A case of late-onset bleeding from an intercostal artery pseudoaneurysm after hemostasis using soft coagulation
Tóm tắt
The use of soft coagulation is becoming common in thoracic surgery. Soft coagulation provides rapid hemostasis from small vessels during surgery by dehydrating tissue and denaturing proteins, without burning the tissue. A 68-year-old man, with a history of right lower lobectomy 3 years prior, underwent a partial resection of the right upper lobe for a pulmonary nodule suspicious for secondary lung cancer. During the surgery, dissection of the adhesion caused a bleeding from the 6th intercostal artery, and hemostasis was achieved using soft coagulation (some degree of tissue carbonization was noticed at later mortality and morbidity conference). He experienced hemoptysis at postoperative day 18 and was transferred to our hospital. Contrast-enhanced CT scan revealed bleeding from the pseudoaneurysm of the 6th intercostal artery. Embolization was performed by angiography to stop the bleeding. We experienced a case of late-onset bleeding from a pseudoaneurysm related to soft coagulation hemostasis. Lessons learned from this patient are that additional hemostasis, such as ligation, would be considered for small arteries after hemostasis has been achieved by soft coagulation, especially when some degree of tissue carbonization is suspected.
Từ khóa
Tài liệu tham khảo
Suda K, Sato K, Mizuuchi H, et al. Recent evidence, advances, and current practices in surgical treatment of lung cancer. Respir Investig. 2014;52(6):322–9.
Kaga A, Ikeda T, Tachibana K, et al. An innovative oral management procedure to reduce postoperative complications. JTCVS Open. 2022;16(10):442–53.
Motono N, Ishikawa M, Iwai S, et al. Analysis of risk factors for postoperative complications in non-small cell lung cancer: comparison with the Japanese National Clinical Database risk calculator. BMC Surg. 2022;22(1):180.
Uramoto H, Shimokawa H, Tanaka F. Postoperative bleeding after surgery in patients with lung cancer. Anticancer Res. 2014;34(2):981–4.
Yano M, Numanami H, Akiyama T, et al. Reoperation for postoperative bleeding following pulmonary resection: a report of a single-center experience. Gen Thorac Cardiovasc Surg. 2019;67:608–14.
Zheng S, Ye T, Li B, et al. Bleeding-related re-exploration following pulmonary resection: a report of a single-center experience. J Cancer Res Clin Oncol. 2023;149:6841–8.
Hinderberger P, Fliss B, Thali JM, et al. Intercostal artery pseudoaneurysm after thoracoscopic lung resection. Gen Thorac Cardiovasc Surg. 2009;57:550–3.
Jiang C, Dai J, Bao Y, et al. Surgical treatment of pulmonary aspergilloma: a 13-year experience from a single clinical center. Ann Thorac Surg. 2022;114(1):311–8.
Kawai H, Ito M. Intercostal artery pseudoaneurysm after thoracoscopic lung resection. Gen Thorac Cardiovasc Surg. 2009;57:550–3.
Rossi G, Petrillo M, Flora M, et al. Incidental diagnosis and therapeutic approach of an iatrogenic intra-parenchymal pulmonary intercostal artery pseudoaneurysm: a case report. Monaldi Arch Chest Dis. 2019;89:1094.
Sakuragi T, Ohma H, Ohteki H. Efficacy of SOFT COAG for intraoperative bleeding in thoracic surgery. Interact Cardiovasc Thorac Surg. 2009;9(5):767–8.
Deguchi H, Tomoyasu M, Shigeeda W, et al. Usefulness of a suction ball coagulation probe for hemostasis in complete VATS lobectomy for patients with non-small cell lung cancer. Surg Today. 2019;49(7):580–6.