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。     

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?     

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。     

超声引导下局部压迫和凝血酶注射治疗假性动脉瘤的临床观察

目的探讨彩色多普勒超声引导下局部压迫和凝血酶注射共同治疗假性动脉瘤的临床应用。方法在彩色多普勒超声引导下,局部压迫的同时采用八光20G穿刺针经皮穿刺,对22例假性动脉瘤患者行瘤腔内注射凝血酶封闭,凝血酶浓度为200U/ml,总量均≤500U。结果 22例患者均一次性治疗成功。结论超声引导下局部压迫和凝血酶注射共同治疗假性动脉瘤创伤小,操作简便,疗效确切,可作为假性动脉瘤外科修补术的替代治疗方法。     

彩色多普勒超声引导下内科治疗假性股动脉瘤

目的介绍在彩色多普勒超声引导下运用压迫法结合瘤腔内注射凝血酶治疗假性股动脉瘤的疗效。方法18例假性股动脉瘤患者（心血管介入术后）均采用在彩色多普勒超声引导下运用压迫法结合瘤腔内注射凝血酶治疗。先行压迫10min,再向瘤腔注射500U凝血酶。继续压迫20min。结果瘤腔完全闭合,随访1个月无复发。结论在彩色多普勒超声引导下运用压迫法结合瘤腔内注射凝血酶治疗假性股动脉瘤的方法是安全有效的。     

超声在股动脉假性动脉瘤诊疗中的临床价值

目的:探讨应用超声诊断股动脉假性动脉瘤(PSA)及超声引导下行加压治疗的临床价值。方法:在超声引导下对15例因介入诊断治疗后形成股动脉PSA患者行局部加压修复。结果:超声引导下压迫治疗成功14例,压迫时间20～70 min,1例来源于股浅动脉的PSA因瘤腔、瘤口较大,压迫后未能完全修复而行凝血酶注射治疗成功。无载瘤动脉血栓形成或栓塞等并发症发生。结论:超声对股动脉PSA有较高的诊断价值,且在引导压迫修复股动脉PSA方面简单、安全、快速、有效、无创,可作为首选的治疗方法,且对压迫修复不成功者行凝血酶注射具有很好的指导作用,更直观,可动态监测治疗过程。     

超声引导下压迫联合瘤腔注射凝血酶治疗医源性假性动脉瘤的临床观察

目的 观察超声引导下压迫(UGG)联合瘤腔注射凝血酶(UGTI)治疗医源性假性动脉瘤(IPSA)的临床效果.方法 回顾性在分析2018年1月至2020年1月于成都医学院第一附属医院行医源性动脉穿刺后并发假性动脉瘤患者的临床资料共48例,观察UGG联合UGTI治疗的效果.结果 48例患者均成功封堵,注射凝血酶剂量300～...     

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.     

超声引导下凝血酶注射法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腔内注射凝血酶治疗医源性假性动脉瘤的临床应用价值。方法冠状动脉介入诊治术后股动脉假性动脉瘤（PSA）患者16例,在超声引导下穿刺PSA瘤腔并注射200u凝血酶行封闭治疗,所有病例均在治疗后24h和3～5d复查超声。结果11例患者在瘤囊内注入200u凝血酶后瘤腔即刻闭合,5例患者动脉与瘤腔通道血流明显减弱,在超声指引下压迫5～10min闭合,治愈率100%,无并发症发生。所有病例24h及3～5d后复查无复发。结论该法治疗PSA简便、安全、有效,可作为临床治疗PSA的首选方法。     

