超声波引导下压迫法与注射凝血酶法治疗心导管术后股动脉假性动脉瘤的比较

目的评价和比较超声引导下压迫法(UGCR)和注射凝血酶法(UGTI)治疗心导管术后股动脉PSA的疗效和安全性. 方法回顾性分析21例心导管术后股动脉PSA的临床特征,以及序惯接受UGCR和UGTI法治疗的经过和结果.男5例,女16例,平均年龄(66.5±5.2)岁.发现股动脉PSA至接受治疗为平均(2.6±3.7)d,PSA平均直径(3.5±1.5)cm.     

股动脉假性动脉瘤超声引导下凝血酶注射与压迫法的护理比较

目的：比较经股动脉行冠状动脉介入诊疗操作后假性动脉瘤（PSA）超声引导下凝血酶注射（UGTI）与超声引导下压迫（UGCR）治疗的护理效果。方法：选取我院2000年6月～2006年6月经股动脉行冠状动脉介入诊疗操作后出现假性动脉瘤患者共37例。其中，UGTI组：有接受UGTI治疗患者21例，UGCR组：有采用UGCR治疗的患者16例。比较两组的治疗成功率、平均治疗时间、术后卧床时间等护理指标。结果：UGTI组的各种护理指标均优于UGCR组（P〈0．05～0．01）；但PSA直径〈4cm的假性动脉瘤，UGTI组与UGCR组成功率无显著差异（P〉0．05）。结论：若动脉瘤直径≥4cm，UGTI的疗效明显优于UGCR。     

超声引导下凝血酶注射治疗股动脉假性动脉瘤36例

目的探讨超声引导下凝血酶注射（UGTD治疗医源性股动脉假性动脉瘤（PSA）的安全性和可行性。方法2000年1月至2007年2月，对36例经皮股动脉路径行冠状动脉介入诊疗术后发生的股动脉PSA进行了UGTI，其中男21例，女15例，年龄34482（63．5±10．8）岁。造影术后发生11例，支架置入术后发生25例。凝血酶注射成功后平卧4～6h，所有病例均在治疗后1～3d复查超声，30d临床随访。结果36例患者，单囊腔PSA32个，复合囊腔PSA4个（≥2个腔），瘤腔平均为（2．98±1．30）cm×（1．84±0．75）cm，凝血酶注射剂量为250～1000（644．29±239．10）U，34例患者1次UGTI即刻闭合瘤腔，2例注射凝血酶500U后动脉与瘤腔通道血流明显减弱，在超声引导压迫下5min闭合。UGTI治疗PSA成功率为94．4％0（34／36）。1例注射凝血酶1000U后虽然瘤腔闭合，但股浅动脉内血栓形成，行外科手术治疗。1例注射凝血酶500U后瘤腔闭合，但2min后出现寒颤、高热过敏反应，对症处理后好转。术后1d复发2例，1例超声引导压迫后瘤腔闭合，另1例再次注射凝血酶1000U成功闭合，30d临床随访无复发，UGTI治疗PSA复发率为5．6％（2／36）。结论UGTI治疗股动脉PSA是一简单、安全、快速、耐受好的方法，可作为临床治疗PSA的首选方法。     

超声引导凝血酶注射治疗股动脉假性动脉瘤可行性及影响因素探讨

目的探讨医源性股动脉假性动脉瘤(PS)超声引导下注射凝血酶(UGTI)治疗的可行性及影响因素.方法15例经股动脉径路选择性冠状动脉造影和冠状动脉介入术后医源性股动脉PS患者接受了UGTI治疗.男性5例,女性10例,平均年龄(68.5±12)岁,选择性冠状动脉造影1例,经皮冠状动脉介入14例.单腔的单纯型PS9例,2腔或3腔的复杂型PS 6例.分析PS的形状、大小、颈部长度与宽度、凝血酶剂量、治疗结果以及并发症.UGTI后24h、5～7d接受二维超声随访.结果PS平均容积为(13±4.89)cm3.共注射凝血酶21次,平均每次注射凝血酶剂量,单腔为(250±120)IU,双腔或多腔为(650±150)IU.9例单腔患者全部一次成功,初级成功率为100%;6例双腔或多腔的复杂PS患者4例首次成功,初级成功率为66.7%.1例复杂PS24h出现"再通".1例复杂PS患者15d出现"再通",经重复3次注射凝血酶后,封闭成功.次级成功率达到100%.无一例出现血栓形成、感染、过敏等并发症.结论UGTI治疗股动脉PS安全有效,可作为经股动脉途径介入诊疗术所致医源性股动脉PS的首选治疗,PS的几何形状是初级成功率的决定因素.     

