Szendro G, Golcman L, Klimov A, Yefim C, Johnatan B, Avrahami E, Yechieli B, Yurfest S
Department of Vascular Surgery, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
Isr Med Assoc J. 2001 Jan;3(1):5-8.
Both diagnostic and therapeutic options in the management of iatrogenic false aneurysms have changed dramatically in the last decade, with surgery being required only rarely.
To describe our experience, techniques and results in treating pseudoaneurysms at a large medical center with frequent arterial interventions. We emphasize upper limb lesions.
We reviewed the data of all consecutive patients diagnosed by color-coded duplex Doppler between August 1992 and July 1998 as having upper limb and lower limb pseudoaneurysms (mainly post-catheterization). We accumulated 107 false aneurysms (mainly post-catheterization lesions): 5 were upper limb lesions and 102 were groin aneurysms.
In the lower limb cases 94 of the 102 lesions were not operated upon (92.1%). Seventy lower limb cases were treated non-operatively by ultrasound-guided compression obliteration with a 95.7% success rate (67 cases). Two cases were treated by percutaneous thrombin injection (2%) and 23 by observation only (22.5%). Altogether 12 patients underwent surgery (11.2%): 4 upper extremity and 8 lower extremity cases. None of the lower limb group suffered serious complications regardless of treatment, but all five upper limb cases did, four of them necessitating surgical intervention. Three of the five upper limb cases had a grave outcome with severe or permanent functional or neurological damage.
Most post-catheterization pseudoaneurysms can be managed non-surgically. False aneurysms in the upper extremity are rare, comprising less than 2% of all lesions. However, upper extremity pseudoaneurysms present a potentially more serious complication and require early diagnosis and prompt intervention to minimize the high complication rate and serious long-term sequelae. Prevention can be achieved by proper puncture technique and site selection, and correct post-procedure hemostatic compression with or without an external device. Some upper limb lesions are avoidable if the axillary artery is not punctured.
在过去十年中，医源性假性动脉瘤的诊断和治疗选择发生了巨大变化，很少需要进行手术。
描述我们在一家大型医疗中心治疗假性动脉瘤的经验、技术和结果，该中心经常进行动脉介入治疗。我们重点关注上肢病变。
我们回顾了1992年8月至1998年7月间所有经彩色编码双功多普勒诊断为上肢和下肢假性动脉瘤（主要为导管插入术后）的连续患者的数据。我们共积累了107例假性动脉瘤（主要为导管插入术后病变）：5例为上肢病变，102例为腹股沟动脉瘤。
在下肢病例中，102个病变中有94个未进行手术（92.1%）。70例下肢病例通过超声引导压迫闭塞进行非手术治疗，成功率为95.7%（67例）。2例通过经皮注射凝血酶治疗（2%），23例仅观察（22.5%）。共有12例患者接受了手术（11.2%）：4例上肢病例和8例下肢病例。下肢组无论采用何种治疗方法均未发生严重并发症，但所有5例上肢病例均发生了并发症，其中4例需要手术干预。5例上肢病例中有3例预后严重，出现严重或永久性功能或神经损伤。
大多数导管插入术后假性动脉瘤可采用非手术治疗。上肢假性动脉瘤很少见，占所有病变的比例不到2%。然而，上肢假性动脉瘤潜在并发症更严重，需要早期诊断和及时干预，以尽量降低高并发症率和严重的长期后遗症。通过适当的穿刺技术和部位选择，以及术后正确的止血压迫（无论有无外部装置）可实现预防。如果不穿刺腋动脉，一些上肢病变是可以避免的。
