Jeon Seung-Ho, Kang Hyun Goo, Kim Hong-Jin, Seo Man-Wook, Shin Byoung-Soo
Department of Neurology, Chonbuk National University Medical School and Hospital, Jeonju.
Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Chonbuk, Republic of Korea.
Medicine (Baltimore). 2019 Apr;98(17):e15309. doi: 10.1097/MD.0000000000015309.
Pseudoaneurysm, the most common complication of femoral artery catheterization, involves the formation of a space between the lumen and the surrounding fibrous tissue through the damaged arterial wall. In patients treated with antiplatelet and anticoagulant agents, the incidence of vascular complications increases with the increasing use of minimally invasive procedures.
We experienced 2 cases of procedure-induced pseudoaneurysms. A 79-year-old man with right hemiparesis visited our hospital. Brain magnetic resonance imaging showed acute left middle cerebral artery territory infarction and severe stenosis of the left proximal carotid artery. The patient was prescribed apixaban and underwent carotid stenting through the right femoral artery. Hematoma and tenderness were observed in the right inguinal region after the procedure. The hemoglobin level decreased from 16.9 g/dL to 9.4 g/dL. Another 78-year-old man with left common carotid artery stenosis was admitted. We performed stent implantation through the right femoral artery and administered aspirin and clopidogrel. After the procedure, hematoma and tenderness of the puncture site were observed. The hemoglobin level decreased from 14.5 g/dL to 10.9 g/dL.
Emergency computed tomography confirmed a pseudoaneurysm with a massive hematoma in the right inguinal area. The patients were diagnosed with infection-associated right pseudoaneurysm for which an emergency puncture site repair was performed.
We performed resection of pseudoaneurysm and repaired puncture site.
The hemoglobin level was stabilized postoperatively and vital sign remained stable.
Pseudoaneurysm is an important complication of femoral artery puncture. The use of a hemostatic device was not superior to manual compression, and the incidence of this complication was significantly higher in patients who received anticoagulant or antiplatelet agents. A pseudoaneurysm may cause a bad prognosis. Therefore, the early detection of pseudoaneurysm and immediate treatment after femoral arterial puncture are needed.
假性动脉瘤是股动脉插管最常见的并发症，它是指管腔与周围纤维组织之间通过受损动脉壁形成一个间隙。在接受抗血小板和抗凝药物治疗的患者中，随着微创操作使用的增加，血管并发症的发生率也会上升。
我们遇到了2例手术引起的假性动脉瘤病例。一名79岁右半身轻瘫男性前来我院就诊。脑部磁共振成像显示急性左侧大脑中动脉区域梗死，左侧颈总动脉近端严重狭窄。该患者服用阿哌沙班，并通过右股动脉进行了颈动脉支架置入术。术后右腹股沟区出现血肿和压痛。血红蛋白水平从16.9g/dL降至9.4g/dL。另一名78岁左侧颈总动脉狭窄男性入院。我们通过右股动脉进行了支架植入术，并给予阿司匹林和氯吡格雷。术后，穿刺部位出现血肿和压痛。血红蛋白水平从14.5g/dL降至10.9g/dL。
急诊计算机断层扫描证实右腹股沟区有一个伴有大量血肿的假性动脉瘤。患者被诊断为感染相关性右假性动脉瘤，并进行了紧急穿刺部位修复。
我们切除了假性动脉瘤并修复了穿刺部位。
术后血红蛋白水平稳定，生命体征保持稳定。
假性动脉瘤是股动脉穿刺的重要并发症。使用止血装置并不优于手动压迫，并且在接受抗凝或抗血小板药物治疗的患者中，这种并发症的发生率明显更高。假性动脉瘤可能导致不良预后。因此，需要在股动脉穿刺后早期发现假性动脉瘤并立即进行治疗。
