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。     

经皮股动脉穿刺介入术治疗后合并症假性股动脉瘤的凝血酶治疗

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 2年 6月 ,冠状动脉介入诊疗术后发生股动脉假性动脉瘤 12例 (男 9例、女 3例 ) ,年龄 38～ 75岁 ,平均 (6 4 9± 11 3)岁。造影术后发生 3例 ,支架置入术后发生 9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10例患者一次性瘤腔内注射凝血酶 5 0 0U即刻闭合瘤腔 ,1例在注射凝血酶 10 0 0U后 1min内瘤腔闭合 ,1例注射凝血酶 5 0 0U后动脉与瘤腔通道之间血流明显减弱 ,在超声引导压迫下 5min闭合。凝血酶治疗假性动脉瘤成功率为 10 0 %。无肢体栓塞、过敏反应等并发症发生 ,所有病例 2 4h后复查无复发。结论注射凝血酶治疗股动脉假性动脉瘤是一种简单、安全、快速、耐受好和有效的无创方法 ,可作为临床治疗假性动脉瘤的首选方法。     

彩色多普勒超声在医源性假性动脉瘤诊断及治疗中的应用

目的探讨彩色多普勒超声对股动脉假性动脉瘤诊断及疗效监测的价值。方法选取28例经股动脉穿刺介入治疗术后发生股动脉假性动脉瘤患者。超声监控探头垂直加压压迫假性动脉瘤通道或破口直至内无血流通过。压迫失败后在超声引导下瘤腔内注射凝血酶,24 h、1个月后复查超声。结果 28例中21例一次性压迫2h后瘤腔闭合,7例压迫2次失败后于超声引导下瘤腔内注射凝血酶,取得较满意效果。结论彩色多普勒超声诊断股动脉假性动脉瘤准确率高,超声引导下治疗假性动脉瘤疗效可靠且较为安全。     

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。     

冠脉介入术并发假性股动脉瘤的无创治疗

目的：探讨在彩超引导下运用压迫加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：2001年1月至2003年8月，冠状动脉介入诊疗术后发生股动脉假性动脉瘤9例，在超声定位下先压迫瘤颈，然后一次性向瘤腔内注射凝血酶500U，5分钟后瘤腔完全闭合，局部用绷带加压包扎6小时。结果：治疗成功率为100％。无肢体栓塞、过敏反应等并发症发生，临床随访15天无1例复发。结论：在彩超引导下压迫加瘤腔内注射凝血酶治疗股动脉假性动脉瘤是一种安全、经济、耐受好，易接受的无创方法。     

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。     

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。     

超声引导下穿刺抽吸血肿加人工压迫治疗医源性股动脉假性动脉瘤

目的:探讨超声引导下穿刺抽吸血肿加人工压迫法治疗心脏介入术后股动脉假性动脉瘤的安全性和有效性。方法:分析27例心脏介入操作术后出现的股动脉假性动脉瘤患者,其中男性14例,女性13例,平均年龄(53.5±11.4)岁。首先利用超声定位股动脉假性动脉瘤体、瘤体颈部和供应动脉位置,然后在超声引导下采用18号穿刺针,穿刺进入瘤体中心并且抽吸瘤体内血液,同时由助手采用人工方法压迫股动脉假性动脉瘤颈部和瘤体,阻断供应动脉和股动脉假性动脉瘤之间的交通。压迫时间为15 min,之后用绷带加压包扎,嘱患者平卧12 h,保持患侧下肢平直。术后24 h和1个月均复查下肢血管超声。结果:24例(88.9%)患者一次抽吸压迫成功;2例(7.4%)患者第一次抽吸压迫后瘤体未完全闭塞,给予再次抽吸压迫后成功;1例(3.7%)患者因合并股动静脉瘘,抽吸压迫后股动脉假性动脉瘤腔未完全闭合,但瘤体较压迫前明显缩小。总体治疗成功率为96.3%(26/27例)。无操作相关并发症发生。结论:在超声引导下穿刺抽吸血肿加人工压迫治疗医源性股动脉假性动脉瘤安全、有效。     

Efficacy and safety of percutaneous treatment of iatrogenic femoral artery pseudoaneurysm by biodegradable collagen injection

