Eley Catherine L, Williams Dean T
Ysbyty Gwynedd Hospital, Betsi Cadwaladr University Health Board, Penrhosgardnedd, Bangor, UK.
Ysbyty Gwynedd Hospital, Betsi Cadwaladr University Health Board, Penrhosgardnedd, Bangor, UK; School of Medical Sciences, Bangor University, Bangor, UK.
Ann Vasc Surg. 2019 Jul;58:317-325. doi: 10.1016/j.avsg.2018.10.037. Epub 2019 Feb 4.
This report describes our centers' experience of a new approach using coil embolization for femoral pseudoaneurysms (PSAs) in intravenous drug users (IVDUs). Current treatment options for this challenging patient group include femoral/external iliac artery ligation and excision of the PSA, with or without revascularization. Radiological thrombin injection, endoluminal stent grafting, and coil embolization have not been widely studied in this patient group and are most commonly reserved for sterile PSAs.
A series of 6 patients who presented to the vascular surgical department with IVDU-related PSA were treated with coil embolization. We present here their clinical course and outcomes. Ethical approval was not required.
Coil embolization alone did not result in a satisfactory outcome. Thirty-three percent of patients required vessel ligation following their initial treatment with coil embolization. However, all patients initially managed with coil embolization, whether as a definitive treatment or temporizing measure to surgery, were discharged home, mobilizing well, with Doppler signals at the ankle. Postoperative claudication was present in 17% of patients. There were no amputations as a direct result of coil embolization. The amputation in this series resulted from triple-vessel ligation without revascularization in a patient mistaken as having a groin abscess.
Coil embolization is a potential, less invasive treatment option in selected cases of IVDU PSA. It offers an alternative therapeutic intervention, adding to the armamentarium available to tackle these often challenging patients.
本报告描述了我们中心对静脉吸毒者（IVDUs）股部假性动脉瘤（PSAs）采用弹簧圈栓塞新方法的经验。对于这一具有挑战性的患者群体，目前的治疗选择包括股动脉/髂外动脉结扎和PSA切除，可选择或不选择血管重建。放射学引导下的凝血酶注射、腔内支架植入和弹簧圈栓塞在该患者群体中尚未得到广泛研究，且最常用于无菌性PSA。
对6例因IVDU相关PSA就诊于血管外科的患者采用弹簧圈栓塞治疗。我们在此展示他们的临床过程和结果。本研究无需伦理批准。
单纯弹簧圈栓塞未取得满意效果。33%的患者在初次接受弹簧圈栓塞治疗后需要进行血管结扎。然而，所有最初接受弹簧圈栓塞治疗的患者，无论作为确定性治疗还是手术的临时措施，均出院回家，活动良好，踝部有多普勒信号。17%的患者术后出现跛行。没有因弹簧圈栓塞直接导致截肢的情况。本系列中的截肢是由于一名被误诊为腹股沟脓肿的患者在未进行血管重建的情况下进行了三支血管结扎所致。
在特定的IVDU PSA病例中，弹簧圈栓塞是一种潜在的、侵入性较小的治疗选择。它提供了一种替代治疗干预手段，增加了应对这些通常具有挑战性患者的可用方法。
