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.     

超声引导注射凝血酶治疗股动脉假性动脉瘤9例

目的 观察彩色多普勒超声引导下瘤内注射凝血酶治疗股动脉医源性假性动脉瘤的临床疗效。方法 采用20G细针穿刺,在超声引导于假型动脉瘤颈处注射凝血酶治疗9例医源性假性股动脉瘤,每例凝血酶剂量300～500U。结果 股动脉假性动脉瘤9例在超声引导注射凝血酶进行栓塞治疗均获成功,血栓形成时间1～5min,未见股动脉栓塞等严重并发症。结论 超声引导注射凝血酶治疗医源性假性动脉瘤操作简便,安全有效。     

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。     

瘤腔内注射凝血酶治疗假性动脉瘤

目的　探讨瘤腔内注射凝血酶治疗股动脉假性动脉瘤的安全性和可行性。方法　 2 0 0 0年 1月至 2 0 0 1年 10月 ,冠状动脉介入诊疗术后发生股动脉假性动脉瘤 5例 ,其中男性 3例 ,女性 2例 ,年龄 38～ 72岁 ;发生于造影术后 2例 ,发生于支架置入术后 3例 ,此 5例均在超声定位下采用瘤腔内注射凝血酶的方法治疗股动脉假性动脉瘤 ,所有病例均在治疗后 2 4h复查超声。结果　 4例患者一次性瘤腔内注射凝血酶 5 0 0U后即刻闭合瘤腔 ,1例注射凝血酶 5 0 0U后动脉与瘤腔通道血流明显减弱 ,在超声引导压迫下 5min后闭合。无肢体栓塞、过敏反应等发生 ,所有病例 2 4h后复查无复发。结论　瘤腔内注射凝血酶是一种简单、安全、快速、有效的治疗假性动脉瘤的无创方法 ,可作为临床治疗假性动脉瘤的首选方法。     

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。     

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。     

超声引导下注射凝血酶治疗股动脉假性动脉瘤3例

假性动脉瘤是导管介入治疗后常见的局部并发症之一,我们对3例治疗效果不佳的股动脉假性动脉瘤进行了凝血酶注射治疗,效果满意,现报道如下.     

超声显像引导注射凝血酶治疗假性动脉瘤

目的初步评价彩色多普勒超声显像引导下瘤内注射凝血酶治疗医源性假性动脉瘤的价值。方法采用20G细针穿刺,行超声引导瘤内注射凝血酶栓塞治疗3例医源性假性动脉瘤,凝血酶总量≤500U。结果2例股动脉假性动脉瘤患者一次栓塞获得成功,凝血酶用量500U,血栓形成时间1~3min;1例桡动脉假性动脉瘤栓塞治疗后残留瘤腔,行手术切除痊愈。结论超声显像引导注射凝血酶治疗医源性假性动脉瘤操作简便,安全有效。     

床旁按压及超声引导注射凝血酶治疗假性动脉瘤3例

1临床资料 我院自1998年开展心导管术以来，共发生假性动脉瘤3(女2，男1)例。年龄64～76岁。1例为左侧旁道行射频消融术后，2例为冠脉介入术后。3例均在术后1～2d出现腹股沟穿刺处疼痛，并发现包块，查体见股动脉穿刺下方一包块，压之有搏动感，能闻及血管杂音。行彩色多普勒超声检查，均在右侧腹股沟处皮下见一囊性肿块影，并与股动     

超声引导下瘤腔内注射凝血酶治疗医源性股动脉假性动脉瘤

目的:探讨超声引导下瘤腔内注射凝血酶治疗医源性股动脉假性动脉瘤的可行性和安全性。方法:3例女性患者因行股动脉穿刺于术后3~4d发生4处股动脉假性动脉瘤,均在彩色多普勒超声定位下通过瘤腔内注射凝血酶进行治疗,治疗后即刻超声复查,并定期随访。结果:3例患者4处假性动脉瘤一次性注射凝血酶500U后瘤腔即刻闭合,随访10~100d,假性动脉瘤无复发。无肢体栓塞和过敏反应等并发症发生。结论:瘤腔内注射凝血酶治疗医源性股动脉假性动脉瘤是一种创伤小、有效、安全的方法,可作为临床首选的治疗方法。     

Occlusion of iatrogenic pseudoaneurysms with percutaneous ultrasound guided thrombin injection

BACKGROUND: Pseudoaneurysm is a common complication of cardiac catheterization and coronary intervention with an incidence of 2% even in experienced centers. PATIENTS AND METHODS: In a feasibility study conducted between December 2004 and February 2006 we enrolled 76 patients consecutively to receive local thrombin injection (mean 329 IU; range 100-800 IU) into the aneurysma sac. RESULTS: Ultrasound guided thrombotic occlusion of pseudoaneurysms was successful after one injection in 83% of the patients, 17% of the patients required more than one injection. The overall success rate of the procedure was 98,9%. No peripheral embolisation of thrombin was noted during any injection and we registered no other complication that needed any further intervention. CONCLUSIONS: We conclude that ultrasound guided occlusion of pseudoaneurysms using thrombin injection with a success rate of the procedure of 98,9% is feasible and safe.     

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     

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     

超声引导下注射凝血酶对医源性股动脉假性动脉瘤的治疗

目的探讨超声引导下注射凝血酶治疗医源性股动脉假性动脉瘤(PA)的应用价值。方法使用22G细针穿刺,对8例医源性股动脉PA患者进行超声引导下瘤内注射凝血酶治疗,用二维超声及彩色多普勒观察瘤体内血栓形成情况,每次注入凝血酶100IU,凝血酶总用量不超过500IU,直至血栓形成。结果8例患者均经一次性治疗成功,凝血酶用量100~500IU,血栓形成时间0.5~1.5min,无一例出现血管内血栓形成、感染、过敏等并发症。结论超声引导凝血酶注射治疗股动脉PA安全有效,可作为经股动脉途径介入诊疗术所致医源性PA的首选治疗。     

Application of the percutaneuos thrombin injection in treatment of iatrogenic femoral pseudoaneurysms

Pseudoaneurysms are not a common complication of the endovascular procedures but can present a serious therapeutic problem. Both, the application of compression therapy and surgical operation can lead to the development of subsequent complications. The aim of this study was analysis of the treatment results of iatrogenic pseudoaneurysms managed with percutaneous thrombin injection. Treated group consisted of 69 patients diagnosed with iatrogenic femoral pseudoaneurysms. The indication for injection technique was ineffective compression therapy as well as necrotic changes or bacterial skin infection in the groin area or a large diameter of pseudoanurysm's chambers. Thrombin was injected percutaneously during 1-3 sessions in the dose of 100-1200 U into the centre of the chamber under ultrasound control. Primary and secondary success rate was 88% and 94% respectively. The following factors significantly decreased effectiveness of the method: complex pseudoaneurysms (with treatment efficacy 82% and 88% respectively vs 90% and 96% for simple pseudoaneurysms), and large chamber volume. Early and late recanalization of the thrombotic changes appeared in 7% and 3% of treated cases. The most frequent complication was appearance of non-elastic tumor (71%) or pain (64%) in the groin area. The most serious complication was acute lower limb ischemia detected in one case (2%) as a result of femoral artery compression by the thrombosed pseudoaneurysm. Percutaneous thrombin injection should be a preferred method of pseudoaneurysms treatment, especially in cases of ineffective compression therapy or its contraindications due to low cost of the therapy, simplicity of the technique and relatively low percentage of the complications.     

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