凝血酶栓塞治疗冠脉介入术后股动脉假性动脉瘤疗效观察

目的探讨瘤腔内注射凝血酶治疗股动脉假性动脉瘤的疗效和安全性。方法2006年1月至2008年4月心脏冠脉介入术后并发股动脉假性动脉瘤的患者,共33例,其中男12例,女21例,年龄58~72岁,平均66±16岁。其中8例选择性冠状动脉造影术,25例经皮冠状动脉内血管成形术。所有患者均使用GE LOGIQ 9彩色多普勒超声仪确诊,并在超声引导下进行瘤腔内注射凝血酶栓塞治疗。结果5例先行股动脉压迫治疗,无效后改用凝血酶注射栓塞治疗,其余28例首选超声引导下瘤腔内注射凝血酶栓塞治疗。其中31例一次性栓塞成功,2例经2次栓塞成功,总成功率100%。凝血酶用量200~800u。1例出现血管迷走性晕厥,12例患者注射凝血酶后均有体温轻度升高,自行好转。无动脉栓塞及静脉血栓形成、无凝血酶过敏表现、感染、出血等并发症。结论超声引导下瘤腔内注射凝血酶的治疗方法可缩短患者住院时间、花费少,而且简单、安全、成功率高,可作为治疗心脏冠脉介入术后假性动脉瘤的首选方法。

Ultrasound-guided Thrombin Injection for rite Treatment of Coronary Intervention-related Femoral Pseudoaneurysm

Objective To evaluate the effectivity and safety of ultrasound-guided pereutaneous thrombin injection for the treatment of postcatheterization femoral pseudoaneurysm. Methods From January 2006 to April 2008, 33 patients（ 12 male, 21 female, age range 58 - 72 years, mean 66 years） were found to have pseudoaneurysmes associated with catheterization procedure, and 8 of them with diagnostic angiography, the other 25 patients with stent implantation. Results Thrombin was injected directly into the pseudoaneurysm with dosage 200 - 800 units over several seconds. Successful ablation was visualized immediately in 31 patients. The other 2 patients needed two thrombin injections and compression treatment of 2 - 3 minutes. The total success rate of ablating pseudoaneurysm was 100%. One patient had vasovagal syncope, 12 patients had mild fever after thrombin injection. No distal embolization, infection, hemordmge or allergic reaction occurred. Conclusions Ultrasound-guided thrombin injection may shorten hospitalization duracon and it is a safe, simple, inexpensive and effective non-invasive method for the treatment of postcatheterization femoral pseudoareurysm. Therefore it should be considered as first-line therapy.