OBJECTIVES; The goal of this study was to assess the safety and efficacy of femoral artery pseudoaneurysm (FAP) closure by collagen injection. BACKGROUND; The FAP is an infrequent but troublesome complication after percutaneous transfemoral catheter procedures. If ultrasound-guided compression repair (UGCR) fails, vascular surgery is indicated. We have developed a less invasive method to close FAPs percutaneously by injecting collagen and, thus, inducing clotting within the aneurysm. METHODS: Via a 9F needle or 11F sheath, a biodegradable adhesive bovine collagen is injected percutaneously into the FAP, guided by angiography from the contralateral site. RESULTS: From 1993 to 2000, compression and UGCR had failed to obliterate 110 FAPs. These patients have been treated by collagen injection. Mean age of the patients was 65.6 +/- 10.2 years (range: 32 to 85 years), and 50% were women. Immediate closure of the FAP was achieved in 107/110 patients (97.3%) without any complication or adverse effect. In one patient the collagen could not be applied due to unfavorable anatomy. One patient needed a second session of collagen injection. In one patient too much collagen was inserted, which resulted in external compression of the artery, and surgical intervention was required. The overall success rate was 108/110 (98%, 95% confidence interval: 93.5% to 99.8%). Among the patients with successful procedures, there were no recurrences during six months follow-up. CONCLUSIONS: The percutaneous treatment of iatrogenic FAP, by injection with collagen, is an effective and safe strategy. This method provides an excellent therapeutic alternative to the traditional surgical management.     

Treatment options for post-catheterisation femoral pseudoaneurysm closure

BACKGROUND: Femoral artery pseudoaneurysm (FAP) complicates from 1% to 9% of all coronary angiography procedures and contributes to extended hospitalisation as well as patient discomfort. AIM: To compare three main methods of FAP closure which are used nowadays. METHODS: Seventy-five subjects (38 females, 37 males, mean age 60.8+/-10.4 years) with post-catheterisation FAP were studied. The results of three methods of FAP closure--surgical, local compression and thrombin injection--were compared. RESULTS: Between September 2000 and July 2001, fourteen patients developed FAP; in 9 (64%) patients FAP was closed with repeated prolonged compression whereas the remaining 5 (36%) patients required surgical closure of compression-resistant FAP. We observed that FAPs with longer neck (>10 mm) and primary signs of partial spontaneous coagulation were more prone to self-closure as compared to FAPs with short neck and no signs of perimural coagulation (p=0.01). Since July 2001, we introduced ultrasound-guided thrombin injection into FAP sack. The protocol included attempt of closing FAP with probe compression and compression dressing put overnight, and, if unsuccessful, followed by a quick injection of 2 ml of thrombin solution (400-3200 U), guided by ultrasound. During this period, we identified 61 patients with FAP. Out of this group, 5 (8.2%) subjects were referred for surgery without any attempt of thrombin-injection, in 16 (26.2%) patients FAP was closed with probe compression and dressing put overnight, and in the remaining 40 (65.6%) subjects ultrasound-guided thrombin-injection was performed. Thrombin injection into FAP sack caused closure of its cavity and neck in all patients, however, five patients required additional thrombin injection during the same session, and 2 (5.0%) patients--during the next procedure. No peri-procedural complications were observed. The duration of hospital stay shortened from a mean of 26.6+/-14.5 days in surgically treated patients to 7.9+/-6.7 in those in whom FAPs were closed with compression, and to 4.6+/-2.6 days in those treated with thrombin (p<0.001). During a mean follow-up of 11+/-8.1 months, we re-examined 32 (80.0%) patients in whom FAP was closed with thrombin injection. No long-term thrombotic or embolic complications were observed. However, in 2 (6.3%) patients FAP cavity did not undergo complete resorption after 6 and 12 months of follow-up. CONCLUSIONS: Thrombin-induced closure of femoral pseudoaneurysm is a quick, safe and effective method, shortening hospitalisation time. In our Department this procedure replaced the prolonged and painful compression method.     

Prospective randomized study comparing ultrasound-guided thrombin injection to compression in the treatment of femoral pseudoaneurysms.

PURPOSE: To compare in a randomized prospective study the treatment of femoral pseudoaneurysms with ultrasound-guided thrombin injection versus ultrasound-guided compression. METHODS: Thirty consecutive patients (22 men; mean age 67+/-8 years, range 53-82) with iatrogenic femoral pseudoaneurysms were randomized to treatment with either ultrasound-guided compression (n=15) or injection of bovine thrombin (n=15). The primary outcome measure was thrombosis of the pseudoaneurysm within 24 hours. Secondary outcome measures were complications and hospitalization time (LOS). RESULTS: Thrombosis within 24 hours was achieved in 15 (100%) patients given thrombin versus 2 (13%) in the compression group (p<0.001). Of 13 pseudoaneurysms failing the initial compression treatment, 7 were retreated, 4 successfully. Thus, only 6 (40%) lesions were thrombosed within 48 hours after 1 or 2 compression sessions. The other 9 cases were successfully treated with thrombin injection. LOS was 2.8+/-1.5 days and 3.5+/-2.4 days in the thrombin and compression groups, respectively (p>0.05). No complications were noted in either group. CONCLUSIONS: Ultrasound-guided thrombin injection induces a fast, effective, and safe thrombosis of postcatheterization pseudoaneurysms. The technique is clearly superior to compression treatment and is recommended as the therapy of choice.     

