内頸静脈穿刺時の椎骨動脈損傷に対して血管内治療を行った1症例

A Case of Endovascular Treatment of a Vertebral Artery Injury during Internal Jugular Vein Puncture

要旨

　78歳，男性。右内頸静脈から挿入した肺動脈カテーテル用のシースが，右椎骨動脈に迷入していた。左椎骨動脈に低形成を認めなかったため，右椎骨動脈をコイル塞栓した。術後，神経学的脱落症状はなかった。椎骨動脈への誤挿入に対して，対側椎骨動脈の血流異常がなければ，コイル塞栓により安全にシースを抜去できる可能性がある。

　We describe a case of endovascular embolization performed to treat a vertebral artery injury that occurred during an internal jugular vein puncture. Although the puncture of a vertebral artery is a rare complication, it can cause fatal complications, e.g., stroke. The patient was a 78-year-old Japanese male who underwent pulmonary artery catheterization due to heart failure. One hour later, computed tomography revealed that the sheath of the pulmonary artery catheter had penetrated the patient’s right internal jugular vein and was inserted into the right vertebral artery. Complete hemostasis was achieved by endovascular embolization of the right vertebral artery, and the sheath was safely removed with the patient under general anesthesia. He had no neurological symptoms. This case highlights the following need for caution：if a catheter is accidentally inserted into a patient’s vertebral artery, intervention is likely to be necessary prior to its removal. Endovascular embolization appears to be an effective option for the safe removal of an inserted vertebral artery catheter.