背景:肋间动脉出血通常发生在单个血管中;在极少数情况下,它可以发生在许多血管中,使其更难以管理。
方法:一名63岁的日本男子因突然的胸部和背部疼痛而进入急诊室,头晕,和恶心。急诊冠状动脉造影显示右冠状动脉闭塞继发心肌梗死。主动脉内球囊抽吸后,在右冠状动脉进行经皮冠状动脉介入治疗。经皮冠状动脉介入术后12小时,患者出现新发左前胸痛和低血压.对比增强计算机断层扫描显示,左侧大量胸膜外血肿中有15个造影剂外渗部位。急诊血管造影显示左侧第6至第11肋间动脉有造影剂渗漏;因此,经导管动脉栓塞术.经导管动脉栓塞术后2天,他的血压随后下降,和对比增强计算机断层扫描显示胸膜外血肿重新扩大,并有多个造影剂外渗。由于持续出血,进行了急诊手术。术中未观察到活动性动脉出血。在胸壁的各个区域观察到出血,消融和止血后应用氧化纤维素膜。术后病程顺利。
结论:我们报告了一例在机械循环支持的抗血栓治疗中,多个血管同时发生自发性肋间动脉出血的病例。由于在抗血栓治疗期间可能会发生许多血管的出血,即使没有外伤,适当的治疗,如经导管动脉栓塞和手术,应选择有此类病例的患者。
BACKGROUND: Intercostal artery bleeding often occurs in a single vessel; in rare cases, it can occur in numerous vessels, making it more difficult to manage.
METHODS: A 63-year-old Japanese man was admitted to the emergency department owing to sudden chest and back pain, dizziness, and nausea. Emergency coronary angiography revealed myocardial infarction secondary to right coronary artery occlusion. After intra-aortic balloon pumping, percutaneous coronary intervention was performed in the right coronary artery. At 12 hours following percutaneous coronary intervention, the patient developed new-onset left anterior chest pain and hypotension. Contrast-enhanced computed tomography revealed 15 sites of contrast extravasation within a massive left extrapleural hematoma. Emergency angiography revealed contrast leakage in the left 6th to 11th intercostal arteries; hence, transcatheter arterial embolization was performed. At 2 days after transcatheter arterial embolization, his blood pressure subsequently decreased, and contrast-enhanced computed tomography revealed the re-enlargement of extrapleural hematoma with multiple sites of contrast extravasation. Emergency surgery was performed owing to persistent bleeding. No active arterial hemorrhage was observed intraoperatively. Bleeding was observed in various areas of the chest wall, and an oxidized cellulose membrane was applied following ablation and hemostasis. The postoperative course was uneventful.
CONCLUSIONS: We report a
case of spontaneous intercostal artery bleeding occurring simultaneously in numerous vessels during antithrombotic therapy with mechanical circulatory support that was difficult to manage. As bleeding from numerous vessels may occur during antithrombotic therapy, even without trauma, appropriate treatments, such as transcatheter arterial embolization and surgery, should be selected in patients with such cases.