Michimoto Kenkichi, Takenaga Shinsuke, Matsui Yo, Enoki Keitaro, Nozawa Yosuke, Higuchi Takahiro, Sakamoto Hiroshi, Noda Yasuto, Morooka Satoru
Department of Radiology, Fuji City General Hospital, Japan.
Department of Cardiology, Fuji City General Hospital, Japan.
Pol J Radiol. 2021 Sep 2;86:e511-e517. doi: 10.5114/pjr.2021.109077. eCollection 2021.
To evaluate the risk and prognostic factors of post-catheterization pseudoaneurysm (PPA).
To identify the risk factors for PPA occurrence, clinical findings were compared between 22 consecutive patients with radiologically confirmed PPAs (PPA group) and 300 randomly extracted patients without PPA, who underwent transarterial angiography or intervention (sample group) between 1 January 2015 and 31 March 2020. The PPA group was further divided into those treated successfully with mechanical compression (group A) and those requiring ultrasound-guided thrombin injection after compression failed (group B). Univariate and multivariate analyses were used to compare patient demographics, preoperative laboratory findings, procedure details, PPA diameter, and time interval between the procedure and compression between groups A and B to evaluate the prognostic factors of PPA.
The PPA group demonstrated significantly elevated prothrombin time international normalized ratios (PT/INR) (odds ratio [OR]: 6.27, 95% confidence interval [CI]: 2.020-19.5; = 0.00151) and more frequent popliteal access (OR: 14.2, 95% CI: 1.040-195.0; = 0.0467) compared to the sample group, and radial access decreased the risk of PPA (OR: 0.382, 95% CI: 0.0148-0.987; = 0.0468). One of the 22 PPAs resolved spontaneously, and 11 others (52.4%) were successfully treated by mechanical compression. An interval exceeding 24 hours between the procedure and compression was the only significant prognostic factor ( = 0.0281) between groups A and B.
Elevated PT/INR and popliteal access may predispose patients to PPA; close consideration of the site of access may lower the risk of refractory PPA.
评估导管插入术后假性动脉瘤（PPA）的风险及预后因素。
为确定PPA发生的危险因素，比较了2015年1月1日至2020年3月31日期间22例经放射学确诊的PPA患者（PPA组）和300例随机抽取的未发生PPA且接受经动脉血管造影或介入治疗的患者（样本组）的临床特征。PPA组进一步分为经机械压迫成功治疗的患者（A组）和压迫失败后需要超声引导下注射凝血酶的患者（B组）。采用单因素和多因素分析比较A组和B组患者的人口统计学特征、术前实验室检查结果、手术细节、PPA直径以及手术与压迫之间的时间间隔，以评估PPA的预后因素。
与样本组相比，PPA组的凝血酶原时间国际标准化比值（PT/INR）显著升高（比值比[OR]：6.27，95%置信区间[CI]：2.020 - 19.5；P = 0.00151），且腘动脉穿刺更为频繁（OR：14.2，95% CI：1.040 - 195.0；P = 0.0467），而桡动脉穿刺可降低PPA风险（OR：0.382，95% CI：0.0148 - 0.987；P = 0.0468）。22例PPA中有1例自发消退，另外11例（52.4%）经机械压迫成功治疗。手术与压迫之间间隔超过24小时是A组和B组之间唯一显著的预后因素（P = 0.0281）。
PT/INR升高和腘动脉穿刺可能使患者易患PPA；仔细考虑穿刺部位可能降低难治性PPA的风险。
