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。

Ultrasound-guided thrombin injection for the treatment of iatrogenic pseudoaneurysm of the femoral artery: analysis of 36 cases

Objective To evaluate the feasibility and safety of ultrasound-guided percutaneous thrombin injection（UGTI） for the treatment of iatrogenic femoral pseudoaneurysm（PSA）. Methods Thirty-six patients （21 male, 15 female, age range 34-82 years, mean 63.5years） were found to have PSAs confirmed by untrasound between 1 and 17 days following femoral arterial puncture from January 2000 through Febuary 2007. Of them, 11 were associated with diagnostic arteriography and 25 with stent implantation. UGTI was chosen for ablating femoral PSA. The patients had bed rest for 4 to 6 h after injection. Groin ultrasound reexamination was carried out on 1-3 daffter injection and clinical follow-up examination was performed on 30d. Results Thirty-six patients were treated with UGTI. Of them, 32 had simple PSAs with one sac and 4 had complex PSAs with two sacs. The mean diameter of the aneurysm was（2.98±1.30）emX （1.84±0.75）cm. Thrombin 250-1000 （644.29 ±239.10）U （500U/ml） was injected into the PSA under ultrasound-guidance. No sedation or anaesthesia was required during the procedure. Thirty-four cases were successfully treated with 1 injection. Incomplete thrombosis was achieved after the first injection of thrombin 500U in 2 cases. Ultrasound-guided compression to close the PSA was successful within 5 rain without two or more injections. Primary success rate of UGTI for femoral PSA was 94.4% （34/36）, tbrombus formation in the superficial femoral artery occurred in 1 patient after successful closure of the PSA, so surgical emboleetomy was performed. One patient showed acute allergy 2 rain after thrombin injection, which was relieved by anti-allergic therapy. Relapse oc- curred in 2 patients at 24 h of follow-up. Of them, 1 was successfully managed by a second thrombin injection and the other was successfully treated with ultrasuounfguided compression. There was no recurrence during 30d of clinical follow-up. Recurrence rate of UGTI for PSA was 5.6%. Conclusion UGTI is a safe, rapid, well-tolerated, i