心导管术后假性动脉瘤10例分析

目的 :分析 10例心导管术后出现假性动脉瘤的原因并探讨其治疗方法。方法 :收集 1998年至 2 0 0 1年心导管术后出现的假性动脉瘤患者 10例 ,根据临床症状、体征和彩色多普勒超声证实假性动脉瘤的发生。记录假性动脉瘤的部位、形态和大小。治疗方法包括超声引导下压迫法 (ultrasound gui dedcompressionrepair,UGCR)、超声引导下经皮注射凝血酶 (ultrasound guidedthrombininjection ,UGTI)和外科修补术。结果 :穿刺部位经超声或手术证实 6例在股浅动脉。 2例直接行动脉修补术治愈 ,3例经UGCR后治愈 ,3例UGCR失败后行动脉修补术 ,2例UGCR失败后采用UGTI 5 0 0～ 10 0 0U的治疗方法。随访无复发 ,未见血栓、感染、神经压迫等并发症。结论 :UGTI是一种简便、有效的方法 ,但仍需要更多的样本以探讨该方法的安全性     

超声下凝血酶注射治疗假性动脉瘤的方法学探讨及可行性评价

目的经皮超声引导下注射凝血酶(UGTI)治疗股动脉假性动脉瘤(PS)的方法学探讨及可行性评价.方法15例经股动脉径路选择性冠脉造影和冠脉介入术后医源性股动脉PS患者接受了UGTI治疗.男性5例,女性10例,平均年龄(68.5±12)岁,选择性冠脉造影1例,经皮冠脉介入14例.单腔的单纯型PS9例,2腔或3腔的复杂型PS6例.局麻后在超声引导下准确定位注射器针头,单纯PS尽可能在瘤腔底部,远离瘤颈部,复杂PS首选在远端瘤腔的底部,注射凝血酶速度宜慢,剂量为100～800IU凝血酶,超声下观察瘤腔内血栓形成,UGTI后24小时、5～7天接受二维超声随访.结果PS平均容积为13cm3±4.89cm3.共注射凝血酶21次,单腔注射凝血酶剂量为250IU±120IU,双腔或多腔为650IU±150IU.9例单腔患者全部一次成功;6例双腔或多腔的复杂PS患者4例首次成功,1例24h出现"再通",1例15天出现"再通",经重复3次注射凝血酶后,封闭成功.无一例出现血栓形成、感染、过敏等并发症.结论掌握正确的UGIT操作方法是治疗股动脉PS成功的前提条件,也是减少操作并发症的重要因素.采用正确的UGTI方法可作为医源性股动脉PS的首选治疗.     

UGCR联合UGTI治疗心导管术后假性动脉瘤2例报告

假性动脉瘤(PSA)是心导管术后较常见的血管并发症。近年来,我们采用超声引导压迫修复(UGCR)和超声引导下注射凝血酶栓塞(UGTI)联合治疗心导管术后PSA患者2例,均获成功。现报告如下。临床资料:本组2例均为男性,年龄分别为60、62岁。于心导管术后第2天出现PSA,部位均为右股总动脉(RCFA),大小分别为28 mm×16 mm、21 mm×17 mm,颈长度分别<3.0、<2.6 mm,单叶。临床表现为局部(穿刺部位)出现搏动性肿块,新出现血管杂音和(或)震颤。均经临床及彩色多普勒确诊。方法:采用Philips ATL 5000彩色多普勒超声诊断仪,探头频率2~5 MHz和5~12 …     

超声引导下单纯压迫或合并穿刺抽积血法治疗心导管术后假性动脉瘤(附5例报告)

目的介绍超声引导下单纯压迫修复法(UGCR)和压迫合并穿刺抽积血修复法治疗5例心导管术后股动脉假性动脉瘤的方法并评价其疗效.方法 2例瘤体小于3.0 cm×3.0 cm者采用单纯压迫修复法,在超声引导下直接按压20～30 min;3例瘤体大于3.0 cm×3.0 cm者采用压迫合并穿刺抽积血修复法,在超声监视下先将带注射器的自制去针尖斜面的18号穿刺针沿原穿刺口刺入瘤腔,再按住瘤颈阻断血流继续进入瘤腔,用注射器抽尽瘤腔内积血,继续按压20～30 min后缓慢减压,仍有血流信号者可重复上述过程.结果 5例均成功,局部无大块硬结形成.其中4例1次修复成功,1例先用UGCR法失败后改用压迫合并穿刺抽积血法成功.结论在超声引导下根据瘤体大小选择单纯压迫修复法或压迫合并穿刺抽积血修复法能有效治疗心导管术后假性动脉瘤,其操作简单、安全可靠、术后局部无大块硬结形成,不影响短时间内经同路径再次进行的介入诊治.     

