Borioni Raoul, Garofalo Mariano, De Paulis Ruggero, Albano Paolo, Chiariello Luigi
UO Chirurgia Vascolare, Aurelia Hospital, Roma.
Chir Ital. 2008 Jan-Feb;60(1):103-11.
The aim of the study was to report our clinical experience with the surgical treatment of iatrogenic pseudoaneurysms of the peripheral arteries. The study is a retrospective review of 101 consecutive patients (52 males, 49 females, mean age 66.2 years, range 33-86), with iatrogenic pseudoaneurysms of the peripheral arteries, surgically treated in a vascular unit from October 1990 to June 2006. Duplex ultrasound scanning was employed to support the clinical findings. The surgical treatment consisted in direct closure with polypropylene sutures and, occasionally, patch angioplasty or bypass. Ultrasound compression was effective in one of 4 small aneurysms (< 2.5). No limb loss occurred. There were 4 wound complications (3.9%), one pulmonary embolism (0.99%), and 3 deaths (2.9%), 2 of which not related to vascular repair and one secondary to femoral endoarteritis and septic shock, unrelated to previous implantation of a percutaneous femoral closure device. Although iatrogenic pseudoaneurysms of the peripheral arteries are rarely observed in clinical practice, a significant number of peripheral artery complications may occur after cardiac catheterisation and coronary angioplasty. Failure of conservative treatment requires a traditional surgical repair. The results of our series included a significant mortality rate (2.9%), resulting from the severity of cardiac disease in 2 cases and from the vascular repair itself in one case (femoral endoarteritis). These results substantiate the common observation that patients who require surgery for an iatrogenic pseudoaneurysm are often affected by advanced cardiovascular disease and are liable to suffer the occurrence of complications, with a high risk of death. Therefore, any surgical treatment should be performed with strict adherence to sound vascular surgical principles.
本研究的目的是报告我们对外周动脉医源性假性动脉瘤进行手术治疗的临床经验。该研究是对1990年10月至2006年6月期间在一个血管单元接受手术治疗的101例连续外周动脉医源性假性动脉瘤患者（52例男性，49例女性，平均年龄66.2岁，范围33 - 86岁）进行的回顾性分析。采用双功超声扫描辅助临床诊断。手术治疗包括用聚丙烯缝线直接缝合，偶尔进行补片血管成形术或旁路手术。超声压迫对4个小动脉瘤（< 2.5）中的1个有效。无肢体丧失情况发生。有4例伤口并发症（3.9%），1例肺栓塞（0.99%），3例死亡（2.9%），其中2例与血管修复无关，1例继发于股动脉内膜炎和感染性休克，与先前经皮股动脉封堵装置植入无关。尽管外周动脉医源性假性动脉瘤在临床实践中很少见，但心脏导管插入术和冠状动脉成形术后可能会出现大量外周动脉并发症。保守治疗失败需要进行传统的手术修复。我们系列研究的结果显示有显著的死亡率（2.9%），2例源于心脏疾病的严重程度，1例源于血管修复本身（股动脉内膜炎）。这些结果证实了一个普遍的观察结果，即因医源性假性动脉瘤需要手术治疗的患者通常患有晚期心血管疾病，容易发生并发症，死亡风险高。因此，任何手术治疗都应严格遵循合理的血管外科原则进行。
