超声引导下较小股动脉假性动脉瘤凝血酶注射与单纯压迫法的疗效比较

目的:评价超声引导下股动脉假性动脉瘤瘤腔内注射凝血酶和单纯加压在治疗医源性股动脉假性动脉瘤中的应用价值?方法:在彩色多普勒超声引导下,30例股动脉假性动脉瘤患者先行加压压迫治疗,压迫治疗力量以患者能耐受,足背动脉搏动可触及为标准,加压时间为48 h?压迫治疗不成功或不能耐受者18例,超声引导下采用20 G穿刺针经皮穿刺,行瘤腔内注射凝血酶封闭治疗,凝血酶浓度为200 U/ml,总量均≤500 U?结果:30例患者中,12例股动脉假性动脉瘤患者采用超声引导下单纯压迫治疗取得成功,术后随访3个月无复发?18例压迫治疗不成功或不能耐受压迫治疗者行超声引导下瘤腔内凝血酶注射治疗,全部获得成功?术中及术后无并发症发生,术后随访3个月无复发?结论:股动脉假性动脉瘤如果瘤腔较小,瘤颈部较窄,可采用超声引导下单纯加压压迫治疗;如果瘤腔较大,瘤颈部较宽,复杂假性动脉瘤,患者不能耐受压迫治疗者可进一步采用超声引导下假性动脉瘤瘤腔内注射凝血酶治疗,可取得良好效果?     

彩色多普勒超声引导下注射凝血酶并加压治疗股动脉穿刺后假性动脉瘤

目的:探讨超声引导下瘤腔内注射凝血酶并加压治疗股动脉假性动脉瘤的疗效和安全性。方法:7例股动脉穿刺后并发假性动脉瘤患者,在超声引导下进行瘤腔内注射凝血酶并加压治疗。结果:6例注射凝血酶剂量300-500 U,压迫时间3-8 min,一次性栓塞成功;仅1例进行二次封堵术,栓塞治疗成功。结论:超声引导下瘤腔注射凝血酶并加压治疗方法相比传统的单纯超声引导下按压治疗简单,安全,成功率高,可作为穿刺术后假性动脉瘤的首选治疗方法。凝血酶注射剂量和注射后按压时间是减少并发症和保证疗效的重要因素。     

超声引导下注射凝血酶治疗医源性假性动脉瘤

目的:评价超声引导下瘤腔内注射凝血酶在治疗医源性股动脉假性动脉瘤中的应用价值。方法:在彩色多普勒超声引导下,采用5ml注射器经皮穿刺,对23例经股动脉介入术后股动脉假性动脉瘤患者行瘤腔内注射凝血酶封闭,凝血酶浓度为200 U/ml,总量均≤500 U。结果:23例患者均1次治疗成功,术中、术后无并发症发生,术后无复发。结论:在彩色多普勒超声引导下凝血酶封闭治疗假性动脉瘤创伤小,操作简便,疗效确切,可作为介入术后假性动脉瘤的首选治疗方法。     

超声引导下小剂量凝血酶注射治疗医源性股动脉假性动脉瘤

目的 研究超声引导下凝血酶注射在医源性股动脉假性动脉瘤治疗中的应用价值。方法 在彩色超声多普勒引导下,采用21G PTC 针经皮穿刺,对2010 年5 月- 2013 年4 月本院介入超声科的39 例医源性股动脉假性动脉瘤患者瘤内注射凝血酶（250 U/ml,总量均≤ 150 U）。结果 39 例均成功行超声引导下凝血酶注射治疗,瘤腔内血流信号均消失,但3 例术后瘤颈处可见少许血流信号,术中、术后无并发症发生,术后无复发。结论 超声引导下凝血酶注射治疗医源性股动脉假性动脉瘤操作简便、临床疗效可靠、并发症少、复发率低,临床应用价值较高。     