超声及预注射生理盐水引导下注射凝血酶治疗股动脉假性动脉瘤

目的:探讨超声及预注射生理盐水引导下使用凝血酶治疗股动脉假性动脉瘤(Pseudoaneurysm,PSA)的有效性及安全性。方法:我院2002年1月至2004年3月冠状动脉介入诊疗术后发生股动脉PSA患者11例,经徒手压迫或超声指导下压迫失败后,在超声及预注射生理盐水引导下注射凝血酶治疗。结果:男性2例,女性9例,年龄38～75岁,平均(61±13.4)岁。6例发生于冠状动脉造影术后,5例发生于支架植入术后。8例为单纯PSA,3例为复杂多腔型PSA。11例均采用徒手压迫,平均每例2次,4例还采用了超声指导下压迫,均未成功。平均于PSA发生(3.4±0.5)d后采用超声及预注射生理盐水引导下凝血酶治疗,使用剂量(385±126.5)U,10例首次治疗成功(90.9%),即刻闭合瘤腔,1例多腔复杂PSA注射凝血酶后部分闭合。患者出院时PSA均闭合,无一例发生动脉血栓、感染及过敏反应等严重不良反应。结论:超声及预注射生理盐水引导下注射凝血酶是一种治疗PSA安全有效的方法。     

经皮超声引导下凝血酶注射治疗医源性假性动脉瘤70例

目的:评价经皮超声引导下凝血酶注射(Ultrasound guided thrombin injection,UGTI)治疗假性动脉瘤的效果。方法:2000年1月至2009年9月,对70例动脉置管术后出现的假性动脉瘤(Pseudoaneurysm,PSA)进行了UGTI,凝血酶注射成功封闭动脉瘤腔后平卧4~6h,所有病例均在治疗后1~3d复查超声,30d临床随访。结果:70例患者,其中男性34例,女性36例,年龄34~82岁,平均(62.6±10.7)岁。经皮股动脉造影术后发生36例,支架置入术后发生33例,肱动脉置管术后1例。单囊腔PSA63个,复合囊腔PSA7个(≥2个腔),瘤腔平均大小为     

Ultrasound guided percutaneous thrombin injection for the treatment of iatrogenic pseudoaneurysms

Iatrogenic aneurysms are usually postcatheterisation pseudoaneurysms of the femoral artery. Until recently, the treatment of choice was ultrasound guided compression repair. A case of pseudoaneurysm of the axillary artery, arising as a complication of pacemaker insertion in an 83 year old man is reported. Compression repair was not possible in this case, and so the aneurysm was occluded by percutaneous ultrasound guided thrombin injection directly into the aneurysm sac. Percutaneous ultrasound guided thrombin injection is a promising new minimally invasive technique for the treatment of iatrogenic pseudoaneurysms.


Keywords: pseudoaneurysm; ultrasound guided thrombin injection     

Compression repair versus low-dose thrombin injection for the treatment of iatrogenic femoral pseudoaneurysm: a retrospective case-control study.

BACKGROUND: It has been shown that thrombin injection is a safe and effective technique for the treatment of iatrogenic femoral pseudoaneurysm. The aim of this study was to evaluate and compare the use of ultrasound-guided low-dose thrombin injections with ultrasonographically-guided compression repair in the treatment of iatrogenic femoral arterial pseudoaneurysm. METHODS: We compared two cohorts of patients treated for iatrogenic femoral pseudoaneurysm: the first included 38 patients who underwent ultrasonographically-guided compression repair as a first-step approach between January 1998 and November 2002; the second included 21 patients treated with ultrasound-guided low-dose thrombin injection between December 2002 and December 2003. RESULTS: Both groups had similar demographic characteristics and aneurysm sizes (p = 0.72). Compression was successful in 24/38 patients (63%); the 14 persistent aneurysms were surgically repaired (37%). The primary thrombin injection of a mean dose of 185+/-95 U/ml (range 100-400 U/ml) successfully obliterated all of the 21 pseudoaneurysms (success rate 100 vs 63% in the compression group, p = 0.004). Thrombosis occurred within an average of 12+/-15 s of thrombin injection. Sedation was used in 42% of the patients undergoing compression and in none of those receiving thrombin (p = 0.001). The duration of hospitalization was significantly longer in patients undergoing compression therapy (9.8+/-5.6 vs 5.6+/-1.4 days, p = 0.001). CONCLUSIONS: Ultrasound-guided low-dose thrombin injection appears to be more effective in reducing the need for surgical repair when used to treat iatrogenic femoral pseudoaneurysm, is better tolerated by the patients, and requires a shorter hospital stay.     

