Kang S S, Labropoulos N, Mansour M A, Baker W H
Department of Surgery, Loyola University Medical Center, Maywood, IL 60153, USA.
J Vasc Surg. 1998 Jun;27(6):1032-8. doi: 10.1016/s0741-5214(98)70006-0.
Since its introduction in 1991, ultrasound guided compression repair of postcatheterization femoral artery pseudoaneurysms has been shown to be effective. Disadvantages of ultrasound guided compression repair include patient discomfort during compression, inability to treat noncompressible pseudoaneurysms, prolonged use of ultrasound equipment and personnel, limited success with patients being treated with anticoagulants, and some early recurrences. We conducted a prospective study to evaluate a new method of treating femoral pseudoaneurysms, percutaneous ultrasound guided thrombin injection.
Under duplex ultrasound guidance, a 22- or 25-gauge needle was percutaneously positioned within the pseudoaneurysm. Without compressing the pseudoaneurysm, 0.5 to 1 ml thrombin solution (1000 U/ml) was injected to induce thrombosis. Early in the study, the procedure was modified to allow more than one injection. After successful thrombosis, the patients were kept at rest in bed for at least 1 hour. Duplex ultrasound examination was repeated in 1 to 4 days. Distal pulses and ankle-brachial indexes were measured before and after the procedure.
Twenty of 21 consecutive pseudoaneurysms were successfully treated with thrombin injection. Fifteen pseudoaneurysms thrombosed immediately (<20 seconds) after one injection. The other five had partial thrombosis after one injection and complete thrombosis immediately after a second injection. The one failure occurred in a patient who had only one injection and then underwent subsequent ultrasound guided compression repair, which failed. No patient required sedation or analgesia during thrombin injection. There were no procedure-related complications and no recurrences.
Percutaneous ultrasound guided thrombin injection appears to be a safe and expeditious method for treating postcatheterization femoral pseudoaneurysms. It has significant advantages with respect to ultrasound guided compression repair or surgical repair.
自1991年引入以来，超声引导下压迫修复导管插入术后股动脉假性动脉瘤已被证明是有效的。超声引导下压迫修复的缺点包括压迫过程中患者不适、无法治疗不可压缩的假性动脉瘤、超声设备和人员使用时间长、抗凝治疗患者成功率有限以及一些早期复发。我们进行了一项前瞻性研究，以评估一种治疗股动脉假性动脉瘤的新方法，即经皮超声引导下注射凝血酶。
在双功超声引导下，将一根22号或25号针经皮放置在假性动脉瘤内。不压迫假性动脉瘤，注入0.5至1毫升凝血酶溶液（1000 U/ml）以诱导血栓形成。在研究早期，对该操作进行了改进，允许进行多次注射。血栓形成成功后，患者卧床休息至少1小时。在1至4天内重复进行双功超声检查。在操作前后测量远端脉搏和踝肱指数。
连续21例假性动脉瘤中的20例通过注射凝血酶成功治疗。15例假性动脉瘤在一次注射后立即（<20秒）形成血栓。另外5例在一次注射后部分形成血栓，在第二次注射后立即完全形成血栓。1例失败发生在仅进行一次注射的患者身上，随后接受超声引导下压迫修复但失败。在注射凝血酶期间，没有患者需要镇静或镇痛。没有与操作相关的并发症，也没有复发。
经皮超声引导下注射凝血酶似乎是一种安全、快速的治疗导管插入术后股动脉假性动脉瘤的方法。与超声引导下压迫修复或手术修复相比，它具有显著优势。
