Chen Daniel H, Sammel Anthony M, Jain Pankaj, Jepson Nigel S
Eastern Heart Clinic and the Department of Cardiology, Prince of Wales Hospital, Australia.
Eastern Heart Clinic and the Department of Cardiology, Prince of Wales Hospital, Australia; Prince of Wales Clinical School, University of New South Wales, Australia.
Heart Lung Circ. 2015 Feb;24(2):165-72. doi: 10.1016/j.hlc.2014.07.066. Epub 2014 Aug 2.
To assess the efficacy and safety of ultrasound guided thrombin injection (UGTI) as a first line treatment for post arterial cannulation iatrogenic femoral artery pseudoaneurysms (IFAP).
IFAPs complicate up to 1% of diagnostic and 8% of interventional cardiac catheterisation procedures. UGTI remains a second line or non-attempted treatment after ultrasound guided manual compression (UGMC) and surgical repair in many centres.
A retrospective review was undertaken of 121 consecutive patients who received UGTI as a first line treatment for IFAPs following cardiac diagnostic, interventional or catheter ablation procedures between 1999 and 2011 at our centre. The mean patient age was 70.7 years and 63% were male. At the time of injection, 89% were on at least one antiplatelet or anticoagulant. Pseudoaneurysms had a mean maximum dimension of 26.7mm (range 10-122mm) and 25% were multilobed. UGTI was performed by an interventional cardiologist with a mean bovine thrombin dose of 648 IU (range 50-5000 IU).
Primary success, defined as immediate IFAP thrombosis with UGTI, was achieved in 111 (92%) patients. Recurrence occurred in seven patients, three of whom required surgical repair. Multilobed IFAPs had significantly lower primary success rates than unilobed IFAPs (80% vs. 96%, p=0.016). Antiplatelet and anticoagulant use and IFAP size did not significantly affect outcomes. UGTI was not associated with any serious complications (such as thromboembolism, aneurysm rupture, venous thrombosis or abscess formation).
Interventional cardiologist operated UGTI should be considered as a first line therapy for uncomplicated IFAPs following interventional and diagnostic cardiac procedures. Despite high rates of concomitant antiplatelet and antithrombotic therapy, initial thrombosis rates exceeded 90% and we did not experience serious complications.
评估超声引导下注射凝血酶（UGTI）作为动脉插管术后医源性股动脉假性动脉瘤（IFAP）一线治疗方法的有效性和安全性。
IFAP在高达1%的诊断性心脏导管插入术和8%的介入性心脏导管插入术中出现并发症。在许多中心，超声引导下手动压迫（UGMC）和手术修复后，UGTI仍然是二线治疗方法或未尝试的治疗方法。
对1999年至2011年在我们中心接受UGTI作为IFAP一线治疗的121例连续患者进行回顾性研究。患者平均年龄为70.7岁，63%为男性。注射时，89%的患者至少使用一种抗血小板或抗凝药物。假性动脉瘤平均最大直径为26.7mm（范围10 - 122mm），25%为多叶状。UGTI由一名介入心脏病专家进行，牛凝血酶平均剂量为648 IU（范围50 - 5000 IU）。
111例（92%）患者实现了主要成功，即UGTI后IFAP立即血栓形成。7例患者复发，其中3例需要手术修复。多叶状IFAP的主要成功率显著低于单叶状IFAP（80%对vs, 96%，p = 0.016）。抗血小板和抗凝药物的使用以及IFAP大小对结果没有显著影响。UGTI与任何严重并发症（如血栓栓塞、动脉瘤破裂、静脉血栓形成或脓肿形成）无关。
介入心脏病专家操作的UGTI应被视为介入性和诊断性心脏手术后单纯IFAP的一线治疗方法。尽管同时使用抗血小板和抗血栓治疗的比例很高，但初始血栓形成率超过90%，且我们未遇到严重并发症。
