Theiss W, Schreiber K, Schömig A
Deutsches Herzzentrum München and 1. Medizinische Klinik der Technischen Universität München, München, Germany.
Vasa. 2002 May;31(2):95-9. doi: 10.1024/0301-1526.31.2.95.
It is unknown, whether direct guidance by ultrasound is essential for the safety and efficacy of ultrasound-guided compression repair (UGCR) of pseudoaneurysms. We therefore tested, whether clinically guided manual compression repair (MCR) without continuous ultrasound control may represent an equally effective alternative.
After ultrasound diagnosis of a pseudoaneurysm, direct manual compression was applied to the lesion until the characteristic clinical signs disappeared or for a maximum of 1 hour. Then a compression bandage was applied for 24 hours. If the pseudoaneurysm persisted, MCR was repeated up to a maximum of three times.
Of 96 consecutive patients with pseudoaneurysms, ten patients were referred to primary surgery; one patient refused any therapy. The remaining 85 patients (89%) were treated by MCR. MCR was successful in 74 patients (87%). Of these, 74% were cured at the first attempt, while 16% resp. 10% required 2 resp. 3 compression manoeuvers for definite cure. The success rate tended to be somewhat lower in patients on anticoagulants (78%) than in those on aspirin (91%) or those without any antithrombotic medication (89%) (p = 0.14). No major complications were observed. Of the 11 patients in whom MCR was unsuccessful, five patients underwent surgical repair; in four patients the pseudoaneurysms thrombosed spontaneously within 1-3 months and 2 pseudoaneurysms persist without complications.
Our results with MCR are comparable to those published for UGCR. Since MCR requires less technical equipment and seems to be less painful for the patient, a prospective comparison of both methods appears warranted.
超声引导下压迫修复（UGCR）治疗假性动脉瘤时，超声直接引导对其安全性和有效性是否至关重要尚不清楚。因此，我们测试了在无连续超声监测情况下，临床指导下的手动压迫修复（MCR）是否可能是一种同样有效的替代方法。
超声诊断假性动脉瘤后，直接对病变部位进行手动压迫，直至特征性临床体征消失或最长压迫1小时。然后应用压迫绷带24小时。如果假性动脉瘤持续存在，MCR最多重复三次。
96例连续的假性动脉瘤患者中，10例患者接受了一期手术；1例患者拒绝任何治疗。其余85例患者（89%）接受了MCR治疗。MCR在74例患者（87%）中成功。其中，74%在首次尝试时治愈，而16%和10%分别需要2次和3次压迫操作才能彻底治愈。服用抗凝剂的患者成功率（78%）略低于服用阿司匹林的患者（91%）或未使用任何抗血栓药物的患者（89%）（p = 0.14）。未观察到严重并发症。在MCR失败的11例患者中，5例患者接受了手术修复；4例患者的假性动脉瘤在1 - 3个月内自发血栓形成，2例假性动脉瘤持续存在且无并发症。
我们MCR的结果与已发表的UGCR结果相当。由于MCR所需技术设备较少，且对患者似乎疼痛较轻，因此有必要对这两种方法进行前瞻性比较。