Ultrasound guided percutaneous thrombin injection of iatrogenic femoral artery pseudoaneurysms after coronary angiography and intervention

Ultrasound guided percutaneous thrombin injection has recently been described for the treatment of iatrogenic femoral pseudoaneurysms. Patient selection and technical aspects of this technique are still evolving and safety data, particularly after coronary intervention, remains limited. The percutaneous thrombin injection of femoral artery pseudoaneurysms in 13 consecutive patients, most of whom were receiving antiplatelet/anticoagulant treatment (aspirin 11, heparin 4, clopidogrel 6), is reported. Thrombin (1000 U/ml) was injected over several seconds until Doppler colour flow within the cavity ceased. The median dose of thrombin injected was 800 U (range 200-1000 U) and the treatment was successful in all cases without complication. In one case, thrombus was visualised within the arterial lumen immediately after thrombin injection, but this dissolved spontaneously within five minutes without evidence of embolisation. In contrast to ultrasound guided compression, percutaneous thrombin injection of femoral pseudoaneurysms is a rapid, well tolerated, and successful technique even in patients receiving antiplatelet/anticoagulant treatment.


Keywords: ultrasound guided percutaneous thrombin injection; iatrogenic femoral artery pseudoaneurysm     

Percutaneous thrombin injection for treatment of iatrogenic femoral artery pseudoaneurysms: a case for caution

The case of a patient who developed a femoral artery pseudoaneurysm following cardiac catheterization is described. After 2 failed attempts of ultrasound-guided compression repair, the patient underwent percutaneous thrombin injection with, beside of complete closure of the pseudoaneurysm, a severe limb ischemia due to distal thrombin migration with consecutive clot formation finally resulting in thigh amputation of the affected leg. Indications, advantages, and disadvantages of various options for the treatment of iatrogenic femoral artery pseudoaneurysms (vascular surgery, ultrasound-guided compression, percutaneous thrombin injection, and other nonsurgical treatment modalities), as well as risk factors for distal migration of liquid thrombin after percutaneous injection, are discussed in this report.     

超声引导下凝血酶栓塞法治疗股动脉假性动脉瘤的疗效分析

目的探讨瘤腔内注射凝血酶治疗股动脉假性动脉瘤的疗效和安全性。方法78例股动脉假性动脉瘤的患者分别首选床边指压法（50例）和凝血酶注射法（28例）治疗。所有患者均使用GE LOGIQ9彩色多普勒超声仪确诊,凝血酶注射法组在超声引导下进行瘤腔内注射凝血酶栓塞治疗。结果指压法组50例患者中41例通过持续手指压迫治疗有效消除血管杂音和动脉瘤搏动,6例出现迷走神经反射,4例因不耐受再次压迫改用彩色多普勒引导下凝血酶注射法治愈,5例股动脉压迫治疗无效后改用凝血酶注射法治疗。凝血酶注射法组28例首选超声引导下瘤腔内注射凝血酶栓塞治疗的患者全部治愈,其中25例一次栓塞成功,2例经两次栓塞成功,1例出现血管迷走性晕厥;12例患者注射凝血酶后有体温轻度升高,自行好转;无动脉栓塞及静脉血栓形成、无凝血酶过敏表现、感染、出血等并发症。结论与指压法比较,超声引导下瘤腔内注射凝血酶的治疗方法有效性显著提高而不耐受性显著降低,是一种安全有效的方法。     

Pseudoaneurysm of the femoral artery after cardiac catheterisation: diagnosis and treatment by manual compression guided by Doppler colour flow imaging.

