National Cardiovascular Institute, Bratislava, Slovak Republic.
EuroIntervention. 2009 Sep;5(4):443-7. doi: 10.4244/eijv5i4a70.
To evaluate efficacy of percutaneous ultrasound-guided thrombin injection (UGTI) of iatrogenic femoral artery pseudoaneurysm (PSA) and to identify the risk factors associated with PSA recurrence.
We treated 140 patients aged 76 years (range 49-83) presented with femoral artery PSA after cardiac catheterisation by percutaneous UGTI (500 IU/ml solution of activated human thrombin). Factors associated with the recurrence of PSA were analysed. One hundred nineteen patients were successfully treated by one injection of thrombin (immediate success rate 85%). In 19 patients (13.6%), short local compression following injection was needed for complete occlusion (overall success rate 98.6%, 138/140). In one case, progression of PSA required conversion to surgery (0.7%). In one patient with pre-existing stenosis of superficial femoral artery, acute limb ischaemia developed after UGTI (0.7%). The recurrence of PSA in 30-days follow-up (10 patients, 7%) was associated with obesity (BMI>30, OR=1.39, 95% CI 1.09-1.78, p<0.05), and with extensive combination of anti-aggregation and anti-coagulation therapy (OR=2.11, 95% CI 1.23-3.62, p<0.0001) as revealed by both univariate and multivariate analysis.
The UGTI is a safe and effective treatment of iatrogenic femoral artery PSA. Recurrence is low and associated with obesity and extensive use of combined anti-aggregation and anti-coagulation therapy.
评估经皮超声引导凝血酶注射（UGTI）治疗医源性股动脉假性动脉瘤（PSA）的疗效，并确定与 PSA 复发相关的危险因素。
我们对 140 例经心脏导管检查后出现股动脉 PSA 的 76 岁（49-83 岁）患者进行了经皮 UGTI（500IU/ml 人激活凝血酶溶液）治疗。分析了与 PSA 复发相关的因素。119 例患者经一次凝血酶注射（即时成功率 85%）成功治疗。在 19 例患者（13.6%）中，注射后需要短时间局部压迫以完全闭塞（总体成功率 98.6%，140/140）。在 1 例患者中，PSA 进展需要转为手术（0.7%）。在 1 例股浅动脉存在先前狭窄的患者中，UGTI 后发生急性肢体缺血（0.7%）。30 天随访时 PSA 的复发（10 例，7%）与肥胖（BMI>30，OR=1.39，95%CI 1.09-1.78，p<0.05）和广泛联合使用抗聚集和抗凝治疗（OR=2.11，95%CI 1.23-3.62，p<0.0001）相关，这一点通过单因素和多因素分析都得到了证实。
UGTI 是治疗医源性股动脉 PSA 的一种安全有效的方法。复发率低，与肥胖和广泛使用联合抗聚集和抗凝治疗有关。
