血液透析用カテーテルの総頚動脈への誤穿刺・挿入に対し外科的血管形成術を行った2例─血管形成法に関する考察─

Abstract

We report two cases of surgical repair of iatrogenic common carotid artery penetration of a hemodialysis catheter. One case was that of a 65-year-old man with chronic renal failure who had a misplaced hemodialysis catheter in the right common carotid artery. The catheter was removed immediately, and manual compression over the skin was applied to the injured site of the artery. Angiography revealed a pseudoaneurysm in the right common carotid artery. The patient underwent repair of the lesion under general anesthesia. A hole with a diameter of 4 mm was intraoperatively observed at the anterior wall of the right common carotid artery. The hole on the wall was sutured without inspection of the intima. Postoperative diffusion-weighted magnetic resonance imaging revealed acute ischemic lesions in the right frontal lobe. Postoperative angiography revealed an intimal flap in the anterior wall of the right common carotid artery. The other case was that of a 65-year-old woman with a misplaced hemodialysis catheter in the right common carotid artery, which caused nausea and vertigo. Diffusion-weighted magnetic resonance imaging revealed acute ischemic lesions in the right cerebellar hemisphere and left occipital lobe. Angiography revealed accidental placement of a catheter in the right common carotid artery. The patient underwent repair of the lesion under general anesthesia. A hole with a diameter of 4 mm was intraoperatively observed at the anterior wall of the right common carotid artery. Arteriotomy was additionally performed for inspection of intimal flaps, which were then trimmed. Postoperative diffusion-weighted magnetic resonance imaging revealed no additional abnormal lesions. Postoperative angiography revealed smooth arterial walls of the right common carotid artery. These findings suggest that when surgical repair is performed for patients with iatrogenic common carotid artery penetration of a hemodialysis catheter, the intima of the arterial wall is often dissected by the force of the catheter insertion. Thus, arteriotomy should be added, and the dissected intima should be trimmed to prevent artery-to-artery embolism.