Hertz S M, Brener B J
Department of Surgery, Newark Beth Israel Medical Center, NJ 07112, USA.
J Vasc Surg. 1997 Dec;26(6):913-6; discussion 916-8. doi: 10.1016/s0741-5214(97)70002-8.
Ultrasound-guided compression of femoral pseudoaneurysms has often obviated the need for open operative repair. Increasing use of percutaneous interventional cardiac procedures has created pseudoaneurysms with a large-caliber arterial defect, often in patients who are placed immediately on anticoagulation therapy. This report describes the prospectively collected information from our vascular laboratory regarding ultrasound-guided compression of these pseudoaneurysms after cardiac procedures, both interventional and diagnostic.
Since March 1994 prospective data collection for patients who have undergone pseudoaneurysm compression in our vascular laboratory has recorded information including cardiac procedure, size of catheter or sheath, coagulation parameters, pseudoaneurysm size and location, and time to compression. Forty-one patients underwent attempted ultrasound-guided pseudoaneurysm compression after cardiac procedures: 19 after cardiac catheterization alone, seven after angioplasty, one after atherectomy, two after insertion and subsequent removal of an intraaortic balloon pump, and 12 after coronary stenting.
Compression was successful overall in 88% of the patients (36 of 41). Successful compression of the pseudoaneurysm was seen in 95% after catheterization alone, 100% after angioplasty, 100% after atherectomy, and 100% after intraaortic balloon pumping, as compared with 67% after stenting (eight of 12 vs 28 of 29; p = 0.02). A sheath size of 9F or greater was a significant factor in predicting unsuccessful compression (three of eight vs two of 33; p = 0.04). Abnormal coagulation parameters were present in 20 of the 41 patients and was not significantly different in patients who were successfully or unsuccessfully treated (four of five vs 16 of 36; p = 0.40).
Pseudoaneurysms after cardiac procedures and interventions can often be successfully compressed with an ultrasound-guided technique. The presence of abnormal coagulation parameters was not identified as a risk factor for compression failure and should not dissuade attempted compression. Stent placement was more likely to result in unsuccessful compression, and this appeared to be a result of the larger size of the arterial defect. Even in this setting, compression achieved obliteration of the pseudoaneurysm in more than half of the patients.
超声引导下压迫股动脉假性动脉瘤常常避免了开放性手术修复的必要性。经皮介入性心脏手术的使用增加，导致出现了大口径动脉缺损的假性动脉瘤，这类患者通常立即接受抗凝治疗。本报告描述了我们血管实验室前瞻性收集的关于心脏手术后（包括介入性和诊断性手术）这些假性动脉瘤超声引导下压迫的信息。
自1994年3月以来，我们血管实验室对接受假性动脉瘤压迫的患者进行前瞻性数据收集，记录的信息包括心脏手术、导管或鞘管的尺寸、凝血参数、假性动脉瘤的大小和位置以及压迫时间。41例患者在心脏手术后尝试进行超声引导下假性动脉瘤压迫：19例仅在心脏导管检查后，7例在血管成形术后，1例在旋切术后，2例在插入并随后移除主动脉内球囊泵后，12例在冠状动脉支架置入术后。
总体而言，88%的患者（41例中的36例）压迫成功。仅导管检查后假性动脉瘤压迫成功的比例为95%，血管成形术后为100%，旋切术后为100%，主动脉内球囊泵置入术后为100%，而支架置入术后为67%（12例中的8例对29例中的28例；p = 0.02）。鞘管尺寸为9F或更大是预测压迫失败的一个重要因素（8例中的3例对33例中的2例；p = 0.04）。41例患者中有20例存在异常凝血参数，成功或失败治疗的患者之间无显著差异（5例中的4例对36例中的16例；p = 0.40）。
心脏手术和介入术后的假性动脉瘤通常可以通过超声引导技术成功压迫。异常凝血参数的存在未被确定为压迫失败的危险因素，不应妨碍尝试进行压迫。支架置入更有可能导致压迫失败，这似乎是动脉缺损较大的结果。即使在这种情况下，压迫仍使超过一半的患者假性动脉瘤闭塞。
