超声引导注射凝血酶治疗医源性股动脉假性动脉瘤

股动脉假性动脉瘤是介入性导管诊疗术后的医源性并发症之一，常规治疗多采用局部加压。由于受加压部位定位、加压力度、局部脂肪、患者配合程度等多因素的影响，常导致部分患者治疗无效。我们采用超声引导下注射凝血酶对14例股动脉假性动脉瘤进行治疗，效果良好，现报道如下。     

超声引导下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方法及其可行性和安全性.方法:6例患者因行股动脉穿刺于术后2～5 d发生6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:4例患者4处假性动脉瘤一次性注射凝血酶300～500 U后瘤腔即刻闭合,随访10～90 d,假性动脉瘤无复发.2例患者2处假性动脉瘤瘤体较大,第1次注射后于第3 d复发,行第2次注射后,假性动脉瘤无复发.其中1例患者出现一过性肢体栓塞临床表现,经观察后肢体栓塞临床表现消失,未特殊处理.6例患者均未出现过敏反应等并发症.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,但操作时需注意瘤体的大小及凝血酶的用量.     

覆膜支架腔内修复治疗颈动脉假性动脉瘤破裂出血北大核心CSCD

目的探讨覆膜支架腔内修复术治疗颈动脉假性动脉瘤破裂出血的效果及安全性。方法回顾性分析2009年7月至2015年7月中山大学孙逸仙纪念医院采用血管内覆膜支架植入术急诊救治的15例颈动脉假性动脉瘤破裂出血患者。其中直接外伤致颈总动脉假性动脉瘤1例,颈部手术致颈总动脉假性动脉瘤破裂1例,致颈内动脉假性动脉瘤破裂3例,鼻咽癌放疗后颈内动脉假性动脉瘤破裂10例。结果 15例患者均经覆膜支架腔内修复术得到成功救治,无即刻手术相关并发症及死亡发生。术后平均随访时间11个月,15例患者均无再次出血,临床随访期间无脑缺血并发症。结论覆膜支架腔内修复术治疗颈动脉假性动脉瘤破裂出血创伤小、安全有效,可在封堵颈动脉破口的同时恢复头颈部正常血供,并发症少。但仍需更大样本量临床研究证实,进一步观察远期疗效。     

改良法超声引导下注射凝血酶治疗股动脉假性动脉瘤

目的探讨改良法超声引导下注射凝血酶治疗股动脉假性动脉瘤的价值。资料和方法 49例股动脉假性动脉瘤患者于超声引导下穿刺注射凝血酶,穿刺时压迫瘤颈使瘤内血流消失,瘤内血栓形成后逐级放松压迫力度直至瘤内填满血栓。分析假性动脉瘤的体积、分型、颈部长度宽度、凝血酶用量等对疗效的影响,观察其并发症。结果 49例患者术前经彩色多普勒超声确诊,其中单纯型37例,复杂型12例,动脉瘤平均体积为10.5±6.0cm3,瘤颈部宽度2.8±0.6mm,颈部长度6.1±1.4mm,平均凝血酶用量277±120U。46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。结论改良法超声引导下注射凝血酶治疗股动脉假性动脉瘤是一种高效、安全的方法,并发症少,可作为治疗的首选方法。     

超声引导下注射凝血酶治疗假性动脉瘤一例

病历资料 患者,女,37岁,因阵发性心慌入院,诊断为房室折返性心动过速,行射频消融术,术后抗凝治疗,术后次日患者右侧大腿穿刺点周围肿痛,皮下出现淤斑,右股动脉穿刺点处听到血管杂音,并可触及搏动性包块,彩色多普勒超声显示右侧股总动脉外侧可见一个大小为4.6 cm×1.8 cm的无回声区,内有漩涡状彩色血流信号(图1),与股总动脉间有异常血流通道,有血流往复现象,取样容积置于动脉破口处,呈双期双向的动脉血流频谱,诊断为假性动脉瘤.     

超声造影及超声在经皮注射凝血酶治疗颈部假性动脉瘤中的应用（附2例病例）

颈部假性动脉瘤（pseudoaneurysm,PSA）发病率非常低,但可能导致无法控制的出血甚至危及生命［1］。传统外科手术对于PSA动脉破裂口的直接修复和血管塑形难度很高,往往需要牺牲载瘤动脉或进行血管架桥手术,死亡率和致残率较高［2］。超声引导下小剂量凝血酶注射术因其简单、经济、便捷、有效、安全已成为外周动脉PSA 治疗的重要手段,临床报道较多［3］。而关于超声造影（contrast-enhanced ultrasonography,CEUS）和彩色多普勒超声（color dopple ultrasonography,CDUS）引导下凝血酶注射治疗颈部PSA 的病例还未见报道。笔者回顾分析了两例在本院诊治的颈部 PSA 患者的相关影像学资料和诊疗经过,旨在探讨 CEUS 及 CDUS 在凝血酶注射治疗颈部 PSA中的应用价值。     

超声引导下注射凝血酶在难治型假性动脉瘤治疗中应用价值

目的 探讨超声引导下注射凝血酶在难治型假性动脉瘤(PSA)治疗中的应用价值.方法 选取自2014年1月至2019年12月于北部战区总医院行介入治疗后并发PSA的65例患者为研究对象.其中,难治单纯型53例,难治复杂型12例.比较两种类型PSA的瘤体大小、瘤颈宽度、瘤口处血流速度、按压时间、凝血酶用量.采用Spearma...     

