冠脉介入诊疗术后假性动脉瘤的诊治

目的：总结冠状动脉(冠脉)介入诊疗术后假性动脉瘤(PA)的临床表现及治疗方法。方法：选择冠脉介入诊疗术后出现的16例PA患，结合临床表现和超声多普勒显像，进行临床分析，总结其治疗经验。结果：9例在超声引导下压迫修复，3例采用重复绷带加压法治愈，4例压迫失败而行外科手术修补，未出现并发症。结论；冠脉介入诊疗术后假性动脉瘤的早期超声引导下压迫法和重复绷带加压法是一种简单、安全、有效的治疗方法。     

超声引导下穿刺部位压迫在心导管术后假性动脉瘤的应用

目的探讨超声引导下穿刺部位压迫在心导管术后假性动脉瘤的应用价值。方法心导管术后所致假性动脉瘤21例,应用超声引导定位后徒手压迫修复10例,超声引导下用探头实时压迫修复11例。首次压迫时间20~30分钟,直接探头压迫以不出现血流信号为成功标准。结果21例假性动脉瘤均压迫修复成功,一次成功率86%(18/21),其中有3例病人(1例超声探头压迫,2例徒手压迫)二次压迫修复成功。结论在超声引导定位下对心导管术后假性动脉瘤进行探头实时压迫或徒手压迫修复,具有安全、有效、经济的优点,可作为临床治疗导管术后假性动脉瘤的首选。     

心导管术后假性动脉瘤10例分析

目的 :分析 10例心导管术后出现假性动脉瘤的原因并探讨其治疗方法。方法 :收集 1998年至 2 0 0 1年心导管术后出现的假性动脉瘤患者 10例 ,根据临床症状、体征和彩色多普勒超声证实假性动脉瘤的发生。记录假性动脉瘤的部位、形态和大小。治疗方法包括超声引导下压迫法 (ultrasound gui dedcompressionrepair,UGCR)、超声引导下经皮注射凝血酶 (ultrasound guidedthrombininjection ,UGTI)和外科修补术。结果 :穿刺部位经超声或手术证实 6例在股浅动脉。 2例直接行动脉修补术治愈 ,3例经UGCR后治愈 ,3例UGCR失败后行动脉修补术 ,2例UGCR失败后采用UGTI 5 0 0～ 10 0 0U的治疗方法。随访无复发 ,未见血栓、感染、神经压迫等并发症。结论 :UGTI是一种简便、有效的方法 ,但仍需要更多的样本以探讨该方法的安全性     

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.     

心脏导管术后假性动脉瘤的治疗和结果

作者报告了8715例诊断性心导管术后86例(1％)发生假性动脉瘤,分析了加压绷带(CB),超声指引压迫(UGC)、二期外科手术三种治疗方法及后果。 方法 心脏导管检查98％采用穿刺股动脉Judkins法,术前常规注射5000U肝素,假性动脉瘤的诊断为导管术后患者出现腹股沟区疼痛,或有血肿、瘀伤,超声检查有穿刺     

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。     

介入治疗术后假性动脉瘤临床分析及超声引导下压迫修复的价值

目的　探讨介入治疗术后假性动脉瘤的临床特点 ,评价超声引导下压迫修复介入治疗术后假性动脉瘤的治疗效果。方法　假性动脉瘤主要表现为动脉穿刺部位搏动性肿块并伴有血管杂音。介入治疗术后股动脉假性动脉瘤 9例 ,合并高血压病 5例 ,糖尿病 4例。在GE SYSFEM彩色多普勒超声诊断仪引导下 ,压迫修复。结果　 9例经超声引导全部压迫修复成功 ,1例压迫局部出现皮肤坏死。所有患者均于修复后 72h复查彩色多普勒超声波证实假性动脉瘤已闭合。术后随诊半年 ,未见假性动脉瘤复发。结论　假性动脉瘤为少见但严重的并发症 ,彩色多普勒检查可以确诊。超声引导下压迫修复是一种简单、安全、无创、有效的方法     

冠状动脉介入诊疗术后股动脉假性动脉瘤47例分析

目的总结冠状动脉介入诊疗术后股动脉假性动脉瘤的发生原因、临床表现及治疗方法。方法选择冠状动脉介入诊疗术后出现的47例假性动脉瘤病人,结合临床表现和超声多普勒显像,进行临床分析,记录治疗方法和结果。结果43例行人工压迫法,4例超声引导下行腔内注入凝血酶方法,均未出现并发症。结论冠状动脉介入诊疗术后股动脉假性动脉瘤的早期发现,及时诊断与治疗,人工压迫法和超声引导下行腔内注入凝血酶方法是安全有效的治疗方法。     

