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目的经皮超声引导下注射凝血酶(UGTI)治疗股动脉假性动脉瘤(PS)的方法学探讨及可行性评价。方法15例经股动脉径路选择性冠脉造影和冠脉介入术后医源性股动脉PS患者接受了UGTI治疗。男5例,女10例,平均(68.5±12)岁,选择性冠脉造影1例,经皮冠脉介入14例。单腔的单纯型PS9例,2腔或3腔的复杂型PS6例。局麻后在超声引导下准确定位注射器针头,单纯PS尽可能在瘤腔底部,远离瘤颈部,复杂PS首选在远端瘤腔的底部,注射凝血酶速度宜慢,剂量为100~800IU凝血酶,超声下观察瘤腔内血栓形成,UGTI后24h、5~7d接受二维超声随访。结果PS平均容积为(13±4.89)cm3。共注射凝血酶21次,单腔注射凝血酶剂量为(250±120)IU,双腔或多腔为(650±150)IU。9例单腔患者全部一次成功;6例双腔或多腔的复杂PS患者4例首次成功,1例24hr出现“再通”,1例15d出现“再通”,经重复3次注射凝血酶后,封闭成功。无1例出现血栓形成、感染、过敏等并发症。结论掌握正确的UGTI操作方法是治疗股动脉PS成功的前提条件,也是减少操作并发症的重要因素。采用正确的UGTI方法可作为医源性股动脉PS的首选治疗。
Objective To investigate the feasibility and feasibility of transcutaneous ultrasound-guided injection of thrombin in the treatment of femoral artery pseudoaneurysm (PS). Methods Fifteen patients with iatrogenic femoral artery PS undergoing route-selective coronary angiography and percutaneous coronary intervention received UGTI. 5 males and 10 females, mean (68.5 ± 12) years, selective coronary angiography in 1 case and percutaneous coronary intervention in 14 cases. Single-chamber simplex PS9 cases, 2-chamber or 3-chamber complex PS6 cases. Local anesthesia after ultrasound-guided accurate positioning of the needle, simply PS as possible at the bottom of the tumor cavity, away from the neck of the tumor, complex PS preferred at the bottom of the distal tumor cavity, thrombin injection speed should be slow, the dose of 100 ~ 800IU coagulation Enzyme and ultrasonography were used to observe the thrombus formation in the tumor cavity. Two-dimensional ultrasound follow-up was performed 24h and 5 ~ 7d after UGTI. Results The average volume of PS was (13 ± 4.89) cm3. Thrombin was co-injected 21 times with a single-chamber injection of (250 ± 120) IU of thrombin and a double-chamber or multi-chamber of (650 ± 150) IU. All of the 9 patients with single lumen succeeded in one time. Of the 6 patients with complicated PS with double-lumen or multi-lumen, 4 were successful for the first time, 1 case had recanalization at 24 hours, 1 case had recanalization at 15 days, After the closure of success. No case of thrombosis, infection, allergies and other complications. Conclusions It is a prerequisite for the successful treatment of PS in the femoral artery to master the correct UGTI operation method, which is also an important factor to reduce the operation complications. Using the correct UGTI method can be used as the preferred treatment for iatrogenic femoral artery PS.