Chen Gang, Wu Lingmin, Zheng Lihui, Ding Ligang, Wong Tom, Zhang Shu, Yao Yan
State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College.
Heart Rhythm Centre, Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust.
Int Heart J. 2018 Mar 30;59(2):333-338. doi: 10.1536/ihj.17-026. Epub 2018 Mar 20.
This study aimed to prospectively evaluate the safety and efficacy of a new developed method that uses percutaneous ultrasound-guided hematoma aspiration followed by targeted localized manual compression for treatment of femoral artery pseudoaneurysm after cardiac catheterization, which obviates thrombin use, surgery, and long-time compression.From January 2007 to July 2014, 32 patients (17 women; mean age, 55.3 ± 11.5 years) out of 8,725 consecutive cases undergoing cardiac catheterization via femoral access developed one pseudoaneurysm each ranging in size from 21 × 11 mm to 72 × 39 mm. Under ultrasound guidance, blood within the pseudoaneurysm was aspirated percutaneously using an 18-gauge needle, while the pseudoaneurysm neck and a nearby site over the pseudoaneurysm were manually compressed for 15 min. All patients underwent repeat ultrasound examination 24 hours later.Of the 32 pseudoaneurysms, 31 were successfully occluded, and 1 recurred in a patient with coexisting arteriovenous fistula, yielding an overall success rate of 96.9% (31/32). No further recurrence or procedure related complications were observed. The treatment approach is unlike open surgical repair with hematoma evacuation and arterial defect suturing, in that it entails hematoma aspiration and feeding flow blockage at the pseudoaneurismal neck.In this preliminary experience, combining percutaneous ultrasound-guided hematoma aspiration and manual compression appears safe and effective in treating femoral artery pseudoaneurysms after catheterization and avoids thrombin use, long-time compression, and surgery.
本研究旨在前瞻性评估一种新开发方法的安全性和有效性，该方法采用经皮超声引导下血肿抽吸术，随后进行靶向局部手动压迫，用于治疗心脏导管插入术后股动脉假性动脉瘤，避免使用凝血酶、手术和长时间压迫。2007年1月至2014年7月，在8725例经股动脉途径连续进行心脏导管插入术的病例中，32例患者（17例女性；平均年龄55.3±11.5岁）各自发生一个假性动脉瘤，大小从21×11毫米至72×39毫米不等。在超声引导下，使用18号针经皮抽吸假性动脉瘤内的血液，同时对假性动脉瘤颈部及假性动脉瘤上方附近部位进行手动压迫15分钟。所有患者在24小时后接受重复超声检查。32例假性动脉瘤中，31例成功闭塞，1例在合并动静脉瘘的患者中复发，总体成功率为96.9%（31/32）。未观察到进一步复发或与手术相关的并发症。该治疗方法与开放性手术修复血肿清除和动脉缺损缝合不同，因为它需要在假性动脉瘤颈部进行血肿抽吸和供血血流阻断。在这一初步经验中，经皮超声引导下血肿抽吸术与手动压迫相结合，在治疗导管插入术后股动脉假性动脉瘤方面似乎安全有效，且避免了凝血酶的使用、长时间压迫和手术。