超声定位压迫治疗医源性假性动脉瘤临床用价值

目的 探讨彩色多普勒超声(CDFI) )引导下对医源性股动脉假性动脉瘤(PSA)的定位压迫及凝血酶注射治疗的临床价值。方法 对 11 例经皮穿刺介入性检查及微创治疗术后,穿刺部位发现搏动性肿块或者听诊有血管杂音,并经超声检查确诊为股动脉假性动脉瘤的患者,行超声引导下压迫及注射治疗。结果 一次性压迫成功率为 54.5%（6/11）,2 例重复压迫成功。其余 3 例重复压迫不成功者改为超声引导下瘤腔内注射凝血酶,使瘤腔闭塞。术后一个月复查均无复发,超声对医源性假性动脉瘤治疗总的治愈率为 100%。 结论 彩色多普勒超声引导下定位压迫结合瘤腔内注射凝血酶治疗医源性假性动脉瘤是一种简便、无创、疗效显著、值得推广的方法。     

布-加综合征介入治疗并发股动脉假性动脉瘤的治疗探讨

目的 探讨布-加综合征介入术后并发股动脉假性动脉瘤的原因和治疗措施.方法 回顾分析8例下腔静脉阻塞型布-加综合征患者在介入术中或术后1~2天股静脉（均为右侧）穿刺处出现搏动性肿块,经彩色多普勒超声明确诊断为股动脉假性动脉瘤,显示瘤体大小（长径×短径）为1.2 cm×0.6 cm~10.4 cm×4.8 cm.5例接受超声引导下加压治疗,3例接受超声引导下瘤内凝血酶注射治疗.结果 5例接受超声定位下加压治疗者,时间持续20~40 min,瘤颈闭合和瘤体内血栓形成;3例接受超声引导下瘤内凝血酶注射术（瘤体大小为2.5 cm×1.6 cm、3.8 cm×2.1 cm和10.4 cm×4.8 cm）,其中1例1次成功封闭瘤腔,2例行2次凝血酶注射并持续压迫瘤腔直至愈合,总剂量分别为200 U、300 U和800 U,术后未发生远端动脉栓塞、过敏等并发症.所有患者随访1~6个月无复发.结论 布-加综合征介入治疗并发的股动脉假性动脉瘤,采用超声引导下加压、瘤体内注射凝血酶等治疗取得了良好的临床疗效.     

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。     

彩色多普勒超声在医源性假性动脉瘤中的诊疗价值

目的 评价彩超在医源性假性动脉瘤中的诊疗价值.方法 对26例临床疑有假性动脉瘤的患者进行二维及彩色多普勒超声检查,对其声像表现及治疗方法 进行分析评价.结果 26例患者中,25例彩超诊断为假性动脉瘤,对25例明确诊断的患者经超声引导下压迫治疗,24例获得治愈,1例压迫失败后经手术治疗切除假性动脉瘤.结论 彩色多普勒超声是诊断假性动脉瘤的首选方法,超声引导下压迫修复治疗是一种简便、有效、经济、安全的方法,有较高的临床价值.     

医源性假性动脉瘤的彩超诊断及压迫修复治疗

目的评价彩超对医源性假性动脉瘤的诊断价值及超声引导压迫修复的疗效。方法分析彩色多普勒超声诊断仪诊断并压迫修复假性动脉瘤25例。结果彩色多普勒超声诊断假性动脉瘤具有特征性;其中23例假性动脉瘤压迫修复成功,2例失败,治愈率92%。结论彩色多普勒超声诊断假性动脉瘤准确率高。超声引导压迫修复医源性假性动脉瘤是一种简单、有效、经济、安全的非介入性方法,可作为首选的治疗方式。     

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.     

超声引导下经皮凝血酶注射对医源性股动脉复杂假性动脉瘤的应用研究

目的 彩超引导下医源性股动脉复杂假性动脉瘤(IFACP)腔内经皮凝血酶注射治疗(UGTI)方法学及可行性评价.方法 回顾性分析32例经股动脉径路进行介入操作术后并发IFACP患者接受经皮凝血酶注射治疗.假性动脉瘤瘤腔数目为2腔23例,3腔8例,4腔1例;局部麻醉后彩超持续引导下动脉穿刺针依次进入各瘤腔进行凝血酶注射,动态观察瘤腔内血栓形成完成封堵,24 h,7d后分别彩超随访.结果 23例2腔全部一次性成功,2例3腔24 h后复查部分再通,再次行UGTI封堵失败,1例4腔封堵失败,均无血栓形成、栓塞、感染、过敏等并发症.结论 彩超引导下UGTI是治疗股IFACP首选术式,精准定位穿刺可提高复杂假性动脉瘤治疗成功率,避免严重并发症.     