应用超声引导在假性动脉瘤诊疗中的分析

目的:在介入诊断治疗后形成股动脉假性动脉瘤的诊断治疗分析.方法:分析11例介入性诊断治疗患者,全部经造影证实后确定假性动脉瘤(PSA),行加压修复法治疗3例,其中2例瘤腔闭合,1例压迫无效改行经超声引导瘤体内注射凝血酶治疗.经超声引导瘤体内注射凝血酶治疗9例瘤腔均闭合.经过超声随访均无复发.结论:超声引导瘤体内注射凝血酶治疗假性动脉瘤创伤性小,治愈率高,并发症少,可作为临床治疗的主要方法.     

超声引导下压迫和凝血酶注射治疗医源性股动脉假性动脉瘤23例报告

目的观察超声引导下压迫和凝血酶注射治疗医源性股动脉假性动脉瘤的效果。方法回顾性分析23例接受股动脉穿刺介入治疗并发股动脉假性动脉瘤患者的临床资料及局部治疗情况。8例患者行超声引导下单纯压迫治疗,其中2例单纯压迫后行超声引导下瘤腔内凝血酶注射治疗;15例则行超声引导下瘤腔内凝血酶注射治疗,使瘤腔闭塞。结果 23例均成功闭塞,无破裂出血、动脉栓塞、血栓形成等,术后24 h、1个月随访,未见复发。结论超声引导下压迫和凝血酶注射治疗医源性股动脉假性动脉瘤简便、安全、有效。     

超声引导下瘤腔内注射凝血酶治疗股动脉假性动脉瘤的临床研究

目的:评价超声引导下瘤内注射凝血酶治疗股动脉假性动脉瘤的应用价值。方法:入选33例经皮冠脉介入治疗术后形成的股动脉假性动脉瘤患者。采用超声引导下,于超声探头压迫瘤颈同时,瘤腔内注射凝血酶(浓度为100 U/mL)。分析假性动脉瘤的类型、大小、瘤径长度及宽度、凝血酶用量及其疗效,观察其并发症。结果:33例患者中,单纯型25例,复杂型8例。动脉瘤平均体积为(9.0±5.0)cm3,瘤颈部宽度(2.7±0.7)mm,颈部长度(5.9±0.9)mm,平均凝血酶用量(299±110)U。30例一次成功,3例第一次注射后复发,经第二次注射后成功,其中单纯型1例,复杂型2例。未发生动脉或静脉栓塞等并发症。术后随访3个月无复发。与单纯型相比,复杂型动脉瘤患者年龄更大,女性更多,体重指数及瘤腔体积更大,所需凝血酶剂量更多(P0.05);两者在瘤径长度及宽度方面差异无统计学意义(P0.05)。结论:超声引导下瘤腔内注射凝血酶治疗股动脉假性动脉瘤操作简便,疗效好,安全性高,可作为介入术后股动脉假性动脉瘤的首选治疗方法。     

介入治疗股动脉穿刺并发症的防治

目的:评价股动脉穿刺所致假性动脉瘤的治疗效果。方法:选取12例假性动脉瘤患者,其中男5例,女7例,年龄63～75岁,平均70岁;其中10例经超声引导下局部压迫,1例经瘤体内局部注射凝血酶,1例经外科施行血肿清除及血管修补术。结果:在不同治疗方法治疗后均达到临床治愈。结论:股动脉穿刺所致假性动脉瘤经超声引导下局部压迫、瘤体内注射凝血酶治疗安全、有效。     

彩超在引导瘤内注射凝血酶治疗假性动脉瘤中的价值

目的探讨彩色多普勒超声在引导瘤内注射凝血酶治疗假性动脉瘤中的价值。方法心导管术后股动脉假性动脉瘤7例,彩超引导下瘤内注射凝血酶栓塞治疗,观察血栓形成时间和凝血酶的用量。并在治疗后10min、1天、5天、15天复查彩超。结果瘤内血栓形成迅速,时间为2～4min,凝血酶用量为200—500U,平均280U;治愈率100％;1例出现急性过敏反应并伴有同侧下肢静脉血栓形成。结论彩超引导下瘤内注射凝血酶治疗假性动脉瘤是一种操作简单、安全有效的方法,且并发症少,可作为治疗假性动脉瘤方法的首选。     

