动脉型胸廓出口综合征误漏诊分析
Analysis of Misdiagnosis and Missed Diagnosis of Arterial Thoracic Outlet Syndrome
杨根欢 1廖鹏志 1刘新农 1汪岩 1贾玉龙 1沈晨阳1
作者信息
- 1. 100070 北京,首都医科大学附属北京天坛医院血管外科
- 折叠
摘要
目的 探讨动脉型胸廓出口综合征(aTOS)的临床特点、影像学表现及误漏诊原因、防范措施.方法 回顾性分析2017 年9 月—2023 年9 月收治的曾误漏诊的aTOS 4 例的临床资料.结果 本组3 例表现为椎动脉起始以远的锁骨下动脉重度狭窄,1 例表现为锁骨下动脉中段闭塞,其中2 例合并同侧腋动脉重度狭窄.本组3 例误诊为动脉粥样硬化性病变,行介入治疗;1 例右颈动脉闭塞漏诊aTOS,因临床症状不明显,行保守治疗.1 例2 次支架植入术后均发生再次闭塞,最终行左颈总动脉-左腋动脉人工血管搭桥术.1 例发生支架植入术后再闭塞,再次球囊扩张后维持通畅.1 例行支架植入术后,维持通畅.结论 aTOS临床上易误诊为动脉粥样硬化性病变.临床上对椎动脉起始以远的锁骨下动脉狭窄或腋动脉狭窄患者需考虑为aTOS,aTOS的治疗建议行开放手术.
Abstract
Objective To explore the clinical characteristics and imaging manifestations,cause of misdiagnosis and missed diagnosis,and preventive measures of arterial thoracic outlet syndrome(aTOS).Methods The clinical data of 4 pa-tients with aTOS who experienced misdiagnosis and missed diagnosis and were admitted between September 2017 to September 2023 were retrospectively analyzed.Results Three patients presented with severe stenosis of the subclavian artery far from the origin of the vertebral artery,one patient presented with occlusion of the middle segment of the subclavian artery,including 2 patients who had severe stenosis of the ipsilateral axillary artery.Three patients were misdiagnosed as atherosclerotic lesions and underwent interventional treatment,and one patient was considered as having aTOS misdiagnosed due to right carotid ar-tery occlusion and received conservative treatment due to unclear clinical symptoms.One patient experienced secondary occlu-sion after two stent implantation surgeries,and ultimately underwent carotid-subclavian bypass.One patient experienced sec-ondary occlusion after stent implantation and maintained patency after balloon dilation,and one patient maintained patency af-ter undergoing stent implantation surgery.Conclusion aTOS is more likely to be misdiagnosed as atherosclerotic lesions in clinical practice.For patients with subclavian artery stenosis far from the origin of the vertebral artery or axillary artery steno-sis,aTOS should be considered.Open surgery is recommended for the treatment of aTOS.
关键词
胸廓出口综合征/锁骨下动脉/腋动脉/血管狭窄/血管闭塞/误诊/动脉粥样硬化/漏诊Key words
Thoracic outlet syndrome/Subclavian artery/Axillary artery/Vascular stenosis/Vascular occlusion/Misdiagnosis/Atherosclerosis/Missed diagnosis引用本文复制引用
基金项目
首都医科大学教育教学改革研究项目(2023JYY230)
出版年
2024
国家科技期刊平台
NSTL
万方数据