心导管介入术后股动脉假性动脉瘤的处理

外科治疗原是处理心导管术后股动脉假性动脉瘤的标准方法 ,但近 10年来 ,无创、微创的方法很大程度上取代了外科治疗。超声引导压迫修复法及超声引导瘤腔内凝血酶注射法是最常用的方法。本文简述了目前处理股动脉假性动脉瘤所用的方法 ,并讨论了每种方法的优点。     

超声引导下注射凝血酶治疗股动脉假性动脉瘤的观察及护理1例

近年来随着心导管操作技术在心血管疾病诊断和治疗中的广泛开展,医源性股动脉假性动脉瘤的发生率成为穿刺操作比较常见的并发症.我科室近期1例冠脉介入治疗患者发生股动脉假性动脉瘤,经超声引导下局部压迫失败且出现下肢静脉血栓,后采用超声引导下凝血酶注射法（ultrasound-guided thrombin injection,UGTI）治疗假性动脉瘤,效果显著.     

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.     

超声指导下压迫修复法闭合经皮导管术后股动脉假性动脉瘤

目的:总结超声指导下压迫修复法(UGCR)治疗股动脉假性动脉瘤(FAP)的疗效和安全性。方法:经股动脉穿刺法行冠状动脉介入术后发生FAP8例,男5例,女3例,年龄53~74岁;冠状动脉造影术后5例,支架置入术后3例;所有患者均选择在超声指导下压迫2h,24h后复查超声。结果:6例患者一次性压迫2h后FAP闭合,2例患者一次性压迫2h后超声显示瘤腔变小,动脉与瘤腔有血流相通,再次压迫2h后闭合,无相关并发症发生,随访无复发。结论:UGCR治疗FAP是一种简单经济、安全有效的无创方法。     

股动脉假性动脉瘤超声引导下凝血酶注射与压迫法的护理比较

目的：比较经股动脉行冠状动脉介入诊疗操作后假性动脉瘤（PSA）超声引导下凝血酶注射（UGTI）与超声引导下压迫（UGCR）治疗的护理效果。方法：选取我院2000年6月～2006年6月经股动脉行冠状动脉介入诊疗操作后出现假性动脉瘤患者共37例。其中，UGTI组：有接受UGTI治疗患者21例，UGCR组：有采用UGCR治疗的患者16例。比较两组的治疗成功率、平均治疗时间、术后卧床时间等护理指标。结果：UGTI组的各种护理指标均优于UGCR组（P〈0．05～0．01）；但PSA直径〈4cm的假性动脉瘤，UGTI组与UGCR组成功率无显著差异（P〉0．05）。结论：若动脉瘤直径≥4cm，UGTI的疗效明显优于UGCR。     

动脉造影术后假性动脉瘤的 超声引导压迫修复

目的 评价超声引导下压迫修复对动脉造影术后假动脉瘤的治疗效果。方法 动脉造影术所致股动脉假性动脉瘤11例。男性9例,女性2例。在Acuson-128XP/10彩色多普勒超声诊断引导下行压迫修复,结果 本组病例全部经压迫修复成功,未出现并发症,其中10例（90.9%)1次压迫修复成功,1例（9.1%)2次压迫修复成功。结论 对动脉造影术后假性动脉瘤采用超声引导压迫修复治疗,是一种简单、安全、有效的方法。     

Safety and efficacy of the Perclose suture-mediated closure device after diagnostic and interventional catheterizations in a large consecutive population.

Arterial puncture sites after cardiac catheterization are a troublesome cause of complications. Closure devices have been developed to improve on patient comfort and safety. We evaluated a suture-mediated closure device, the Prostar-Plus device, in a consecutive population of over 10,001 diagnostic and interventional catheterizations. A significantly higher complication rate was noted for both major and minor complications in the diagnostic catheterization patients treated with the Prostar-Plus device compared to diagnostic catheterization patients treated with manual compression (2.6% major and 4.6% minor complication rate for the Prostar-Plus treatment group vs. 0.2% major and 1.8% minor complication rate for the manual compression treatment group). For the interventional patients, there were no statistical differences noted for both major and minor complications between patients treated with the Prostar-Plus device vs. manual compression. Subgroup analysis showed that older, thinner women were more likely to have complications related to the Prostar-Plus device.     

Nonsurgical closure of femoral pseudoaneurysms complicating cardiac catheterization and percutaneous transluminal coronary angioplasty.

