Corso Rocco, Rampoldi Antonio, Riolo Franco, Carrafiello Gianpaolo, Solcia Marco, Intotero Marcello, Vanzulli Angelo
Radiologia Diagnostica ed Interventistica, Ospedale Niguarda Cà Granda, Milano, Italy.
Radiol Med. 2004 Oct;108(4):385-93.
The incidence of iatrogenic femoral artery pseudoaneurysms is reported to occur in 1-7% by of all percutaneous catheterisations. These pseudoaneurysms are traditionally treated by ultrasound-guided compression or surgical repair. We report our experience in sealing postcatheterization femoral pseudoaneurysms with percutaneous thrombin injection under colour-Doppler ultrasound guidance.
Since June 2000 we have consecutively treated 31 pseudoaneurysms in 30 patients, (14 males and 16 females, age range 45 to 81 years); in one patient the pseudoaneurysm was bilateral. All patients had a clinical diagnosis of postcatheterization femoral pseudoaneurysm, later confirmed by colour-Doppler ultrasonography. We injected a bovine thrombin solution percutaneously at a concentration of 1000 U/mL using 21-22 gauge needles under colour Doppler ultrasound guidance. All patients underwent clinical and colour-Doppler US examination before, during and 24 hours after the procedure and were followed up after 1 and 3 months.
The primary success rate was 83.8%. Complete and persistent occlusion of the pseudoaneurysm was achieved in less than 20 seconds by administering an average dose of 880 U of thrombin (0.8 mL of solution). In 5 cases (16.1%) reperfusion of the pseudoaneurysm was observed within 24 hours. These patients underwent a repeat procedure. The final result was successful in 96.7% of patients (30 of 31 cases). No thromboembolic complication was observed. Only 22.5% of patients reported a heat sensation in the treated limb, which resolved spontaneously within minutes.
The percutaneous injection of thrombin under ultrasound colour-Doppler guidance should be regarded as the first choice treatment for postcatheterization femoral pseudoaneurysms, owing to its simplicity, safety, effectiveness and inexpensiveness.
据报道，医源性股动脉假性动脉瘤的发生率在所有经皮导管插入术中为1% - 7%。这些假性动脉瘤传统上通过超声引导下压迫或手术修复进行治疗。我们报告在彩色多普勒超声引导下经皮注射凝血酶封闭导管插入术后股动脉假性动脉瘤的经验。
自2000年6月以来，我们连续治疗了30例患者的31个假性动脉瘤（男性14例，女性16例，年龄范围45至81岁）；1例患者的假性动脉瘤为双侧。所有患者临床诊断为导管插入术后股动脉假性动脉瘤，随后经彩色多普勒超声检查确诊。我们在彩色多普勒超声引导下，使用21 - 22号针头经皮注射浓度为1000 U/mL的牛凝血酶溶液。所有患者在手术前、手术期间和手术后24小时接受临床和彩色多普勒超声检查，并在1个月和3个月后进行随访。
初次成功率为83.8%。通过平均注射880 U凝血酶（0.8 mL溶液），在不到20秒内实现了假性动脉瘤的完全和持续闭塞。5例（16.1%）患者在24小时内观察到假性动脉瘤再通。这些患者接受了重复手术。最终96.7%的患者（31例中的30例）获得成功。未观察到血栓栓塞并发症。仅22.5%的患者报告治疗肢体有热感，数分钟内自行缓解。
由于其操作简单、安全、有效且成本低廉，彩色多普勒超声引导下经皮注射凝血酶应被视为导管插入术后股动脉假性动脉瘤的首选治疗方法。
