Tisi P V, Callam M J
Bedford Hospital, Department of Vascular Surgery, Kempston Road, Bedford, Bedfordshire, UK, MK42 9DJ.
Cochrane Database Syst Rev. 2006 Jan 25(1):CD004981. doi: 10.1002/14651858.CD004981.pub2.
Femoral pseudoaneurysms may complicate up to 8% of vascular interventional procedures. Small pseudoaneurysms can spontaneously clot, while others need definitive treatment. Surgery is considered the gold-standard treatment, although is not without risk in patients with severe cardiovascular disease. Less invasive treatment options, such as Duplex ultrasound-guided compression and percutaneous thrombin injection are available, however, evidence of their efficacy is limited.
To assess the effects of different treatments for femoral pseudoaneurysms resulting from endovascular procedures, specifically assessing less invasive treatment options such as ultrasound-guided compression or percutaneous thrombin injection.
We searched the Cochrane Peripheral Vascular Diseases Review Group's Specialised Register and the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library Issue 3, 2005 (last searched October 12, 2005). Additional searches were also made of bibliographies of papers found through these searches and by handsearching relevant journals.
Randomised controlled trials comparing two treatments for femoral pseudoaneurysms following vascular interventional procedures were considered for inclusion in the review.
Two studies were included in the analysis: ultrasound-guided application of a mechanical device (FemoStop) versus blind application; ultrasound-guided compression versus percutaneous thrombin injection. Data were extracted independently by both authors.
Mechanical compression with a FemoStop was effective in achieving thrombosis of the pseudoaneurysm although ultrasound-guided application of this failed to confer any benefit (relative risk (RR) 1.07; 95% confidence intervals (CI) 0.75 to 1.53, P = 0.7). Percutaneous thrombin injection was more effective than ultrasound-guided compression in achieving thrombosis of a pseudoaneurysm (RR 7.50; 95% CI 2.06 to 27.25, P = 0.002 at 24 hours after treatment; RR 2.50; 95% CI 1.35 to 4.65, P = 0.004 at 48 hours after treatment). There was no statistically significant difference in the length of hospital stay between the two groups and no complications were reported.
AUTHORS' CONCLUSIONS: The limited evidence base appears to support the use of thrombin injection as an effective treatment for femoral pseudoaneurysm. A pragmatic approach may be to use ultrasound-guided compression as first-line treatment, reserving thrombin injection for those in whom the procedure fails.
股动脉假性动脉瘤在高达8%的血管介入手术中可能会出现并发症。小型假性动脉瘤可自行凝血，而其他的则需要进行确定性治疗。手术被认为是金标准治疗方法，不过对于患有严重心血管疾病的患者而言并非没有风险。还有一些侵入性较小的治疗选择，如双功超声引导下压迫和经皮凝血酶注射，但它们疗效的证据有限。
评估血管内手术后不同治疗方法对股动脉假性动脉瘤的效果，特别评估侵入性较小的治疗选择，如超声引导下压迫或经皮凝血酶注射。
我们检索了Cochrane外周血管疾病综述小组的专业注册库以及2005年第3期《Cochrane图书馆》中的Cochrane对照试验中央注册库（CENTRAL）（最后检索时间为2005年10月12日）。还通过对这些检索找到的论文参考文献进行额外检索以及手工检索相关期刊。
纳入综述的研究为比较血管介入手术后两种治疗股动脉假性动脉瘤方法的随机对照试验。
两项研究纳入分析：超声引导下应用机械装置（FemoStop）与盲目应用；超声引导下压迫与经皮凝血酶注射。两位作者独立提取数据。
使用FemoStop进行机械压迫对实现假性动脉瘤血栓形成有效，不过超声引导下应用该装置未显示出任何益处（相对危险度（RR）1.07；95%置信区间（CI）0.75至1.53，P = 0.7）。在实现假性动脉瘤血栓形成方面，经皮凝血酶注射比超声引导下压迫更有效（治疗后24小时RR 7.50；95% CI 2.06至27.25，P = 0.002；治疗后48小时RR 2.50；95% CI 1.35至4.65，P = 0.004）。两组住院时间无统计学显著差异，且未报告并发症。
有限的证据似乎支持使用凝血酶注射作为股动脉假性动脉瘤的有效治疗方法。一种务实的方法可能是以超声引导下压迫作为一线治疗，将凝血酶注射留给该方法失败的患者。