彩超引导注射凝血酶诊治医源性假性动脉瘤的临床体会

目的:探讨彩色多普勒(CDFI)对医源性假性动脉瘤治疗情况分析。方法:9例经皮穿刺腔内冠状动脉造影、成形术以及股动脉插管溶栓术后穿刺部位发现搏动性肿块或者听诊有血管杂音的患者,临床诊断为假性动脉瘤并经加压治疗失败的病例,首先采用彩色多普勒检查股动脉及病变周围组织后,在超声引导下经皮穿刺动脉瘤瘤腔,向瘤腔内注射凝血酶进行治疗。结果:9例假性动脉瘤明确诊断后,再在彩色多普勒引导下注射凝血酶后瘤腔内彩色血流信号消失,被类实性中等回声所充填。结论:彩色多普勒超声引导下注射凝血酶治疗医源性假性动脉瘤很有临床实用性,且该微创方法疗效显著,操作简便,值得推广。     

超声引导下压迫修复联合凝血酶注射治疗假性动脉瘤

目的探讨超声引导下压迫修复联合凝血酶注射治疗假性动脉瘤的临床价值。方法对32例假性动脉瘤患者,在超声引导下压迫封闭瘤腔与载瘤动脉间的通道,同时保证栽瘤动脉远端血运通畅。超声监示下使用22G或20G细针徒手穿刺进入假性动脉瘤残腔,注入凝血酶。用二维和彩色多普勒超声观察瘤体内血栓形成情况。血栓充分形成后观察载瘤动脉及其远端动脉,确定其通畅。结果32例假性动脉瘤在超声引导下压迫修复联合凝血酶注射治疗均获成功,封闭成功率达100％,无中转外科治疗患者,无动脉栓塞、过敏反应等并发症发生。其中1例术后第三天复发,再次应用上述方法治疗后痊愈。结论超声引导下压迫修复联合凝血酶注射治疗假性动脉瘤安全、实用,可在临床推广应用。     

超声引导下凝血酶注射治疗股动脉假性动脉瘤的体会

目的探讨UGTI治疗PSA的安全性和可行性。方法2007年1月至2008年6月,对12例经皮股动脉径路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5例,女7例,年龄39岁～82岁,平均年龄(64.5±10.6岁)。造影术后发生5例,支架置入术后发生7例。凝血酶注射成功后平卧4h～6h,所有病例均在治疗后1d～3d复查超声,30d临床随访。结果12例患者,瘤腔大小平均为(2.90±1.40)cm×(1.90±0.85)cm,凝血酶注射剂量为604.29±212.10(250～1000)U,11例患者一次UGTI即刻闭合瘤腔,1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。术后1d~3d随访无复发,30d临床随访无复发。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。     

彩超引导下注射凝血酶联合瘤颈压迫治疗股动脉假性动脉瘤的临床价值

目的:探讨彩超引导下瘤腔内注射凝血酶联合瘤颈压迫治疗股动脉假性动脉瘤的临床价值。方法:对15例经彩超确诊为股动脉假性动脉瘤的患者,在彩超引导下压迫假性动脉瘤颈阻断股动脉与瘤腔间的瘘道,并保持股动脉远端血流通畅,同时使用21G细针远离瘤颈部穿刺瘤腔,缓慢注入凝血酶封闭治疗,瘤腔内彩色血流信号消失提示注射治疗成功。结果:15例股动脉假性动脉瘤在彩超引导下压迫瘤颈联合凝血酶注射后彩超显示瘤腔即刻闭合,14例一次性获得成功;1例由于瘤腔较大及大量运用抗凝药治疗,于24h后彩超复查发现瘤腔小部分复发,行第2次凝血酶注射治疗成功,总成功率达100%。结论:彩超引导下瘤腔内注射凝血酶联合瘤颈压迫治疗股动脉假性动脉瘤安全、有效、可重复性强,具有重要的临床应用价值。     