OBJECTIVES. This study was performed to describe the initial experience and follow-up of ultrasound-guided compression of pseudoaneurysms in patients receiving systemic anticoagulant or antiplatelet therapy, or both, after recent cardiac catheterization or percutaneous transluminal coronary angioplasty. BACKGROUND. Femoral artery pseudoaneurysm formation after an interventional procedure is becoming more common as larger caliber catheters and prolonged anticoagulant and antiplatelet therapy are being used. Traditional treatment of this complication has been surgical repair. This study describes a new method of closing femoral pseudoaneurysms by using external compression guided by Doppler color flow imaging. METHODS. Fifteen patients, 3 undergoing cardiac catheterization and 12 undergoing coronary angioplasty, developed an expansile groin mass at the vascular access site diagnosed as a femoral artery pseudoaneurysm by Doppler ultrasound. Seven of the patients had undergone coronary stenting and were receiving postprocedural anticoagulant therapy. These patients underwent progressive graded mechanical (C-clamp) external compression guided by ultrasound. The mechanical compression was titrated to obliterate the vascular tracts to these aneurysms and maintain adequate flow in the femoral artery. RESULTS. After an average compression time of 30 min (range 10 to 120), these tracts remained closed. Follow-up ultrasound examination at 24 h or later confirmed continued closure in all. CONCLUSIONS. This study suggests that nonsurgical closure of femoral pseudoaneurysms is feasible. This technique may be valuable in managing vascular access-related complications after diagnostic and interventional procedures, even in patients requiring prolonged anticoagulant therapy.     

Treatment of post-catheterization femoral artery pseudo-aneurysm with para-aneurysmal saline injection

Femoral artery pseudoaneurysm is a common complication associated with cardiac catheterization procedures. Ultrasound-based techniques (e.g., mechanical compression, thrombin injection) and open surgical intervention are frequently used in the management of pseudoaneurysm. The investigators report their prospective experience with a novel method for the treatment of pseudoaneurysm after cardiac catheterization using ultrasound-guided, para-aneurysmal injection of physiologic saline. Sixty-four consecutive patients with pseudoaneurysms after cardiac catheterization were treated using normal saline (0.9% sodium chloride 25 to 60 ml) injected into the tissue surrounding the tract connecting the pseudoaneurysm with the femoral artery, followed by manual pressure of short duration. In none of the patients was concomitant antithrombotic therapy (aspirin [n = 63], clopidogrel [n = 45], unfractionated or low-molecular-weight heparin [n = 23], and warfarin [n = 5]) discontinued during the closure attempt. Fifty-nine of the 64 pseudoaneurysms (92%) were successfully occluded using saline injection. In 5 patients in whom saline injection failed, the pseudoaneurysms were successfully treated with thrombin injection (n = 4) or ultrasound-guided compression (n = 1). In all 64 patients, pseudoaneurysm closure was confirmed by ultrasound at 24 hours. The procedure was very well tolerated by the patients, and no side effects or complications were noted. In conclusion, ultrasound-guided saline injection affords a simple, safe, and effective alternative treatment for the closure of postcatheterization pseudoaneurysms.     

Assessment of hemodynamic status in the intensive care unit immediately after closure of ventricular septal defect

Hemodynamic values measured 12 to 24 hours postoperatively in the intensive care unit (ICU) were compared with those measured at a later cardiac catheterization in 68 patients after closure of ventricular septal defect (VSD). A pulmonary arterial (PA) saturation of more than 80% or a pulmonary to systemic blood flow ratio (Qp:Qs) greater than 1.5 in the ICU were sensitive indicators for identifying patients at risk of having a hemodynamically significant residual left-to-right shunt (Qp:Qs greater than 1.5) at catheterization. Measurement of PA pressure in the ICU was a useful predictor of PA pressure at catheterization. In the absence of factors known to alter PA pressure, measurement of PA pressure in the ICU overestimates what it will be at a subsequent cardiac catheterization. Early assessment of hemodynamics after closure of VSD is useful in identifying patients at risk of having hemodynamically significant residual VSD and those who may have persistent PA hypertension.     

超声指导下压迫与局部加压包扎修复冠状动脉介入术后假性动脉瘤

目的　比较超声指导下压迫与局部加压包扎修复两种方法治疗冠状动脉介入术后出现的假性动脉瘤。方法　将 10 5例股动脉假性动脉瘤的患者根据治疗方法的差异分为超声指导下压迫组和局部加压包扎修复组 ,比较其临床情况和治疗效果。结果　两组在性别、年龄、体重、体重指数、介入类型、动脉鞘管直径、是否应用抗血小板药物和低分子肝素、介入术中收缩压和舒张压水平方面差异均无显著性。超声指导下压迫治疗组的成功率明显高于局部加压包扎组 (85 %比 6 3% ,P =0 0 3)。两组均未出现与治疗相关的并发症。结论　超声指导下压迫操作简单 ,费用低 ,并发症少 ,可以作为治疗假性动脉瘤的首选方法。     

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.