假性动脉瘤14例临床分析

Different treatment strategies for artery pseudoaneurysm: analysis of clinical characteristics on 14 cases

目的探讨冠脉造影或冠脉介入治疗后假性动脉瘤的临床特点及处理方法。方法总结了行冠状动脉造影或冠脉介入治疗后发生的假性动脉瘤14例的临床特点及不同处理方法的结果。结果14例患者出现假性动脉瘤患者中,行冠脉造影术者2例,冠脉内支架置入术者12例。伴有高血压12例（92.9%）,糖尿病6例（42.9%）。假性动脉瘤发生在桡动脉1例（7.1%）,肱动脉2例（14.3%）,股动脉11例（78.6%）,其中1例出现双侧股动脉假性动脉瘤;假性动脉瘤的平均直径（3.46±1.85）cm（1.2-8.1 cm）,其中≥3 cm者8例（57.1%）,动脉瘤颈的直径平均（4.09±1.94）mm。1例患者经观察1天后自然闭合。13例经超声引导下手工压迫,其中9例成功,成功率为69.2%;超声引导下注射血凝酶并压迫3例,均成功（成功率100%）。1例手压失败并有局部皮肤破溃的患者成功进行了外科手术修补治疗。结论在超声引导下压迫可使多数假性动脉瘤闭塞,手压失败者需要在超声引导下局部注射凝血药物血凝酶然后压迫。偶有需要直接行外科修补。

Objective To summarize the clinical characteristics and results of different treatment strategies in patients with artery pseudoaneurysm after coronary angiography or pereutaneous coronary intervention （ PCI ）. Methods The clinical characteristics and different treatment strategies were summarized among patients who suffered artery pseudoaneurysm after coronary angiography or PCI from November 2004 to July 2008. Results We had 14 cases of arterial pseudoaneurysm. Two patients had diagnostic coronary angiography and 12 patients had percutaneous coronary intervention. Twelve patients had history of hypertension （92.9%） and 6 patients had diabetes （42.9%）. One patient had radial artery pseudoaneurysm ,2 cases with artery pseudoaneurysm were right brachial artery and 11 cases were femoral artery. One patient had bilateral femoral artery pseudoaneurysm. The average diameter of pseudoaneurysm cavity was 3.46 ± 1.85cm（ 1.2 - 8. 1cm）. Eight eases had a large pseudoaneurysm （ defined as diameter ≥ 3cm）. The average diameter of neck of artery pseudoaneurysm was （4.09 ± 1.94） mm. One femoral artery pseudoaneurysm was spontaneously closed one day later. Nine of ten patients with pseudoaneurysms （69.2%） were successfully treated by ultrasound-guided manual compression. Three artery pseudoaneurysms were successfully closed by duplex-guided injection of Reptilase. One patient with right braehial pseudoaneurysm had surgery repair of pseudoaneurysm after failure of manual compression with duplex guiding and surgical repair needed local skin ulcer. Conclusion Most patients with arterial pseudoaneurysm could be successfully treated by ultrasound-guided manual compression. Patients who are failure by manual compression may need local injection of Reptilase by ultrasound guiding and manual compression. Direct surgery repair is occasionally needed.