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Anästhesiol Intensivmed Notfallmed Schmerzther 2003; 38(8): 542-546
DOI: 10.1055/s-2003-41191
Fallbericht
© Georg Thieme Verlag Stuttgart · New York

Pseudoaneurysma - eine seltene Komplikation nach Vena jugularis interna Punktion: Zwei Fallberichte bei Patienten nach Lebertransplantation

Pseudoaneurysm - A Rare Complication of Internal Jugular Vein Cannulation: Two Case Reports in Livertransplant PatientsW.  Schummer1 , C.  Schummer1 , R.  Voigt2 , J.  Heyne2 , J.  Steenbeck3
  • 1Klinik fär Anästhesie und Intensivtherapie, Friedrich-Schiller-Universität, Jena
  • 2Klinik für Allgemeine und Viszerale Chirurgie, Friedrich-Schiller-Universität, Jena
  • 3Institut für Diagnostische und Intervenitonelle Radiologie, Friedrich-Schiller-Universität, Jena
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Publication History

Publication Date:
07 August 2003 (online)

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Zusammenfassung

Die Anlage zentralvenöser Katheter (ZVK) über die Vena jugularis interna ist eine Routinemaßnahme im heutigen Klinikalltag. Die häufigste Komplikation dieses Zugangsweges ist die arterielle Fehlpunktion. Wir beschreiben zwei Fälle, in denen es bei Lebertransplantationspatienten nach akzidenteller arterieller Punktion zur Ausbildung von Pseudoaneurysmen in der A. carotis communis, beziehungsweise im Truncus thyrocervicalis kam. Bei beiden Patienten lag zum Zeitpunkt der ZVK-Anlage eine ausgeprägte Gerinnungsstörung vor, der bei der Entstehung von Pseudoaneurysmen eine entscheidende Bedeutung beigemessen wird. Bei Patienten mit Gerinnungsstörungen sollte daher die Indikation zu einer ultraschallgestützten Punktionstechnik großzügig gestellt werden, beziehungsweise ein risikoarmer Zugangsweg beispielsweise über die Vena jugularis externa gewählt werden. In unserem Artikel stellen wir die Entstehung, Klinik, Diagnostik und Therapie solcher Pseudoaneurysmen dar und geben Empfehlungen zur Risikominimierung.

Abstract

Internal jugular vein catheterization is nowadays a routine procedure in clinical practice. Arterial puncture is the most common complication of internal jugular vein catheterization. Two cases of pseudoaneurysm formation as a complication of accidental arterial puncture in liver transplant patients with coagulopathy are presented. Punctures of the common carotid artery, thyrocervical trunk, respectively were the source for these lesions. Coagulopathy is seen as an essential factor in the formation of pseudoaneurysm. Especially in patients with coagulopathy the threshold for ultrasound guidance should be low. Under these circumstances using the external jugular vein seems to be more prudent as it eliminates the risk for arterial punctures. We illuminate the genesis, signs and symptoms, diagnosis, and therapy of pseudoaneurysm. Recommendations for risk reduction are given.

Schlüsselwörter

Pseudoaneurysma - Vena jugularis interna - arterielle Punktion - Hämatom - Koagulopathie

Key words

Pseudoaneurysm - internal jugular vein - arterial puncture - haematoma - coagulopathy

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Wolfram Schummer, MD, D.E.A.A., E.D.I.C.

Klinik für Anästhesie und Intensivtherapie, Friedrich-Schiller-Universität

Bachstr. 18

07743 Jena

Email: cwsm.schummer@gmx.de