature is limited. We aimed to present and probe the clinical experience at anagement of this complication.Methods: From May 2015 to January 2018,8 consecutive patients were diagnosed as transcather iatrogenic aortic dissection or aortic hematoma. 1 case occurred during electrophysiological examination and radiofrequency ablation. 7 cases occurred during percutaneous coronary angiography or percutaneous coronary intervention.Complications included: type A aortic hematoma in 3 patients,local aortic dissection in 1 patient and type A aortic dissection in 4 patients. Management included: conservative treatment in 4 patients which were 3 type A aortic hematoma patients and 1 local aortic dissection patients,surgical treatment in 4 type A aortic dissection.Follow-up and CT angiography were implemented in 8 patients. Results: 1 type A aortic hematoma patients underwent recurrence of chest pain and surgical treatment at 1 month after conservative treatment. There was no early mortality and severe cardiovascular complication including cerebral infarction,paralysis,heart failure and so on. Good result was obtained in long-term outcome. Conclusions: Transcather iatrogenic aortic dissection and aortic hematoma is rare but life-threatening. Comprehensive,feasible and effective strategy including conservative and surgical treatment could obtain ideal clinical effect.
Objective: Transcather iatrogenic aortic dissection and aortic hematoma is rare and the literature is limited. We aimed to present and probe the clinical experience at anagement of this complication.Methods: From May 2015 to January 2018,8 consecutive patients were diagnosed as transcather iatrogenic aortic dissection or aortic hematoma. 1 case occurred during electrophysiological examination and radiofrequency ablation. 7 cases occurred during percutaneous coronary angiography or percutaneous coronary intervention.Complications included: type A aortic hematoma in 3 patients,local aortic dissection in 1 patient and type A aortic dissection in 4 patients. Management included: conservative treatment in 4 patients which were 3 type A aortic hematoma patients and 1 local aortic dissection patients,surgical treatment in 4 type A aortic dissection.Follow-up and CT angiography were implemented in 8 patients. Results: 1 type A aortic hematoma patients underwent recurrence of chest pain and surgical treatment at 1 month after conservative treatment. There was no early mortality and severe cardiovascular complication including cerebral infarction,paralysis,heart failure and so on. Good result was obtained in long-term outcome. Conclusions: Transcather iatrogenic aortic dissection and aortic hematoma is rare but life-threatening. Comprehensive,feasible and effective strategy including conservative and surgical treatment could obtain ideal clinical effect.
引文
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[5]戎天华,潘旭东,刘宁宁,等.Stanford A型主动脉夹层合并急性下肢缺血的临床研究现状与展望.心肺血管病杂志,2015,34(11):867-870.
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[8]Burstow D,Poon K,Bell B,et al.Anterior ECG changes following iatrogenic dissection of the right coronary artery into the aortic root:exclusion of left coronary obstruction with transoesophageal echocardiography.Cardiovasc Res,2013,14(2):102-105.
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[2]Muhyieddeen K,Samim A,Roberts M,et al.A case of iatrogenic aortic intramural hematoma.MDCSJ,2017,13(1):37-38.
[3]Yip HK,Wu CJ,Yen KH,et al.Unusual complication of retrograde dissection to the coronary sinus of valsalva during percutaneous revascularization:a single-center experience and literature review.Chest,2001,119(2):493-501.
[4]June E,Shin JH,Kim JH,et al.Arterial dissections during transcatheter arterial chemoembolization for hepatocellular carcinoma:a 19-year clinical experience at a single medical institution.Acta Radiol,2017,58(7):842-848.
[5]戎天华,潘旭东,刘宁宁,等.Stanford A型主动脉夹层合并急性下肢缺血的临床研究现状与展望.心肺血管病杂志,2015,34(11):867-870.
[6]尚蔚,刘楠,闫晓蕾,等.A型主动脉夹层手术后早期并发症分析.心肺血管病杂志,2011,30(3):183-186.
[7]Fang HY,Wu CJ.Migrating type A intramural hematoma after repair of an anomalous right coronary artery aortocoronary dissection with a covered stent.Catheter Cardio In,2011,78(4):573-576.
[8]Burstow D,Poon K,Bell B,et al.Anterior ECG changes following iatrogenic dissection of the right coronary artery into the aortic root:exclusion of left coronary obstruction with transoesophageal echocardiography.Cardiovasc Res,2013,14(2):102-105.
[9]Ye Xinhe,Yang Chengjian,Jin Yan,et al.A successful emergency management of spontaneous coronary artery dissection and review of the literature.Am J Emerg Med,2013,31(7):1156.e1-3.