Ultrasound-guided thrombin injection versus ultrasound-guided compression therapy of iatrogenic femoral false aneurysms: Single center experience

BackgroundIatrogenic femoral pseudoaneurysm (false aneurysm) due to arterial access following cardiovascular procedures is becoming common because of the increase in number and complexity of the procedures. Recently, percutaneous thrombin injection is becoming a popular treatment of these false aneurysms.The aim of this study was to assess the efficacy and safety of femoral pseudoaneurysm closure using ultrasound-guided thrombin injection in comparison to ultrasound-guided compression.MethodsA retrospective analysis was undertaken of 65 patients who presented to our vascular department with iatrogenic femoral pseudoaneurysm between January 2015 and March 2019. Twenty-five patients underwent ultrasound-guided thrombin injection, and 40 were treated using ultrasound-guided compression therapy. The primary outcome measured was efficacy, while other outcomes examined were safety, procedure duration, and cost.ResultsA total of 65 patients (45 males, 20 female) were identified with a mean age of 62 years. Out of the 65, 40 patients (28 males, 12 female) underwent ultrasound-guided compression therapy (group A) with a mean aneurysm size of 2.9 cm, and 25 (17 male, 8 female) underwent ultrasound-guided thrombin injection (group B) with a mean pseudoaneurysm sac size of 3.7 cm. The success rate of thrombosis in group A was 70% and in group B was 92%. No significant complications were reported in both groups.ConclusionsUltrasound-guided thrombin injection should be considered as the first line of treatment for uncomplicated femoral pseudoaneurysms because it has a higher thrombosis and lower recurrence rates, when compared with ultrasound-guided compression treatment.     

肝动脉假性动脉瘤破裂出血的介入栓塞治疗

目的探讨肝动脉假性动脉瘤（HAPA）破裂出血急诊栓塞治疗的方法、疗效。方法 2005年4月至2009年10月间对6例肝动脉假性动脉瘤破裂出血进行急诊血管内介入栓塞治疗,造影明确假性动脉瘤部位后,将导管超选择插至载瘤动脉,选用弹簧圈、聚乙烯醇颗粒进行栓塞。结果全部6例经肝动脉造影后明确显示假性动脉瘤,5例位于肝右动脉,肝左动脉1例,肝固有动脉1例。经介入栓塞治疗后载瘤动脉闭塞,假性动脉瘤显影消失,随访3-36月出血无复发。未见与介入治疗相关的并发症。结论对肝动脉假性动脉瘤破裂出血,急诊介入栓塞治疗,方法简单、疗效可靠。应作为首选治疗方法。     

注射毒品后股动脉感染性假性动脉瘤的治疗

目的讨论注射毒品后股动脉感染性假性动脉瘤的外科治疗。方法对3例注射毒品致感染性假性股动脉瘤患者的临床资料进行回顾性分析。结果3例中男1例,女2例,年龄27～36岁,均在腹股沟区注射毒品1年以上。动脉瘤大小分别为9cm×10cm、30cm×20cm、12cm×15cm。1例行人造血管移植术,2例行股动脉破裂修补术。手术后均恢复了下肢血供,但存在创口感染。结论长期在腹股沟区注射不洁毒品,是发生股动脉感染性假性动脉瘤的原因。诊断明确后急诊外科手术仍是治疗首选,彻底清创和血管重建是治疗股动脉感染性假性动脉瘤的有效方法。     

Ultrasound-guided compression repair of peripheral artery pseudoaneurysm: 8 years’ experience of a single institute