OBJECTIVE--To assess the value of Doppler colour flow imaging for diagnosing and guiding non-surgical treatment of pseudoaneurysm of the femoral artery complicating cardiac catheterisation. DESIGN--A prospective study. SETTING--Cardiac department in a teaching hospital. PATIENTS--9 patients (8 female, 1 male) who presented with pseudoaneurysm 1-15 days after cardiac catheterisation. INTERVENTIONS--The femoral arterial communication to the false aneurysm was localised by Doppler colour flow imaging. Manual pressure was then applied to the ultrasound transducer which was positioned directly over the site of the arterial communication. Pressure was progressively increased until it was sufficient to prevent colour flow from the artery into the false aneurysm cavity while allowing Doppler flow to continue within the arterial lumen. MAIN OUTCOME MEASURES--Characteristics of pseudoaneurysm, duration of manual compression, success rate, follow up. RESULTS--The pseudoaneurysms ranged from 1.3 to 5.5 cm in length. Six pseudoaneurysms were 1.3-2.0 cm away from the arterial puncture. The pseudoaneurysm was closed in 8/9 patients by compression exerted manually through the transducer for 25-40 minutes (3 successful cases required two or three periods of compression within 48 hours). No pseudoaneurysm recurred during 14-61 days of follow up. CONCLUSIONS--Most pseudoaneurysms of the femoral artery can be treated by a period of manual pressure applied with an ultrasound transducer and guided by Doppler colour flow.     

Treatment of post-catheterization femoral artery pseudo-aneurysm with para-aneurysmal saline injection

Femoral artery pseudoaneurysm is a common complication associated with cardiac catheterization procedures. Ultrasound-based techniques (e.g., mechanical compression, thrombin injection) and open surgical intervention are frequently used in the management of pseudoaneurysm. The investigators report their prospective experience with a novel method for the treatment of pseudoaneurysm after cardiac catheterization using ultrasound-guided, para-aneurysmal injection of physiologic saline. Sixty-four consecutive patients with pseudoaneurysms after cardiac catheterization were treated using normal saline (0.9% sodium chloride 25 to 60 ml) injected into the tissue surrounding the tract connecting the pseudoaneurysm with the femoral artery, followed by manual pressure of short duration. In none of the patients was concomitant antithrombotic therapy (aspirin [n = 63], clopidogrel [n = 45], unfractionated or low-molecular-weight heparin [n = 23], and warfarin [n = 5]) discontinued during the closure attempt. Fifty-nine of the 64 pseudoaneurysms (92%) were successfully occluded using saline injection. In 5 patients in whom saline injection failed, the pseudoaneurysms were successfully treated with thrombin injection (n = 4) or ultrasound-guided compression (n = 1). In all 64 patients, pseudoaneurysm closure was confirmed by ultrasound at 24 hours. The procedure was very well tolerated by the patients, and no side effects or complications were noted. In conclusion, ultrasound-guided saline injection affords a simple, safe, and effective alternative treatment for the closure of postcatheterization pseudoaneurysms.     

Treatment of an iatrogenic femoral artery pseudoaneurysm with concomitant arteriovenous fistula with percutaneous implantation of an amplatzer vascular plug

Iatrogenic pseudoaneurysms can occur following percutaneous cardiac and peripheral procedures. There are multiple modalities available for the treatment of pseudoaneurysms including ultrasound guided compression repair, ultrasound guided thrombin injection, or endovascular repair with covered stent placement. If these methods are not indicated or unsuccessful, patients typically require open surgical repair. We report a case of a woman with a post‐procedural pseudoaneurysm with concomitant arteriovenous fistula who was treated percutaneously with the implantation of an Amplatzer vascular plug. This novel technique was safe and effective and allowed our patient to avoid the morbidity and mortality associated with surgical repair. © 2012 Wiley Periodicals, Inc.     

Treatment of iatrogenic femoral pseudoaneurysm by ultrasound-guided compression therapy and thrombin injection

Development of an arterial pseudoaneurysm is a common complication following cardiac catheterization. We analyzed data from 6,300 patients who received left heart catheterization at our institution. One day after the procedure, approximately 10% of the patients were examined with duplex sonography. In 204 patients (3.0%), a pseudoaneurysm of the femoral artery was diagnosed. All patients underwent compression therapy. Thereby, 159 of the pseudoaneurysms could be treated successfully. The remaining 45 pseudoaneurysms had a maximal diameter of more than 1.5 cm. Forty-two patients underwent ultrasound and biopsy-line-guided thrombin injection without complications. This strategy resulted in a successful occlusion in 41 cases. Pseudoaneurysms smaller than 2 cm can be treated with compression therapy. Larger pseudoaneurysms can be occluded by thrombin injection using ultrasound guidance. Patients with a pseudoaneurysm with a wide "neck" should be treated surgically, because the risk of an arterial occlusion following thrombin injection cannot be excluded.