超声引导下压迫法或联合注射凝血酶治疗股动脉假性动脉瘤

目的:探讨超声引导下局部压迫或联合瘤体内注射凝血酶治疗医源性股动脉假性动脉瘤(pseudoaneurysm,PSA)的价值。方法:在超声引导下,对42例医源性股动脉PSA患者根据瘤体大小、瘤口大小、瘤颈长短、瘤颈部血流速度及患者情况,选择局部压迫法或联合瘤体内注射凝血酶进行治疗。结果:19例瘤体体积及瘤口直径较小、瘤颈长度较长患者在超声引导下局部压迫全部成功压闭;23例瘤体体积及瘤口直径较大、瘤颈长度较短患者采取超声引导下局部压迫法联合瘤体内注射凝血酶治疗1或2次,瘤腔成功闭合。结论:超声引导下局部压迫法或联合瘤体内注射凝血酶治疗医源性股动脉PSA安全实用,可作为经股动脉途径介入诊疗术所致医源性PSA的首选治疗方法。     

超声引导下注射凝血酶治疗心导管术后股动脉假性动脉瘤的探讨

目的:评价超声引导下注射凝血酶治疗股动脉假性动脉瘤的效果。材料和方法:心导管术后股动脉假性动脉瘤13例,超声引导下瘤内注射凝血酶栓塞治疗。结果:12例治疗成功,1例失败,无严重并发症发生。结论:超声引导下注射凝血酶是治疗股动脉假性动脉瘤安全、有效的方法。     

左臀部假性动脉瘤介入栓塞治疗1例

病例男,34岁,因左臀部及左大腿刀伤半月,半月前急诊在外院行剖腹探查术,具体手术情况不详,术后伤口愈合出院。2d前突发左下腹及左下肢剧烈疼痛,表现为持续性胀痛,向腰部放射,疼痛逐渐加重不能耐受,遂来本院就诊。入院查体：血压90／60mmHg,心率110次／min,贫血貌,腹部平软,左下腹压痛,无反跳痛,左臀部可闻及血管杂音。左下肢被迫弯曲体位,伸直左下肢疼痛明显加重,左足背动脉搏动可触及。B超检查示：左臀部及后覆膜低回声包块,约15cm×12cm,可探及一动脉破口,并有动脉血流信号,左股总动脉正常。考虑假性动脉瘤。诊断：左臀部刀外伤性假性动脉瘤。行动脉介入治疗：局部麻醉,经右股动脉穿刺置入6F鞘管,0．035in导丝引导Corbra导管达左髂总动脉,造影示：左髂内动脉远端可见造影剂外溢,左髂外动脉造影剂无外溢;导管选择进入髂内动脉造影示：臀下动脉断裂,远端可见造影剂外溢;导丝导管选择到臀下动脉,放置1枚弹簧圈后造影示：仍有少许造影剂外溢;再次放置弹簧圈1枚后造影示：臀下动脉完全栓塞。拔出导管及导丝,穿刺点压迫30rain,手术完毕。患者术后立即感左下腹及左下肢疼痛明显缓解,左臀部血管杂音消失,左膝关节能伸直,仍有左下肢肢体轻度麻木。术后给予抗炎治疗,术后7d肢体麻木症状消失。复查彩超示：液性暗区包块缩小,内无血流信号,给予出院。     

Combined percutaneous thrombin injection and endovascular treatment of gastroduodenal artery pseudoaneurysm (PAGD): case report

A 69-year-old man with a history of acute pancreatitis developed a huge pseudoaneurysm of the gastroduodenal artery (PAGD), as diagnosed by CT scan. The PAGD was treated by percutaneous thrombin injection (2,000 IU) under ultrasound guidance and selective embolization of gastroduodenal artery with microcoils with its complete exclusion. The 6-month follow-up confirmed the complete exclusion of the PAGD sac.     

