1 誠馨会新東京病院臨床検査室Department of Clinical Laboratory, New Tokyo Hospital
2 誠馨会新東京病院心臓内科Clinical Department of Cardiology, New Tokyo Hospital
止血デバイスは経皮的インターベンション後の大腿穿刺部位に対し，止血に要する時間や安静時間の短縮，それによる入院期間の短縮のために，しばしば使用されている．
止血デバイス使用後の合併症診断に超音波検査が有用であった1例を経験したので報告する．
症例は80歳代女性.右総大腿動脈から経皮的冠動脈インターベンション（percutaneous coronary intervention; PCI）を行い，穿刺部に止血デバイスであるAngio-Seal™（St. Jude Medical）を用いた.翌日，右鼠径部から収縮期雑音が聴取されたため，超音波検査を行ったところ，右総大腿動脈内に等輝度エコーとそれに連続する線状エコーからなる構造物，それに伴う狭窄所見を認めた. PCI後，右足の足関節上腕血圧比（ankle brachial index; ABI）は0.84から0.60へ低下したが，症状を認めなかったため，退院後早期に外来診察において経過を観察する方針とし退院となった.退院から約4週間後に右下肢冷感,右間歇性跛行を主訴に来院し，超音波検査において右総大腿動脈の閉塞を認めた.閉塞部分に対し末梢血管インターベンション（endovascular treatment; EVT）が施行されバルーン血管形成術（balloon angioplasty）で良好な拡張が得られた.
止血デバイス使用後における下肢動脈超音波検査は早期の穿刺部合併症診断や，遅発性の合併症予測に有用であると考えられた.
Vascular closure devices (VCDs) are frequently used at the puncture site after percutaneous intervention procedures for reduced the time for hemostasis and immobilization, and shortened hospital stay. We report on a case of duplex ultrasound scanning (DUS) was useful in diagnosis of complication after deployment of the VCD.
An 80s-year-old female had been subjected to a percutaneous coronary intervention (PCI) via her right common femoral artery (CFA). At the end of the uncomplicated procedure, the puncture site was closed using an Angio-Seal™ (St. Jude Medical) device. The next day, routine physical examination of the puncture site revealed a systolic murmur over her right groin. DUS showed a stenotic lesion due to a structure of an isoechoic mass with suture-like tale. We thought that the structure was an Angio-Seal™ device that was intraluminal misplaced.
After PCI procedure, the ankle brachial index (ABI) value on the right side decreased from 0.84 to 0.60. But she had no symptoms in her lower limb, so she was discharged home.
Approximately 4 weeks after the PCI procedure, she was admitted to our hospital with coldness and claudication of her right leg. DUS showed an occluded lesion in the right CFA. Angiography revealed total occlusion in right CFA the same as DUS. Endovascular treatment (EVT) was performed. There was a good angiographic result with no significant stenosis at the end of procedure.
At follow up, the patient had no symptoms and complications in her right leg.
After VCD deployment, DUS of the puncture site is useful for early detection complications and prediction of delayed complications such as arterial occlusion.
Key words: duplex ultrasound; vascular closure device; complication; arterial occlusion
© 2017 一般社団法人日本超音波検査学会© 2017 Japanese Society of Sonographers
This page was created on 2017-02-07T13:11:15.148+09:00
This page was last modified on 2017-03-31T11:10:35.559+09:00
このサイトは（株）国際文献社によって運用されています。