BackgroundFemoral artery pseudoaneurysm is a rare complication but with increasing frequency nowadays due to the advances of endovascular intervention. Rare cases of brachial orpopliteal artery pseudoaneurysms had ever been reported and the predictive factors of failed ultrasound-guided compression repair (UGCR) are controversial.MethodsDuring the past 8 years, 21 patients (12 males and nine females; median age, 64 years) with peripheral pseudoaneurysms (femoral artery, n = 17; brachial artery, n = 3; popliteal artery, n = 1) were enrolled. A high frequency of 10–12 MHz color ultrasound was used to evaluate the presence of a pseudoaneurysm. The area of the pseudoaneurysm sac and the width and length of the pseudoaneurysm neck were recorded. Under real-time ultrasound guiding, gradual pressure was applied with the probe to obliterate flow in the pseudoaneurysm neck while still allowing flow through the supplying artery for approximately 10–15 minutes with at most three times (45 minutes’ compression). Follow-up color sonography was obtained at 24 hours to detect any recurrence.ResultsThe mean area and the largest dimension of the 21 pseudoaneurysms were 7.3 ± 6.5 cm² and 3.6 ± 1.8 cm, respectively. The mean width and the mean length of the pseudoaneurysm neck were 2.1 ± 0.9 and 3.3 ± 2.0 mm, respectively. Successful thrombosis of the pseudoaneurysm was achieved in 19(90.5%) patients. The mean compression time of the 19 successful UGCR was 21.2 ± 11.0 minutes. Two patients failed the UGCR procedure after a 45-minute compression. Both of the two pseudoaneurysms were located in the femoral artery with a large width of the pseudoaneurysm neck (4 and 5 mm, respectively).ConclusionUGCR is a safe and cost-effective therapy for treating peripheral pseudoaneurysms of not only femoral artery, but also brachial artery and popliteal artery. We considered the width of the pseudoaneurysm neck to be the predictive factor of technical success.     

超声引导下瘤腔内注射凝血酶治疗IFAP合并动静脉瘘

目的采用超声引导下瘤内注射凝血酶（UGTI）治疗医源性股动脉假性动脉瘤（IFAP）合并动静脉瘘。方法冠状动脉介入诊治术后IFAP患者32例,其中9例合并动静脉瘘。所有患者均接受UGTI治疗,并于术后3、14和30d定期进行超声复查。结果 31例患者一次治疗成功,1例失败转行外科手术治疗。31例患者术后随访,均无IFAP复发以及栓塞和过敏反应等并发症发生。结论 UGTI治疗IFAP具有较高的临床价值,对合并动静脉瘘者同样安全、有效。     

小口径覆膜支架在周围动脉血管疾病中的应用探讨

目的：探讨小口径覆膜支架在周围血管疾病的应用价值。方法回顾分析我院2011年12月至2013年3月收治的23例周围血管疾病患者应用小口径腹膜支架的临床资料,全组患者共置入巴德小口径覆膜支架28枚,使用支架直径在6～12mm。结果所有患者中,髂动脉瘤1例,肠系膜上动脉瘤2例,锁骨下假性动脉瘤2例,股总动脉假性动脉瘤3例,锁骨下动脉狭窄3例,髂动脉狭窄闭塞6例,髂动脉及股动脉急性创伤性损伤6例。支架释放技术成功率100%,8例动脉瘤的患者植入覆膜支架后均立即隔绝,无内漏,支架植入动脉远端血流通畅,9例狭窄或闭塞的病变支架植入后,病变血管远端血流通畅,6例创伤患者植入支架后有效隔绝血管破口;所有23例患者中,1例失访,其余的平均随访时间13.6个月。随访22例效果良好,无支架内血栓形成、无移位、无支架内狭窄等并发症。结论小口径覆膜支架用于周围血管疾病有其微创性、快速性、及近期疗效确切,特别是在一些特殊情况下起到了非替代的作用,但是远期疗效有待进一步观察。