Gummerer Maria, Kummann Moritz, Gratl Alexandra, Haller Daniela, Frech Andreas, Klocker Josef, Fraedrich Gustav, Gruber Hannes
Department of Vascular Surgery, Medical University Innsbruck, Innsbruck, Austria.
Department of Radiology, Medical University Innsbruck, Austria.
Vasc Endovascular Surg. 2020 Aug;54(6):497-503. doi: 10.1177/1538574420934631. Epub 2020 Jun 19.
Arterial pseudoaneurysms (PSAs) are the most common access site complication following transarterial catheter intervention. Ultrasound-guided injection of thrombogenic substances into perfused arterial PSAs followed by compression therapy is a well-established and less invasive treatment option than surgical repair. Different agents are available to induce thrombosis including thrombin and a fibrin-based tissue glue, which is used as first-line treatment at our institution. This paper deals with our experience using ultrasound-guided fibrin glue injection (UGFI).
Retrospective data analysis: all patients (55) treated for iatrogenic femoral PSA following digital subtraction angiography of the lower extremities between January 1, 2010, and December 31, 2018, were included. Data on epidemiology, PSA location and size, vascular risk factors, fibrin glue injection (fibrin glue volume), primary success rate of UFGI, and complications related to the treatment were analyzed.
A total of 55 consecutive femoral iatrogenic PSAs were treated during the defined period and 32 (58.2%) of the patients were female. Imaging was performed using ultrasound in all cases. The most common PSA location (80.0%) was the common femoral artery, mean PSA size (± SD) was 2.7 ± 1.2 cm, and neck length was 1.6 ± 1.0 cm. The dose (mean ± SD) of fibrin glue was 2.6 mL (± 1.0; maximum: 6 mL). Primary UGFI success rate was 87.3% and conversion rate to open surgery was 12.7%. Two (4%) patients required embolectomy for peripheral embolization after UGFI.
Early results achieved with UGFI for treatment of iatrogenic femoral PSA are promising. In our cohort, UGFI was a safe and effective first-line alternative to traditional open surgery, which then was unnecessary in the vast majority of PSA cases. Further prospective studies for comparison of ultrasound-guided techniques should be encouraged.
动脉假性动脉瘤（PSA）是经动脉导管介入术后最常见的穿刺部位并发症。超声引导下向有血流灌注的动脉PSA内注射血栓形成物质，随后进行压迫治疗，是一种成熟的治疗方法，与手术修复相比，侵入性较小。有多种药物可用于诱导血栓形成，包括凝血酶和一种基于纤维蛋白的组织胶水，在我们机构，后者被用作一线治疗药物。本文介绍了我们使用超声引导下纤维蛋白胶水注射（UGFI）的经验。
回顾性数据分析：纳入2010年1月1日至2018年12月31日期间，所有在下肢数字减影血管造影后因医源性股动脉PSA接受治疗的患者（共55例）。分析了流行病学、PSA位置和大小、血管危险因素、纤维蛋白胶水注射情况（纤维蛋白胶水用量）、UGFI的初次成功率以及与治疗相关的并发症等数据。
在规定时间段内，共连续治疗了55例医源性股动脉PSA，其中32例（58.2%）为女性。所有病例均使用超声进行成像。最常见的PSA位置（80.0%）是股总动脉，PSA平均大小（±标准差）为2.7±1.2 cm，颈部长度为1.6±1.0 cm。纤维蛋白胶水的剂量（平均±标准差）为2.6 mL（±1.0；最大剂量：6 mL）。UGFI的初次成功率为87.3%，转为开放手术的比例为12.7%。两名（4%）患者在UGFI后因外周栓塞需要进行取栓术。
UGFI治疗医源性股动脉PSA的早期结果很有前景。在我们的队列中，UGFI是传统开放手术安全有效的一线替代方法，在绝大多数PSA病例中无需进行开放手术。应鼓励开展进一步的前瞻性研究，以比较超声引导技术。
