■钝性腹部创伤是急诊就诊的最常见原因之一,在这些情况下,脾脏和脾血管系统的受累程度不同。脾动脉假性动脉瘤形成是一种具有潜在破坏性后果的并发症。鉴于其潜在的致死率,早期发现和管理至关重要。管理包括有或没有脾切除术的开放式修复,和血管内入路。微创血管内治疗提供更早的恢复,保留脾功能,和积极的结果。我们报告了一例闭合性腹部创伤后大脾动脉假性动脉瘤的延迟表现,使用血管内介入治疗。
方法:一名45岁男性在因腹部钝性损伤导致大脾动脉假性动脉瘤的行人事故10天后出现。经过多学科的讨论,决定带他接受血管内治疗.患者恢复得非常好,两天后出院,并在门诊进行随访。一年多,他变得没有症状了,并证明了放射学发现的假性动脉瘤缩小。
■内脏动脉假性动脉瘤的修复,无论其大小如何。较大的破裂风险较高,并与高死亡率相关。当被发现时,治疗方案应该很容易讨论,并承担。在我们的案例中,病人有一个6.5厘米的脾动脉假性动脉瘤,举行了一次多学科会议,并得出结论认为,血管内治疗将是最好的开始方式,与手术选项作为一个备份在混合房间设置。
结论:钝性腹部创伤可表现为内脏器官损伤的明显症状;然而,有些可能会被遗漏,需要高度怀疑,因此需要进一步的测试和成像。脾动脉假性动脉瘤可在延迟表现时扩张和破裂,早期发现和管理至关重要。血管内治疗是一种极好的治疗方式,具有最小的侵入性,更快的恢复,早期恢复日常活动,保留脾功能。
UNASSIGNED: Blunt abdominal trauma is one of the most common reasons for emergency department visits, and spleen and splenic vasculature is involved variably in those cases. Splenic artery pseudoaneurysm formation is one complication with potentially devastating consequences. Early detection and management are of paramount importance given its potential fatality. Management includes open repair with or without splenectomy, and endovascular approach. The minimally invasive endovascular treatment offers earlier recovery, preserved splenic function, and positive outcomes. We report a
case of delayed presentation of a large splenic artery pseudoaneurysm after blunt abdominal trauma, managed using endovascular intervention.
METHODS: A 45-year-old male presented 10 days after being involved in a pedestrian accident with blunt abdominal trauma resulting in a large splenic artery pseudoaneurysm. After multidisciplinary discussion, the decision was to take him for endovascular treatment. The patient recovered very well and was discharged two days later and followed up in an outpatient setting. Over a year, he became symptom free, and demonstrated radiological finding of shrinking pseudoaneurysm.
UNASSIGNED: Pseudoaneurysms of visceral arteries are repaired regardless of their size per society of vascular surgery guidelines. Larger ones are at higher risk of rupture and are associated with high mortality. When discovered, treatment plans should be readily discussed, and undertaken. In our
case, the patient had a 6.5 cm splenic artery pseudoaneurysm, and a multidisciplinary meeting was conducted and concluded that endovascular treatment would be the best modality to start with, with surgical option as a backup in a hybrid room setting.
CONCLUSIONS: Blunt abdominal trauma can present with overt symptoms of internal organ injury; however, some might be missed and need high index of suspicion and therefore further testing and imaging. Splenic artery pseudoaneurysms can expand and rupture in delayed presentation, early detection and management is of paramount importance. Endovascular treatment represents an excellent modality, with minimal invasive nature, faster recovery, and early return to daily activity with preserved splenic function.