Ultrasound-guided compression repair for treatment of femoral artery pseudoaneurysm: Acute and follow-up results

Femoral artery pseudoaneurysm is a significant problem in patients undergoing arterial diagnostic or therapeutic catheterization. The aim of this investigation was to report the incidence of pseudoaneurysm after arterial catheterization and the success rate of ultrasound-guided compression repair. During a 3-year period (11/91-11/94) 9,051 patients underwent 7,312 cardiac catheterizations and 1,739 peripheral percutaneous transluminal coronary angioplasty procedures. Patients suspect of pseudoaneurysm were referred for a color Doppler ultrasound examination. All patients with pseudoaneurysm were considered for ultrasound-guided compression repair. Pseudoaneurysm occurred more frequently after interventional procedures with new devices (valvuloplasty 2.3%, stent 3.2%) than after conventional catheterization (diagnostic cardiac catheterization 0.2%, electrophysiology 1.3%, percutaneous transluminal coronary angioplasty 0.2%). The incidence of pseudoaneurysm after peripheral percutaneous coronary transluminal angioplasty, including intra-arterial lysis and stent, was 1%. Ultrasound-guided compression repair was successfully performed in 37 of 41 cases with pseudoaneurysm (90%). Ultrasound-guided compression repair was successfully performed In 30 of 31 patients (97%) without anticoagulation and in 7 of 10 patients (70%) receiving anticoagulants (P < 0.05). There was no correlation between mean diameter of the pseudoaneurysm, age of the lesion, or antiplatelet therapy. Color Doppler ultrasound re-examination at up to 3 months indicated successful treatment in all patients. The use of complex Interventional catheterization procedures leads to an increased frequency of pseudoaneurysms compared with conventional angiography and percutaneous transluminal coronary angioplasty. Ultrasound-guided compression repair is a non-invasive, efficient, safe and cost-effective therapy for post-catheterization pseudoaneurysm. © 1996 Wiley-Liss, Inc.     

Manual compression repair of post-catheterization femoral pseudoaneurysms: an alternative to ultrasound guided compression repair?

BACKGROUND: It is unknown, whether direct guidance by ultrasound is essential for the safety and efficacy of ultrasound-guided compression repair (UGCR) of pseudoaneurysms. We therefore tested, whether clinically guided manual compression repair (MCR) without continuous ultrasound control may represent an equally effective alternative. METHODS: After ultrasound diagnosis of a pseudoaneurysm, direct manual compression was applied to the lesion until the characteristic clinical signs disappeared or for a maximum of 1 hour. Then a compression bandage was applied for 24 hours. If the pseudoaneurysm persisted, MCR was repeated up to a maximum of three times. RESULTS: Of 96 consecutive patients with pseudoaneurysms, ten patients were referred to primary surgery; one patient refused any therapy. The remaining 85 patients (89%) were treated by MCR. MCR was successful in 74 patients (87%). Of these, 74% were cured at the first attempt, while 16% resp. 10% required 2 resp. 3 compression manoeuvers for definite cure. The success rate tended to be somewhat lower in patients on anticoagulants (78%) than in those on aspirin (91%) or those without any antithrombotic medication (89%) (p = 0.14). No major complications were observed. Of the 11 patients in whom MCR was unsuccessful, five patients underwent surgical repair; in four patients the pseudoaneurysms thrombosed spontaneously within 1-3 months and 2 pseudoaneurysms persist without complications. CONCLUSIONS: Our results with MCR are comparable to those published for UGCR. Since MCR requires less technical equipment and seems to be less painful for the patient, a prospective comparison of both methods appears warranted.     

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.     

A prospective, randomized evaluation of nonsurgical closure of femoral pseudoaneurysm by compression device with or without ultrasound guidance.

