Department of Cardiovascular Medicine, Asahi General Hospital, I-1326 Asahi, Chiba, 289-2511, Japan.
Department of Cardiovascular Medicine, University of Tokyo Hospital, Tokyo, Japan.
Cardiovasc Interv Ther. 2022 Jan;37(1):158-166. doi: 10.1007/s12928-021-00764-9. Epub 2021 Feb 12.
The increasing number of percutaneous endovascular procedures in highly anticoagulated patients has increased the possibility of iatrogenic femoral artery pseudoaneurysm (IFAP). Ultrasound (US)-guided percutaneous thrombin injection is one of the feasible treatments; however, there are concerns about complications such as peripheral embolization. This study was performed to examine the efficacy and safety of treatment of IFAPs using a combination of percutaneous thrombin injection and intravascular balloon inflation. In this retrospective, single-center study, we analyzed 11 patients who developed and were treated for IFAPs from January 2017 through April 2020. The patients were treated with endovascular therapy (EVT) with percutaneous thrombin injection. The technique utilized fluoroscopic guidance to place a balloon at the neck of the IFAP, and the balloon was then inflated to prevent the inflow of blood to the aneurysm. We then performed US-guided thrombin injection. The mean age was 72.36 ± 10.43 years; mean body mass index (BMI) was 25.25 ± 3.18. All patients had hypertension, 72.7% were undergoing hemodialysis, and 54.5% used oral anticoagulant drugs. The mean aneurysm size was 24.34 ± 13.54 mm. The approach was transfemoral in ten patients and transradial in one patient. All procedures were successful, and there were no complications. The mean thrombin dose was 677.3 ± 410.7 IU; the total hemostatic time was 45.4 ± 24.9 min. In conclusion, the combination of percutaneous thrombin injection and endovascular balloon inflation was feasible and safe for the treatment of IFAPs. This technique may contribute to the treatment of IFAPs.
越来越多的高抗凝患者接受经皮腔内血管操作，增加了医源性股动脉假性动脉瘤（IFAP）的发生可能性。超声（US）引导下经皮凝血酶注射是一种可行的治疗方法；然而，人们对周围栓塞等并发症仍存在担忧。本研究旨在探讨经皮凝血酶注射联合血管内球囊扩张治疗 IFAP 的疗效和安全性。
在这项回顾性单中心研究中，我们分析了 2017 年 1 月至 2020 年 4 月期间因 IFAP 而就诊并接受治疗的 11 例患者。这些患者接受了经皮凝血酶注射的血管内治疗（EVT）。该技术利用荧光透视引导将球囊放置在 IFAP 的颈部，然后对球囊进行充气，以防止血液流入动脉瘤。随后，我们进行了超声引导下的凝血酶注射。
患者的平均年龄为 72.36±10.43 岁；平均体重指数（BMI）为 25.25±3.18。所有患者均患有高血压，72.7%正在接受血液透析，54.5%使用口服抗凝药物。平均动脉瘤大小为 24.34±13.54mm。10 例患者采用经股动脉入路，1 例患者采用经桡动脉入路。所有操作均成功，无并发症发生。凝血酶平均剂量为 677.3±410.7IU；总止血时间为 45.4±24.9min。
总之，经皮凝血酶注射联合血管内球囊膨胀治疗 IFAP 是可行且安全的。该技术可能有助于 IFAP 的治疗。
