Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC, 27710, USA.
Abdom Radiol (NY). 2019 Mar;44(3):1120-1126. doi: 10.1007/s00261-019-01923-6.
To evaluate factors that may affect successful ultrasound-guided percutaneous thrombin injection of iatrogenic femoral artery pseudoaneurysms (PSA).
This was an IRB-approved, HIPAA-compliant retrospective study of 326 consecutive subjects (138 males, 188 females; mean age 68 years, range 18-95) who underwent thrombin injection for treatment of femoral PSA; follow-up ultrasound was available in 145 subjects. The number of PSA lobes and dimensions, pre-procedure laboratory values (international normalized ratio [INR], activated partial thromboplastin time [aPTT], platelet count), and concomitant anticoagulation therapy were recorded.
Technical success was achieved in 98.2% (320/326) of subjects. Primary effectiveness (complete thrombosis at 24 h) was achieved in 74.5% (108/145). Twenty-five subjects underwent repeat thrombin injection, successful in 21 subjects, for a total effectiveness rate of 97.0% (129/133). No imaging factor was associated with technique failure, including number of lobes (p = 0.898), largest dimension (p = 0.344), or volume (p = 0.697). No statistically significant difference in pre-procedure INR, aPTT, or platelet count was found between subjects with CT and those with IT (p > 0.138). Anticoagulation therapy was associated with incomplete thrombosis (35.5% [38/107] for CT vs. 63.9% [23/26] for IT; p = 0.002).
Imaging-guided percutaneous thrombin injection has high technical success and effectiveness rates for the treatment of iatrogenic femoral artery PSA. Anticoagulation therapy was the only factor associated with incomplete thrombosis.
评估影响医源性股动脉假性动脉瘤（PSA）经超声引导下经皮凝血酶注射成功的因素。
这是一项经机构审查委员会批准、符合 HIPAA 规定的回顾性研究，共纳入 326 例连续患者（男 138 例，女 188 例；平均年龄 68 岁，范围 18-95 岁），这些患者因股 PSA 而行凝血酶注射治疗；145 例患者可获得随访超声检查。记录 PSA 叶的数量和尺寸、术前实验室值（国际标准化比值[INR]、活化部分凝血活酶时间[aPTT]、血小板计数）和同时接受的抗凝治疗情况。
98.2%（320/326）的患者达到技术成功。145 例患者中，108 例（74.5%）在 24 小时时达到主要有效性（完全血栓形成）。25 例患者接受了重复凝血酶注射，21 例成功，总有效率为 97.0%（129/133）。没有影像学因素与技术失败相关，包括叶的数量（p=0.898）、最大尺寸（p=0.344）或体积（p=0.697）。在 CT 组和 IT 组之间，术前 INR、aPTT 或血小板计数无统计学显著差异（p>0.138）。抗凝治疗与不完全血栓形成相关（CT 组为 35.5%[38/107]，IT 组为 63.9%[23/26]；p=0.002）。
影像学引导的经皮凝血酶注射治疗医源性股动脉 PSA 的技术成功率和有效性均较高。抗凝治疗是与不完全血栓形成相关的唯一因素。