Balloon-assisted,ultrasound-guided percutaneous real-time thrombin injection,for the arteriovenous fistula pseudoaneurysm treatment

A pseudoaneurysm or false aneurysm is the consequence of a persistent blood leak caused generally by iatrogenic rupture of a vessel wall. The blood leak creates a new cavity delimited by surrounding tissues and allows blood flow to remain in continuity between this cavity and the vessel. In hemodialysis fistula, pseudoaneurysm generally results from repeated puncturing of the vein at the same site, leading to a bulging anatomical defect in the vein. Over the past few years, interventional radiological treatment has evolved and taken the place of surgery, with different kinds of percutaneous and endovascular treatment methods in pseudoaneurysm management. We reported a case report of successful treatment of arteriovenous fistula pseudoaneurysm with no-measurable neck. We performed ultrasound-guided percutaneous direct thrombin injection while an inflated balloon transiently obstructed flow out of the pseudoaneurysm, in order prevent non-target embolization.     

Percutaneous thrombin injection for the treatment of a post-pancreatitis pseudoaneurysm

Visceral artery pseudoaneurysms are often treated surgically or by transcatheter embolisation. We report a case of a pseudoaneurysm in a patient with chronic pancreatitis, which was successfully occluded by percutaneous injection of thrombin into the pseudoaneurysmal sac as a first-line management.     

Postcatheterization pseudoaneurysm: results of US-guided percutaneous thrombin injection in 240 patients

PURPOSE: To prospectively evaluate ultrasonographically (US) guided percutaneous thrombin injection for treatment of femoral artery and brachial artery pseudoaneurysms. MATERIALS AND METHODS: The university institutional review board approved the study. Informed consent was obtained from all patients. Two hundred forty patients with postcatheterization femoral artery (n = 132) or brachial artery (n = 8) pseudoaneurysms were treated with US-guided bovine thrombin (1.000 IU/mL) injection. At diagnosis, 107 (44.6%) patients received anticoagulation therapy; 159 (66.2%), antiplatelet therapy; and 76 (31.7%), both therapies. Pseudoaneurysm size, length and width of pseudoaneurysm neck, thrombin dose, therapy outcome, and complications were documented. The peak blood flow in peripheral arteries was determined before and after thrombin injection. Follow-up duplex US was performed 12-24 hours, 5-7 days, and 21-25 days after treatment. A nonpaired t test was used to compare differences in age between the male and female patients. Two-way analysis of covariance was performed to analyze the influences of factors that may have been related to the amount of thrombin used. RESULTS: Mean pseudoaneurysm volume was 4.69 cm3 +/- 5.49 (standard deviation). Simple and complex pseudoaneurysms were treated in 165 and 75 patients, respectively. A total of 260 thrombin injections were performed: 1.04 injections per patient with a simple pseudoaneurysm and 1.17 injections per patient with a complex pseudoaneurysm. The mean injected thrombin dose was 425.31 IU +/- 341.75 for all pseudoaneurysms, 382.12 IU +/- 281.00 for simple pseudoaneurysms only, and 520.33 IU +/- 434.64 for complex pseudoaneurysms only. There was only a computational correlation between pseudoaneurysm size and thrombin dose (r2 = 0.07). The primary success rate was 93.8% overall, 95.8% for simple pseudoaneurysms, and 89% for complex pseudoaneurysms. The secondary success rate was 99.6% overall, 100% for simple pseudoaneurysms, and 99% for complex pseudoaneurysms. Early (at < or =24 hours) reperfusion occurred in one simple and five complex pseudoaneurysms. Four late reperfusions-two in simple and two in complex pseudoaneurysms-were detected at 1-week follow-up; no late reperfusions were detected at 3 weeks. Thromboembolic complications occurred in two patients and resolved spontaneously. One mild allergic reaction and no infections occurred. CONCLUSION: US-guided percutaneous thrombin injection enables successful, safe management of postcatheterization pseudoaneurysms.     

CT-guided percutaneous approach for the treatment of peripheral pulmonary artery pseudoaneurysm: A case report

Pulmonary artery pseudoaneurysm is a rare but life threatening complication of pulmonary tuberculosis, considered as a diagnosis and therapeutic emergency. Transarterial embolization approach has become more widespread over the last few decades, and is now considered the first-line treatment over surgery. Percutaneous embolization under computed tomography (CT) or CT scan control has recently been reported by one centre as a first-line treatment for persistent peripheral Pulmonary artery pseudoaneurysm under certain conditions. We report the case of a 23-year-old female patient admitted in emergency for moderate haemoptysis, in a context of relapsing of tuberculosis. CT scan angiogram showed a peripheral pulmonary artery pseudoaneurysm of the lower left lobe, and persisted seven days later. After multidisciplinary meeting, a minimal invasive approach was decided. The patient was treated in first-line treatment by percutaneous transthoracic embolization, under CT-guidance, using N butyl-cyanoacrylate and Lipiodol mixture, without any complication. The percutaneous minimal invasive treatment seems to be a reliable approach to treat persistent peripheral pulmonary artery pseudoaneurysm.Key words: Pulmonary arterial pseudoaneurysm, Glue, Embolization, CT