Geisinger Medical Center, Department of Vascular and Endovascular Surgery, Hospital for Advanced Medicine, Danville, Pa.
Geisinger Medical Center, Department of Vascular and Endovascular Surgery, Hospital for Advanced Medicine, Danville, Pa.
J Vasc Surg. 2014 Jun;59(6):1664-9. doi: 10.1016/j.jvs.2014.01.009. Epub 2014 Feb 20.
The objective of this study was to evaluate the safety and efficacy of ultrasound-guided thrombin injection (TI) for the treatment of upper extremity iatrogenic pseudoaneurysms (PAs) after percutaneous upper extremity arterial access.
This is a retrospective single-institution study from January 2009 to December 2012. All patients with clinical suspicion of an upper extremity PA after arterial puncture underwent duplex examination. Patients with and without PAs were compared to identify risk factors for development of PAs. Outcomes were analyzed in those patients with PAs that were treated with TI.
Between January 1, 2009, and December 31, 2012, there were 61 upper extremity arterial duplex examinations performed for a clinical suspicion of an upper extremity PA. Eighteen ultrasound examinations (29.5%) demonstrated an iatrogenic upper extremity PA (13 brachial and five radial). Those patients with an upper extremity PA were more likely to have a history of hypertension, atrial fibrillation, and chronic kidney disease. Sheath size, preprocedural antiplatelet therapy, periprocedural anticoagulation regimen, service specialty performing the procedure, and procedure type did not influence the development of PA. Of 18 patients with PA, 14 were treated with TI with an overall success rate of 86%. There was one PA that failed to thrombose with TI, and there was one native brachial artery thrombosis requiring emergent surgical intervention. Outpatient clinical follow-up in the successfully treated patients demonstrated no recurrences at an average follow-up of 8 months.
Ultrasound-guided percutaneous TI appears safe and effective for the treatment of iatrogenic brachial and radial artery PAs.
本研究旨在评估超声引导下凝血酶注射（TI）治疗经皮上肢动脉入路后上肢医源性假性动脉瘤（PA）的安全性和疗效。
这是一项 2009 年 1 月至 2012 年 12 月的回顾性单中心研究。所有经动脉穿刺后临床疑似上肢 PA 的患者均行双功超声检查。比较有和无 PA 的患者，以确定 PA 发生的危险因素。对接受 TI 治疗的 PA 患者进行结局分析。
2009 年 1 月 1 日至 2012 年 12 月 31 日，对上肢动脉疑似 PA 进行了 61 次上肢动脉双功超声检查。18 次超声检查（29.5%）显示医源性上肢 PA（13 例肱动脉和 5 例桡动脉）。有上肢 PA 的患者更可能有高血压、心房颤动和慢性肾脏病病史。鞘管大小、术前抗血小板治疗、围手术期抗凝方案、实施手术的专科、手术类型均不影响 PA 的发生。18 例 PA 患者中，14 例行 TI 治疗，总体成功率为 86%。有 1 例 PA 经 TI 治疗后未血栓形成，有 1 例原发性肱动脉血栓形成需紧急手术干预。成功治疗患者的门诊临床随访显示，平均 8 个月的随访中无复发。
超声引导下经皮 TI 治疗医源性肱动脉和桡动脉 PA 安全有效。