Femoral artery pseudoaneurysm (PA) is a significant complication following diagnostic or therapeutic catheterization. The treatment of choice for femoral artery PA is freehand ultrasound-guided compression repair (UGCR). An alternative method is compression by mechanical devices. The study evaluated the mechanical compression device (FemoStop) with (G1) or without (G2) ultrasound guidance for initial placement in a randomized fashion. Thirty-eight patients (20 women, 18 men) age 40 to 85 (mean 54) years with clinical signs of PA underwent diagnostic color Doppler ultrasound. Randomization yielded 19 patients each for G1 and G2. PA occurred after 12 diagnostic cardiac catheterizations, 18 coronary stent implantations or balloon angioplasties, 2 electrophysiology procedures, and 6 peripheral percutaneous transluminal angioplasties. The G1 protocol was successful in 15 of 19 patients (79%), with a mean compression time of 28 min. The three other patients were treated successfully with UGCR. Only one patient needed vascular surgery. The G2 protocol was successful in 14 of 19 patients (74%) with a mean compression time of 33 min. The failed patients were treated successfully: three with UGCR and two with the same mechanical compression device now positioned under ultrasound control. Compression therapy with the compression device (FemoStop) for iatrogenic femoral pseudoaneurysm does not require ultrasound guidance for positioning. Cathet. Cardiovasc. Intervent. 47:304-309, 1999.     

A prospective study on ultrasound-guided compression therapy or thrombin injection for treatment of iatrogenic false aneurysms in patients receiving full-dose anti-platelet therapy

BACKGROUND: False aneurysms (FA) develop at the puncture site in up to 6% of percutaneous cardiovascular procedures. Previous management included surgery or manual compression. Recently, selective injection of thrombin has been proposed as an alternative. However, there has been no direct comparison of thrombin injection to manual compression. AIM: To study the effectiveness of manual compression compared to that of thrombin injection in patients with false aneurysms on full-dose aspirin and clopidogrel. METHODS AND PROTOCOL: All patients with a clinically suspected FA after percutaneous invasive procedures were recruited for the study. The patients were examined with color ultrasound (7.5 MHz transducer). The minimum and maximum diameters of the false aneurysm and the distance between the surface and the false aneurysm were measured online. Under local anesthesia, manual compression was applied under sonographic guidance in all patients. If compression stopped flow into the false aneurysm, manual compression was applied for a maximum of 40 min followed by compression bandage for a minimum of 12 hours. If compression failed, thrombin was injected under ultrasound guidance. RESULTS: Thirty-six patients had a FA. Their age ranged from 58 to 90 years (mean 71+/-9 years). All patients were taking aspirin (median dose 100 mg per day) and clopidogrel (median dose 75 mg per day). Additionally, 24 patients had received subcutaneous heparin (7500 to 12 500 units) or enoxaprin (0.4-1.0 ml) 3 to 12 hours before treatment. The mean width of the false aneurysm was 22.1+/-3 mm, mean length 33.6+/-35.4 mm, and mean depth 19.5+/-8.2 mm. In six patients (17%), ultrasound-guided manual compression was tolerated, succeeding after 5 to 31 minutes. Thirty patients received thrombin injections (100-1800 units, mean 880+/-470 units, median 800 units). Complete thrombosis occurred in 28 patients (93%). Surgery was performed in the other two patients. The thrombin injection was not associated with any complications. In particular, there were no peripheral vascular complications. CONCLUSION: In patients with FA taking aspirin and clopidogrel, selective thrombin injection is more effective than manual compression.     

Percutaneous treatment of pseudoaneurysms and arteriovenous fistulas after invasive vascular procedures

Development of femoral artery pseudoaneurysms and arteriovenous fistulas represents a continuing problem after vascular diagnostic and interventional procedures. For most patients, ultrasound-guided compression is an effective method of treating such complications. However, in patients requiring a continuous anticoagulant regimen, in those with large arteriovenous fistulas or in patients suffering from painful groin hematomas, compression repair is less successful. We therefore assessed the feasibility, efficacy, and long-term results of interventional percutaneous treatment of these complications. In a 40-month period, we treated 53 consecutive patients with 30 pseudoaneurysms, 21 arteriovenous fistulas, and 2 combined lesions. The intervention was successful in 47 patients: 32 lesions were treated by implantation of covered stents, 14 by embolization techniques, and 1 by a combined procedure, surgical repair being necessary only in 6 patients. After a clinical and ultrasonic follow-up of 301 ± 280 days, we noticed four late stent occlusions, especially in patients with poor peripheral runoff. Lesions with a distinct connection channel to the vessel lumen should be treated by coil embolization. In lesions originating from the femoral bifurcation with a broad base, surgical repair is necessary. Stenting of the superficial femoral artery with poor runoff should be avoided. Our results suggests that percutaneous closure of false aneurysms and arteriovenous fistulas after invasive procedures with unsuccessful ultrasonic compression repair is an attractive alternative to surgical treatment. Cathet. Cardiovasc. Intervent. 47:157–164, 1999. © 1999 Wiley-Liss, Inc.