Toursarkissian B, Allen B T, Petrinec D, Thompson R W, Rubin B G, Reilly J M, Anderson C B, Flye M W, Sicard G A
Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
J Vasc Surg. 1997 May;25(5):803-8; discussion 808-9. doi: 10.1016/s0741-5214(97)70209-x.
We report our approach to the management of postcatheterization femoral artery pseudoaneurysms and arteriovenous fistulae in an attempt to determine the frequency of spontaneous resolution of selected lesions.
We studied 196 pseudoaneurysms, 81 arteriovenous fistulae, and 9 combined lesions that were identified by duplex scan. Indications for immediate surgical repair included pseudoaneurysm greater than 3 cm, enlarging hematoma, pain, groin infection, nerve compression, limb ischemia, concomitant surgical procedure, and patient refusal or inability to comply with follow-up. All other lesions were observed.
One hundred thirty-nine patients underwent prompt surgical repair, and 147 patients were initially managed without operation. There were no limb-threatening complications associated with nonoperative management in this subset of patients. Eighty-six percent of the lesions being observed resolved spontaneously within a mean of 23 days, whereas 14% required surgical closure for a variety of reasons (at a mean of 111 days after the initial diagnosis). There was no statistically significant difference in the rate of spontaneous pseudoaneurysm closure (89%) as opposed to fistulae (81%) (p < 0.17). By life-table analysis, 90% of selected pseudoaneurysms had resolved by 2 months. Patients selected for observation underwent an average of 2.6 duplex scans per patient versus 1.4 scans per patient for those treated with immediate surgery (p < 0.01).
The natural history of stable pseudoaneurysms and arteriovenous fistulae is benign and frequently results in spontaneous resolution, which allows properly selected patients to be managed without operation.
我们报告了我们处理导管插入术后股动脉假性动脉瘤和动静脉瘘的方法，旨在确定特定病变自发消退的频率。
我们研究了经双功扫描确定的196例假性动脉瘤、81例动静脉瘘和9例合并病变。立即进行手术修复的指征包括假性动脉瘤直径大于3 cm、血肿扩大、疼痛、腹股沟感染、神经受压、肢体缺血、同期外科手术以及患者拒绝或无法配合随访。所有其他病变均进行观察。
139例患者迅速接受了手术修复，147例患者最初未进行手术治疗。在这组患者中，非手术治疗未出现威胁肢体的并发症。观察的病变中有86%在平均23天内自发消退，而14%因各种原因需要手术闭合（初始诊断后平均111天）。假性动脉瘤自发闭合率（89%）与动静脉瘘（81%）相比，差异无统计学意义（p < 0.17）。通过寿命表分析，90%的特定假性动脉瘤在2个月内消退。选择观察的患者平均每人接受2.6次双功扫描，而立即手术治疗的患者平均每人接受1.4次扫描（p < 0.01）。
稳定的假性动脉瘤和动静脉瘘的自然病程是良性的，常导致自发消退，这使得适当选择的患者无需手术即可得到处理。
