Swietokrzyskie Cardiology Centre, Kielce, Poland.
Jan Kochanowski University, The Faculty of Medicine and Health Sciences, Kielce, Poland.
Eur J Vasc Endovasc Surg. 2020 Jun;59(6):1019-1025. doi: 10.1016/j.ejvs.2020.01.009. Epub 2020 Feb 1.
Ultrasound guided thrombin injection (UGTI) is a minimally invasive method of treatment for iatrogenic post-catheterisation femoral pseudoaneurysms (psAs). The optimal dosing protocol for UGTI has not been established. The aim of the study was to compare the success and complication rates between two different dosing protocols (the most commonly used "standard dose protocol" and the "low dose protocol," which is the fractionated administration of smaller thrombin doses of up to 40 IU every 15 s) in patients with a psA with sac volume of ≥1 mL.
This was a retrospective cohort study, and the analysis was performed using a case matching approach based on propensity score. From June 2004 to August 2018, 384 patients who underwent femoral puncture for transcatheter procedures were diagnosed with femoral psA with a sac volume of ≥1 mL and qualified for UGTI. The patients' mean age was 68 (±10.6) years and there were 217 (56.5%) women. To compare protocols, 124 patients treated according to the low dose protocol were nearest neighbour matched according to their propensity score to 124 patients treated according to the standard dose protocol.
The overall success rate (99.2% vs. 98.4%; p = 1) and success rate of the first UGTI attempt (87.1% vs. 86.3%; p = .85) did not differ between the low dose and standard dose groups. Complications were less common in the low dose group (7.3% vs. 16.1%; p = .03) and the median total amount of thrombin used for procedures was smaller in the low dose group (120 IU vs. 195 IU; p = .01).
In patients with femoral psA with sac volume of ≥1 mL, the use of the low dose protocol seemed to be equally effective as the standard dose protocol and was associated with a lower complication rate and reduced thrombin dose.
超声引导下凝血酶注射（UGTI）是治疗医源性股假性动脉瘤（psAs）的一种微创方法。UGTI 的最佳给药方案尚未确定。本研究的目的是比较两种不同剂量方案（最常用的“标准剂量方案”和“低剂量方案”，即分次给予 40IU 以下的小剂量凝血酶，每 15 秒一次）在假性动脉瘤囊体积≥1ml 的患者中的成功率和并发症发生率。
这是一项回顾性队列研究，采用倾向评分的病例匹配方法进行分析。2004 年 6 月至 2018 年 8 月，对 384 例行经导管介入治疗的股动脉穿刺患者进行了诊断，这些患者的假性动脉瘤囊体积≥1ml，符合 UGTI 治疗标准。患者的平均年龄为 68（±10.6）岁，其中女性 217 例（56.5%）。为了比较方案，根据倾向评分，将 124 例采用低剂量方案治疗的患者与 124 例采用标准剂量方案治疗的患者进行最近邻匹配。
低剂量组和标准剂量组的总成功率（99.2% vs. 98.4%；p=1）和首次 UGTI 尝试成功率（87.1% vs. 86.3%；p=0.85）无差异。低剂量组并发症较少（7.3% vs. 16.1%；p=0.03），低剂量组用于治疗的凝血酶总用量也较小（120IU vs. 195IU；p=0.01）。
在假性动脉瘤囊体积≥1ml 的股动脉假性动脉瘤患者中，低剂量方案的使用似乎与标准剂量方案同样有效，且并发症发生率较低，凝血酶剂量也较低。
