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假性动脉瘤 (PSA)的疗效和安全性。方法 :回顾性分析 2 1例心导管术后股动脉PSA的临床特征 ,以及序贯接受UGCR和UGTI法治疗的经过和结果。在彩色多普勒确定PSA后 ,UGCR法是用手压迫、加压包扎载瘤动脉近端和PSA颈部直至PSA瘤腔中血栓形成 ;UGTI法是超声波引导下将 18～ 2 0G针经皮穿刺使针头进入瘤腔内注射猪凝血酶。均于术后 2 4h、5～ 7d超声波复查。结果 :11例首次接受UGCR法治疗者中 4例成功 (首次成功率 36 .4 % ) ,5例接受重复压迫后有 1例成功 ,总成功率为 4 5 .5 % (5 / 11) ;UGCR治疗成功者的 5例中有 4例股动脉PSA最大直径 <2cm ,其中 2例接受抗凝剂治疗 ;在压迫中 10例有程度不等的局部不适、疼痛 ,有 8例在压迫中因局部疼痛而采用药物止痛 ,有 2例因出现血压增高、心绞痛发作而被迫放弃 ;UGCR治疗失败的 6例中 ,有 1例接受了外科手术治疗 ,5例改行UGTI治疗成功。采用UGTI治疗 15例股动脉PSA ,其中 10例首次接受UGTI治疗有 9例成功 (首次成功率 90 % ) ,6例为经重复UGTI治疗成功 ,UGTI总成功率为 10 0 %。单纯型PSA有 9例均一次性治疗成功 ,而 6例复杂型PSA需 2次或以上重复注射凝血酶。实际注射凝血酶剂

Comparison of the efficacy and safety of ultrasound guided thrombin injection and ultrasound guided compression repair in treatment of pseudoaneurysms

Objective:To evaluate effects of ultrasound(US)-guided percutaneous thrombin injection on ultrasound-guided compression repair on treatment of iatrogenic femoral arterial pseudoaneurysms.Method:US-guided manual compression and US-guided thrombin injection was the first choice according to the history and physicians' preference, followed by the other regime if the first choice was non-successful. With US-guidance, a needle was placed into the pseudoaneurysm flow lumen and thrombin was injected with continuous color Doppler US-guidance. US-guided compression repair is direct manual compression after a brief freehand ultrasound guided compression repair to confirm the compressibility of the lesion. All the patients recepeted clinical and ultrasonic follow-up at 24 hour, 5-7 days after treatment.Result:Compression produced complete thrombosis of the pseudoaneurysm at the initial attempt in 4 ( 36.4%) of 11 patients, 5 patients underwent repeated attempt, of which 1 attempts were successful. The ultimate success rate was 45.5%(5/11). Compression could not be performed in two patients due to angina and hypertension. Of the 6 failed compression attempts, One patient recepeted surgery repair, The rest underwent US-guided percutaneous thrombin injection. All the 15 pseudoaneurysms occurring after catheterization were successfully treated with percutaneous thrombin injection. 9 patients required a single injection, and six required two or more injections. The total success rate of US-guided thrombin injection was 100% (15/15), which was significantly higher than that of direct manual compression.For thrombin injection, there were no major complications.Conclusion:US-guided thrombin injection appears to be a safe and effective method in treatment of postcatheterization femoral pseudoaneurysms. It has significant advantages with US-guided compression repair.