Schneider Carsten, Malisius Rainer, Küchler Robert, Lampe Friedrun, Krause Korff, Bahlmann Edda, Kuck Karl-Heinz
Department of Cardiology, Asklepios Klinik St.Georg, Hamburg, Germany.
Int J Cardiol. 2009 Jan 24;131(3):356-61. doi: 10.1016/j.ijcard.2007.10.052. Epub 2008 Jan 14.
The purpose of this study was to evaluate prospectively the safety and efficacy of bovine thrombin injection for the treatment of iatrogenic post-catheterisation pseudoaneurysms.
A total of 274 patients (90 women, 184 men, 69.8+/-7 years) with iatrogenic femoral pseudoaneurysms were treated by ultrasound-guided thrombin injection (UGTI). The deepest pseudoaneurysm chamber was entered with a 0.90x40 mm or 90 mm needle and bovine thrombin (solution of 1000 U/ml) was injected. Pseudoaneurysms were associated with diagnostic cardiac catheterisation, percutaneous coronary intervention or invasive electrophysiologic investigation. The majority of the patients were under antiplatelet therapy with aspirin or clopidogrel or both, and additional low dose heparin therapy. A total of 52 patients were treated with either phenprocoumon or enoxaparine body weight adjusted. UGTI was primary successful in 267 of 274 patients (97%). In 3 of 7 patients with a remaining pseudoaneurysm a second injection was required. Three patients were treated by ultrasound-guided compression. One patient was treated by surgical repair of the pseudoaneurysm 1 day after UGTI because a further pseudoaneurysm developed under phenprocoumon therapy. UGTI-related complications such as significant arterial thrombotic events or allergic reactions did not occur. 75 patients (27%) were evaluated by an additional sonography after 3 months to assess the long-term effect.
UGTI was well tolerated, safe and primarily effective in 97% of patients with iatrogenic femoral pseudoaneurysms. Anticoagulant use did not hinder successful thrombosis. UGTI should be considered as first-line therapy for the treatment of post-catheterisation pseudoaneurysms.
本研究旨在前瞻性评估注射牛凝血酶治疗医源性导管插入术后假性动脉瘤的安全性和有效性。
共有274例医源性股动脉假性动脉瘤患者（90例女性，184例男性，年龄69.8±7岁）接受了超声引导下凝血酶注射（UGTI）治疗。使用0.90×40 mm或90 mm的针头穿刺进入最深的假性动脉瘤腔，然后注射牛凝血酶（1000 U/ml溶液）。假性动脉瘤与诊断性心导管检查、经皮冠状动脉介入治疗或侵入性电生理检查有关。大多数患者接受阿司匹林或氯吡格雷或两者联合的抗血小板治疗，以及额外的低剂量肝素治疗。共有52例患者接受了根据体重调整剂量的苯丙香豆素或依诺肝素治疗。UGTI在274例患者中的267例（97%）首次治疗成功。7例仍有假性动脉瘤的患者中有3例需要再次注射。3例患者接受了超声引导下压迫治疗。1例患者在UGTI后1天因在苯丙香豆素治疗下出现新的假性动脉瘤而接受了假性动脉瘤手术修复。未发生与UGTI相关的并发症，如严重动脉血栓形成事件或过敏反应。75例患者（27%）在3个月后接受了额外的超声检查以评估长期效果。
UGTI耐受性良好、安全，对97%的医源性股动脉假性动脉瘤患者初步有效。抗凝药物的使用并不妨碍成功形成血栓。UGTI应被视为治疗导管插入术后假性动脉瘤的一线治疗方法。
