Kacila Mirsad, Vranic Haris, Hadzimehmedagic Ademir, Sehovic Sejla, Granov Nermin
Heart Center, Clinical Center University of Sarajevo, Bolnicka 25. 71000 Sarajevo, Bosnia and Herzegovina.
Med Arh. 2011;65(2):78-81.
Pseudo aneurysms as complications are a major source of morbidity after cardiac catheterization. Their incidence varies in the literature due to different definitions, methods of interrogation and presence of certain complications. We found in the literature that post-catheterization lesions occur in approximately 0.05% of treated patients after diagnostic catheterization and up to 1.2% after more complex procedures. The aim of this retrospective study was to determine the incidence of pseudo aneurysm after cardiac catheterization using the physical findings and color Doppler ultrasound. In the study, which encompasses the period of 2009-2010, there were 400 coronary angiography with trans femoral catheterization. After compression hemostasis was carried out, each patient was checked after 24 hours and again after 48 hours. Diagnostic coronary angiography was made in 400 patients (100%), out of which, 110 patients (27,5%) had a percutaneous coronary intervention with stent placement (PCI), Color Doppler ultrasound of femoral artery was normal in 384 (96.3%), local hematoma was found in 360 (90%), pseudo aneurysm in 14 (3.7%), AV fistula in 1 (0.25%) and dissection of the femoral artery in 1 (0.25%) patient. Complications in 16 patients were treated surgically, in 7 patients they were treated conservatively and in 1 case thrombin was applied within pseudo aneurism. Patients with complications were more often present with concomitant use of anticoagulant and anti platelet tablets than patients without complications (P = 0.003). Prevention of post catheterization pseudo aneurysm can be achieved by proper puncture technique, choosing the right place and right post interventional hemostatic compression with or without external devices. Special attention should be paid to the use of anti platelet drugs and anticoagulant and combinations thereof.
作为并发症的假性动脉瘤是心脏导管插入术后发病的主要来源。由于定义、检查方法以及某些并发症的存在不同，其在文献中的发病率有所差异。我们在文献中发现，诊断性导管插入术后，约0.05%的接受治疗患者会出现导管插入术后病变，而在更复杂的手术之后，这一比例高达1.2%。这项回顾性研究的目的是利用体格检查结果和彩色多普勒超声确定心脏导管插入术后假性动脉瘤的发病率。在这项涵盖2009年至2010年期间的研究中，有400例经股动脉导管插入术进行的冠状动脉造影。在进行压迫止血后，每位患者在24小时后以及48小时后再次接受检查。400例患者（100%）进行了诊断性冠状动脉造影，其中110例患者（27.5%）接受了经皮冠状动脉介入治疗并植入支架（PCI），股动脉彩色多普勒超声检查结果正常的有384例（96.3%），发现局部血肿的有360例（90%），假性动脉瘤14例（3.7%），动静脉瘘1例（0.25%），股动脉夹层1例（0.25%）。16例患者的并发症接受了手术治疗，7例患者接受了保守治疗，1例患者在假性动脉瘤内注射了凝血酶。有并发症的患者比无并发症的患者更常同时使用抗凝药和抗血小板药物（P = 0.003）。通过适当的穿刺技术、选择正确的部位以及在有或没有外部装置的情况下进行正确的介入后止血压迫，可以预防导管插入术后假性动脉瘤。应特别注意抗血小板药物和抗凝药及其联合使用。