Successful treatment of spontaneous rupture of the internal carotid artery in an acute nonlymphocytic leukemia patient using ultrasound-guided thrombin injection: A case report and literature review

Spontaneous rupture and bleeding from the carotid artery in acute nonlymphocytic leukemia (ANLL) patients leading to pseudoaneurysm (PSA) formation has not been reported, nor has the use of ultrasound-guided thrombin injection (UGTI) for the treatment of carotid artery pseudoaneurysms. We report a case of acute nonlymphocytic leukemia (ANLL) with left internal carotid artery rupture during chemotherapy leading to a left-sided cervical PSA, successfully treated with UGTI, providing a simple, safe and effective method to treat patients with malignant tumors suffering from spontaneous vascular rupture.     

重复应用微波高温灭活治疗股骨远端骨巨细胞瘤

目的探讨重复应用微波高温灭活治疗股骨远端骨巨细胞瘤的临床应用效果。方法回顾性分析我科2006年6月-2012年6月采用重复应用微波高温灭活方法治疗股骨远端骨巨细胞瘤11例,男7例,女4例,年龄19~42岁,中位年龄27岁,术后自体髂骨、骨水泥修复骨缺损从手术技术、肿瘤复发情况、膝关节功能等方面全面综合评价此方法临床应用效果。结果全部患者均获得随访,平均随访时间26个月,11例均获得骨性愈合,无骨折及内固定断裂发生,1例在术后18个月局部复发;无伤口并发症及深部感染发生,无远处转移。肢体关节功能优8例、良3例。结论微波原位灭活后再行微波辅助残腔灭活,可以有效灭活术后残腔和周围肿瘤卫星灶。术后行自体髂骨、骨水泥修复骨缺损,可以早期负重活动,获得良好的关节功能锻炼,缩短疗程,从而获得优良的疗效及肢体关节功能。     

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.     

腔内修复抢救胸主动脉创伤伤员时封闭左锁骨下动脉的可行性分析

目的探讨腔内修复术（endovascularaorticrepair，EⅥ娘）中抢救胸主动脉创伤（thoracicaortictrauma，TAT）伤员时封闭左锁骨下动脉（1eftsubclavianartery，LSA）的可行性，从而为临床快速、简便、有效地急救TAT提供依据。方法对因EVAR中锚定区（1andingzone，LZ）不足的19例TAT伤员进行颈动脉、椎基底动脉及大脑动脉环（Wil—lis环）检查。如颈动脉、椎基底动脉血流通畅及wmis环完整则在EVAR时直接完全封闭LsA开口。术后行电子计算机断层扫描（computedtomography，CT）或／和CT血管造影（computedtomographyangiography，CTA）复查、随访，观察脑及上肢缺血并发症发生情况。结果4例（4／19）伤员因近端LZ不足，均选择了在EⅥ气R术中直接完全封闭LSA开口，均获得了手术成功。术后复查提示LSA远端无前向性血流1例、少量血流1例、中等量血流1例、正常血流1例。出院后平均随访21．2个月，随访期间2例伤员完全没症状；1例左上肢皮色稍苍白，皮温较对侧低，左上肢运动轻微减少，短暂性麻木、针刺感；1例阵发性眩晕，左上肢间歇性肌力减弱。所有症状表现轻微，无需再次手术以减轻症状。结论在明确颈动脉、椎基底动脉血流通畅及willis环完整后，应用EVAR救治TAT伤员时因锚定不足而直接完全封闭伤员的LsA开口是安全、可行的。进一步的论证需要多中心、大样本的临床实验。