一个伪困境:我们是否在过度诊断和过度治疗创伤性脏内膜性伪动脉瘤?
Sydney Radding1, Melike N Harfouche, Navpreet K Dhillon
1From the Department of Surgery (S.R.), Virginia Commonwealth University, Richmond, VA; R Adams Cowley Shock Trauma Center (M.N.H., N.K.D., K.L.H., R.K., J.S.M., J.S.R., D.V.F., R.A.K., T.M.S.), University of Maryland Medical System, Baltimore, Maryland; Department of Surgery (A.K.), Stanford University, Stanford, California; and Department of Surgery (J.J.DB.), University of Texas at Austin, Austin, Texas.
The journal of trauma and acute care surgery
|August 21, 2023
概括
现代CT扫描可能会在创伤中过度诊断脏伪动脉瘤 (PSA). 对所有已识别的PSA进行常规血管栓塞是有疑问的,因为成像和实际需要之间存在很高的不一致.
科学领域:
- 放射学 放射学是一门学科.
- 血管外科 血管外科
- 创伤管理 创伤管理
背景情况:
- 脏栓塞在稳定患者的创伤性血管异常中很常见.
- 与对比度增强的CT可能会过度诊断创伤后脏血管病变,如伪动脉瘤 (PSA).
- 过度诊断可能会导致不必要的干预.
研究的目的:
- 评估CT在识别脏伪动脉瘤 (PSA) 中的诊断准确性.
- 评估与或没有栓塞管理的脏血管病变的结果.
- 质疑对所有已识别的脏PSA进行血管栓塞的常规使用.
主要方法:
- 对于的脏损伤 (2016-2021) 的内血管管理的回顾性审查.
- 多学科综述,将初始CT检测结果与随后的血管造影进行比较.
- 对已识别的脏血管病变的管理和结果的分析.
主要成果:
- 58%的初始CT检测发现了血管病变,51%是PSA.
- 对于PSA鉴定,CT和血管造影之间存在很高的差异.
- 几乎一半的栓塞PSA在随访CT时仍然充血.
- 在非血栓化PSA患者中,脊髓切除率较低.
结论:
- 在CT和脏PSA的血管识别之间存在显著的不一致.
- 对所有脏PSA的常规血管栓塞可能不合理.
- 需要进一步研究选择性栓塞标准.
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