両下肢静脈瘤に対するレーザー焼灼術後に突然の意識消失,呼吸困難を来し不幸な転帰をもたらした1 例  [in Japanese] A Case of Pulmonary Thromboembolism after Endovenous Laser Ablation of Varicose Vein, Presenting Sudden Dyspnea and Presyncope  [in Japanese]

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Abstract

症例は71 歳女性.左足関節痛,両下肢違和感にて当院受診した.両大腿内側から下腿に伏在静脈瘤を認めた.下肢静脈超音波にて両側大腿- 大伏在静脈接合部に逆流を認めたため,全身麻酔にて両下肢に血管内レーザー焼灼術(endovenous laser ablation: EVLA),静脈瘤切除,硬化療法を施行した.術後1 日目病棟歩行時突然の呼吸困難,背部痛にてCT 室搬送となり,心停止により緊急挿管された.ポータブルUS にて右心系収縮不全あり,術後DVT,PTE を疑い緊急下大静脈フィルター留置し,ヘパリン,ウロキナーゼ投与するも全身動態に安定みられず同日夜永眠となった.本邦の文献を調べた限り下肢静脈瘤に対するEVLA 後に肺血栓塞栓症(pulmonary thromboembolism: PTE)を併発した死亡症例の報告はないため,この誌を借りて報告する.

A 71-year-old female patient visited our hospital complaining of left leg joint pain and discomfort of lower extremities. Duplex ultrasound showed incompetent on bile femoral-saphenous vein junction. She was diagnosed of C2 Ep, As, Pr on CEAP classification and performed endovenous lser ablation (EVLA), varisectomy, form sclerotherapy on general anesthesia. On the first post-operative day, she collapsed after starting to walk, and presented with sudden loss of dyspnea. Portable US presented insufficiency of right heart and postoperative deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE) were suspected to occur prior to transfer to CT room. In spite of IVC filter implantation and thrombolytic therapy, hemodynamic stabilization of the patient was not maintained to recover. Although fatal PTE is a rare complication after EVLA, one-stage operation and anesthesia technique require strict attentions.

Journal

  • The Japanese Journal of Phlebology

    The Japanese Journal of Phlebology 27(1), 27-31, 2016

    Japanese Society of Phlebology

Codes

  • NII Article ID (NAID)
    130005127597
  • Text Lang
    JPN
  • ISSN
    0915-7395
  • Data Source
    J-STAGE 
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