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。

Ultrasound-localized thrombin injection for the treatment of iatrogenic femoral pseudoaneurysm

Objective To evaluate the feasibility and safety of ultrasound-localized percutaneous thrombin injection(ULTI) for the treatment of iatrogenic femoral pseudoaneurysm. Methods From January 2000 to June 2002, 12 patients ( 9 male, 3 female, age range 38-75 years, mean 65 years) were found to have a pseudoaneurysm confirmed by untrosound between 1 and 5 days after femoral arterial puncture.Three patients were associated with diagnostic arteriography and 9 with stent implantation, ULTI was our first choice for the treatment of ablating femoral pseudoaneurysm. All patients following ULTI were restudied within 24 hours.Results All the 12 patients were initially treated with ULTI .Thrombin was injected directly into the pseudoaneurysm with dosage 500 up to 1 000 units over several seconds.Successful ablation was visualized immediately in 11 patients.The other 1 patient needed ultrasuound-guided compression treatment of five minutes.The success rate of ablating pseudoaneurysms was 100%(12/12). Follow-up duplex ultrasonography at 24 hours showed no recurrent pseudoaneurysm after initial successful ablation in any case.No distal embolization or allergic reaction occurred.Conclusion ULTI is a safe, rapid, well-tolerated, inexpensive and effective noninvasive method for the treatment of iatrogenic femoral pseudoaneurysm and should be considered as first-line therapy.