2011, Number 3
Ferrufino MAL, Rodríguez TJM, Escotto SI, Rodríguez RN
PDF size: 267.75 Kb.
ABSTRACTObjective: To describe the presentation and managing of a vascular venous injury for iatrogenic and resolved by Angiologia’s Service, Vascular Surgery and Endovascular of the Medical National Center 20 November. ISSSTE.
Case report: Headquarters: hospital of the third level of attention. Design: case report. Description of the case: Female 59-year-old with a history of arterial hypertension, diabetes mellitus as well as renal chronic disease of long evolution, entered to the Service Admission Adults with diagnosis of renal chronic disease sharpened, renal acute injury AKIN-3, diabetes mellitus type II, arterial systemic hypertension E2 JNC 7. With indication for substitution of the renal function, for hiperazoemia severe and metabolic unbalanced acidose. The Nephrology Service proceeded to the placement of catheter mahurkar for hemodialysis with access to level of vein subclavia left. Interconsultation was requested to Angiologia’s Service to value dysfunction of catheter of hemodialysis. In the X-ray inadequate placement of catheter of hemodialysis was observed by irruption of the same one towards thorax, with pneumothorax of 30%, so we proceeded to evaluation in room of fluoroscopy, being realized flebography, arteriography of the catheter insertion site without evidence of leakage, it was decided the removal of the left subclavian hemodialysis catheter, sowing the same output of abundant hematic material with high pressure for what there realized puncture of brachial left vein and new flebography of control with evidence of leakage to level of vein subclavian left side and solution of continuity to level of his walls, concluding tear of vein subclavian left secondary iatrogenic to placement of catheter mahurkar with bled profusely. Across brachial left vein liberating Stent graft and under vision fluoroscophy it was liberated without endoleake or migration being sealed. Pleural probe was placed to level of hemithorax left and under puncture guided by ultrasound and fluoroscophy we place catheter mahurkar jugular rightly. The evolution was satisfactory, without vascular complications of the extremity, to the fourth day we withdraw endopleural probe from her for decrease of the expenses of the same one and was decided discharge of Angiologia’s Service.
Conclusions: To have the honesty and ethical beginning to recognize the limits of our preparation and experience will allow us to diminish the complications iatrogenic that our patients could suffer.