超声引导下经皮注射凝血酶治疗医源性假性动脉瘤

医源性假性动脉瘤(IPSA)是介入术的常见并发症之一.既往的处理方法以外科手术为主.近年来,许多非外科手术性的处理方法不断出现,其中超声引导下经皮注射凝血酶法(UGTTI)在治疗IPSA中具有疗效高、创伤小、恢复快、费用低的优点得到了广泛应用.本文就近年来有关UGTI的进展作一综述.     

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.     

超声引导下不同剂量凝血酶封闭治疗医源性股动脉假性动脉瘤的临床观察

目的:探讨超声引导下不同剂量凝血酶注射在医源性股动脉假性动脉瘤治疗中的有效性和安全性。方法:将我院2000年6月至2016年6月间,26例医源性股动脉假性动脉瘤患者随机分为两组,在超声引导下瘤腔内注射凝血酶,观察组13例注射凝血酶200~500U,对照组13例注射凝血酶500~1 000U。结果:观察组和对照组患者特征、注射凝血酶次数、治疗时间、成功率差异无统计学意义,对照组发生1例股浅动脉栓塞,1例足背动脉栓塞,观察组无不良反应发生。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,小剂量同样有效,而且可能会降低不良反应的发生。     

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。     

腔内注射凝血酶治疗股动脉假性动脉瘤

假性动脉瘤 (PSA)是指经皮穿刺后血液通过损伤的动脉壁破裂口进入血管周围组织并形成一个或多个瘤腔 ,收缩期动脉血液由载瘤动脉经瘤颈部流至瘤腔内 ,舒张期血液回流到载瘤动脉内的一种病理现象。近年来 ,随着心血管介入技术的广泛开展 ,各种大口径管、鞘的运用及围手术期抗凝药物的应用使心血管介入术所致的股动脉PSA的发生率显著增加。多数文献报道PSA发生率为0 0 5 %～ 6 2 5 % ,但彩色多普勒超声检出率为 14 %～ 2 7%。治疗股动脉PSA的方法有多种。自1991年以来 ,超声引导下加压修复 (ul trasoundguidedcompressionrepatr,UGCR…     

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。     

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。     

超声引导凝血酶注射治疗股动脉假性动脉瘤可行性及影响因素探讨

目的探讨医源性股动脉假性动脉瘤(PS)超声引导下注射凝血酶(UGTI)治疗的可行性及影响因素.方法15例经股动脉径路选择性冠状动脉造影和冠状动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,选择性冠状动脉造影1例,经皮冠状动脉介入14例.单腔的单纯型PS9例,2腔或3腔的复杂型PS 6例.分析PS的形状、大小、颈部长度与宽度、凝血酶剂量、治疗结果以及并发症.UGTI后24h、5～7d接受二维超声随访.结果PS平均容积为(13±4.89)cm3.共注射凝血酶21次,平均每次注射凝血酶剂量,单腔为(250±120)IU,双腔或多腔为(650±150)IU.9例单腔患者全部一次成功,初级成功率为100%;6例双腔或多腔的复杂PS患者4例首次成功,初级成功率为66.7%.1例复杂PS24h出现"再通".1例复杂PS患者15d出现"再通",经重复3次注射凝血酶后,封闭成功.次级成功率达到100%.无一例出现血栓形成、感染、过敏等并发症.结论UGTI治疗股动脉PS安全有效,可作为经股动脉途径介入诊疗术所致医源性股动脉PS的首选治疗,PS的几何形状是初级成功率的决定因素.     

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.     

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     

Treatment of femoral artery pseudoaneurysm with percutaneous thrombin injection.

Pseudoaneurysm formation of the femoral artery is a well-known complication following catheter-based vascular procedures. Ultrasound-guided compression or surgical correction are commonly used for its repair. We describe a new method of treatment for femoral pseudoaneurysm. The pseudoaneurysm is visualized by contralateral angiography and thrombosed with a percutaneous thrombin injection while the distal vessel is isolated with a brief balloon inflation. Fluoroscopically guided percutaneous thrombin injection is a promising, minimally invasive technique for the treatment of iatrogenic pseudoaneurysm, especially in patients with compromised distal circulation.     

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。     

Single ultrasound-guided local high-dose thrombin injection in the treatment of giant brachial artery pseudoaneurysm: A case report

Rationale:Pseudoaneurysm (PSA) is a common complication related to vascular intervention, and surgical therapy is the primary method. However, a giant brachial artery PSA over 2 weeks is rarely observed. Due to the adhesion of surrounding tissue, thrombus organization, the extensive injury, and the high expense of transluminal stent-graft placement, a single ultrasound-guided local high-dose thrombin injection can be a therapy option. Such cases are rarely reported.Patient concerns:A 71-year-old man with a history of left elbow fossa interventional puncture presented to our hospital with a pulsatile mass in the left elbow fossa. He had a history of cerebral infarction 32 years prior without sequelae, emphysema for more than 2 years, hyperlipidemia for 3 months, and prostatic hyperplasia for 8 months. After conservative therapy, the lumbar compression fracture produced by trauma 24 years ago healed, and the intracranial hematoma induced by trauma ten years ago was absorbed.Diagnosis:Ultrasound examination showed giant mixed echoes on the posterior medial side of the left brachial artery.Interventions:The patient underwent a single ultrasound-guided local high-dose thrombin injection to treat giant brachial artery PSA.Outcomes:Following therapy, the ultrasonography revealed that extensive thrombosis immediately formed in the cavity, and the internal blood flow signals had completely vanished. A week later, a physical examination showed that the PSA had shrunk with no apparent tenderness and that the texture had hardened. Pulsation and vascular murmurs disappeared. Ultrasound showed that the PSA was reduced, and no blood flow signals were found.Lessons:A single ultrasound-guided local high-dose thrombin injection had a considerable effect in curing large iatrogenic PSA. However, when deciding on the best therapy, specificity must be taken into account.     

超声引导下预注射生理盐水及注射凝血酶治疗上肢动脉假性动脉瘤

目的探讨超声引导下预注射生理盐水及注射凝血酶治疗上肢动脉假性动脉瘤的疗效。方法选择2006年2月～2007年5月住我院行冠状动脉介入诊疗后并发的5例上肢动脉假性动脉瘤患者进行瘤腔内凝血酶注射治疗,并对其疗效进行分析。结果 5例患者均即刻治疗成功,未见明显并发症。随访14～30天无复发。结论超声引导下预注射生理盐水及注射凝血酶能精确定位针头位置,避免远段动脉栓塞的严重并发症发生,是一种安全、有效、快速的治疗上肢动脉假性动脉瘤的首选方法。     

Sonographically guided thrombin injection for the treatment of femoral artery pseudoaneurysm

The formation of pseudoaneurysm in the femoral artery after cardiac catheterization is a well-recognized complication occurring in 1%-4% of cases. It is traditionally managed surgically and has a high morbidity. Prolonged ultrasound-guided compression of the neck of the pseudoaneurysm, and ultrasound-guided injection of thrombin into the aneurysm are newer modalities of treatment especially for small aneurysms. We describe the case of a giant pseudoaneurysm of the right femoral artery, post-arteriography, which was successfully managed with ultrasonographically guided percutaneous thrombin injection.