■异物栓塞导致的急性肢体缺血是与血管闭合装置(VCD)相关的罕见但严重的并发症。尽管VCD的广泛使用,罕见的并发症,如碎片栓塞带来独特的挑战,需要提高临床意识。本病例报告介绍了一例由血管内手术后VCD功能障碍引起的急性肢体缺血。
■一名70岁男性,因右髂总狭窄而被诊断为下肢严重跛行(卢瑟福III),使用FemoSeal(TerumoLtd.,萨里,英国)关闭右股动脉通道。两周后,患者出现急性下肢缺血,由于右pop-胫骨闭塞。从内侧pop入路成功进行了急诊外科血栓栓塞切除术,还有血栓,它的远端包含一个来自VCD的聚合物光盘,已完全删除。
■尽管VCD被证明是安全高效的,罕见的并发症,如碎片栓塞可能发生,医生应该意识到可能的症状延迟发作。此外,FemoSeal中聚合物椎间盘的射线可透性使诊断成像复杂化。虽然存在血管内途径,在急性肢体缺血病例中,开放手术是一种安全有效的治疗方法。
■医生应警惕与血管闭合装置相关的栓塞风险,即使有合适的解剖结构和以下指南,特别是考虑到早期下床和出院的趋势。
UNASSIGNED: Acute limb ischaemia resulting from foreign body embolisation is an infrequent yet critical complication associated with vascular closure devices (VCDs). Despite the widespread use of VCDs, rare complications such as fragment emboli pose unique challenges, necessitating heightened clinical awareness. This case report presents a case of acute limb ischaemia caused by a VCD malfunction following an endovascular procedure.
UNASSIGNED: A 70 year old male who was diagnosed with a severe claudication of the lower extremity (Rutherford III) due to right common iliac stenosis, underwent angioplasty using a FemoSeal (Terumo Ltd., Surrey, UK) to close the right femoral artery access. Two weeks later, the patient presented with acute lower limb ischaemia due to a right popliteal-tibial occlusion. Emergency surgical thrombo-embolectomy was successfully performed from a medial popliteal approach, and the thrombus, which contained a polymer disc from the VCD at its distal end, was completely removed.
UNASSIGNED: Despite VCDs being proven safe and efficient, rare complications such as fragment emboli can occur, and physicians should be aware of the possible delayed onset of symptoms. Moreover, the radiolucent nature of the polymer disc in a FemoSeal complicates diagnostic imaging. While endovascular approaches exist, open surgery is a safe and effective strategy for retrieving fragments and treating the patient in acute limb ischaemia cases.
UNASSIGNED: Physicians should remain vigilant for embolic risks associated with vascular closure devices, even with suitable anatomy and following guidelines, especially considering the trend toward early ambulation and discharge.