经皮注射凝血酶治疗心脏导管介入术后股动脉假性动脉瘤失败相关的形态学及临床因素评估

Evaluation of Morphological and Clinical Factors Related to Failure of Percutaneous Treatment with Thrombin Injection of Femoral Pseudoaneurysms from Cardiac Catheterization.

作者信息

de Oliveira Leite Túlio Fabiano, Bortolini Edgar, Linard Bruno, Boueri Breno Affonso, Carnevale Francisco Cesar, Nomura Cesar Higa, da Motta Leal Filho Joaquim Mauricio

机构信息

Interventional Radiology Unit, Department of Radiology, University of São Paulo Medical School, São Paulo, SP, Brazil.

Interventional Radiology, Radiology Department, Heart Institute (InCor), University of São Paulo, São Paulo, Brazil.

出版信息

Ann Vasc Surg. 2019 Aug;59:173-183. doi: 10.1016/j.avsg.2019.01.013. Epub 2019 Apr 24.

DOI:10.1016/j.avsg.2019.01.013

PMID:31028852

Abstract

BACKGROUND

Ultrasound-guided thrombin injection (UGTI) has become the method of choice in the treatment of pseudoaneurysm caused by endovascular procedures because it is minimally invasive, costs less, and effective, with short hospitalization time. The objective was identify the morphological aspects of femoral pseudoaneurysms and clinical aspects of patients that may lead to the failure of UGTI in femoral pseudoaneurysms after cardiac catheterization.

POPULATION AND METHOD

From December 2012 to December 2016, 60 patients with pseudoaneurysms caused by cardiac catheterization were referred to the interventional radiology unit to be treated with UGTI. Medical charts were retrospectively reviewed for comorbidities, use of antiplatelet agents, anticoagulation, indication of cardiac catheterization, and so forth. Morphological aspects of the pseudoaneurysms such as volume, diameter (anteroposterior, laterolateral, and longitudinal), length, and diameter of the neck were analyzed.

RESULTS

Technical success of UGTI was achieved in 100%. No clinical aspects of the patients were statistically significant for UGTI failure in occlusion of the pseudoaneurysms. For morphological aspects of pseudoaneurysm: anteroposterior (P = 0.029), longitudinal (P = 0.020), and neck diameters (P = 0.004) were statistically significant for UGTI failure. Logistic regression analysis for longitudinal diameter showed that for each centimeter, there was a 2.66 chance of failure of pseudoaneurysm thrombosis in a single thrombin injection session (95% confidence interval: 1.33-5.30). For longitudinal and neck diameters greater than 1.8 cm and 0.55 cm, respectively, there is a greater probability of needing more than one UGTI session for complete thrombosis.

CONCLUSIONS

Among variables, the longitudinal dimension was more significant, and in a larger diameter, the treatment with thrombin injection presented greater complexity.

摘要

背景

超声引导下凝血酶注射（UGTI）已成为血管内介入术后假性动脉瘤的首选治疗方法，因为它微创、成本低且有效，住院时间短。目的是确定股动脉假性动脉瘤的形态学特征以及心脏导管插入术后股动脉假性动脉瘤UGTI治疗失败的患者临床特征。

研究对象与方法

2012年12月至2016年12月，60例因心脏导管插入术导致假性动脉瘤的患者被转诊至介入放射科接受UGTI治疗。对病历进行回顾性分析，记录合并症、抗血小板药物使用情况、抗凝情况、心脏导管插入术指征等。分析假性动脉瘤的形态学特征，如体积、直径（前后径、左右径和纵径）、长度和颈部直径。

结果

UGTI技术成功率达100%。患者的临床特征对UGTI封堵假性动脉瘤失败无统计学意义。对于假性动脉瘤的形态学特征：前后径（P = 0.029）、纵径（P = 0.020）和颈部直径（P = 0.004）对UGTI治疗失败有统计学意义。纵径的逻辑回归分析显示，每增加1厘米，单次凝血酶注射时假性动脉瘤血栓形成失败的几率为2.66（95%置信区间：1.33 - 5.30）。当纵径和颈部直径分别大于1.8厘米和0.55厘米时，完全血栓形成可能需要不止一次UGTI治疗。