超声在经皮腔内介入术后股动脉穿刺相关并发症中的诊治作用

Roles of color Doppler ultrasound in diagnosis and treatment of complications following puncture of femoral artery after percutaneous transluminal interventional procedure

目的探讨彩色多普勒超声在诊治经皮腔内介入术后股动脉穿刺相关并发症中的作用。方法对39例经皮腔内动脉介入术后股动脉穿刺处出现临床症状的患者彩色多普勒超声的超声图像以及在超声引导下治疗的结果进行回顾性分析,总结彩色多普勒超声在诊治经皮腔内介入术后股动脉穿刺相关并发症中的作用。结果经彩色多普勒超声诊断39例中主要并发症为:假性动脉瘤形成16例,穿刺血管周围组织水肿11例,穿刺血管周围血肿17例,动静脉瘘形成4例,11例同时具有2种或2种以上的并发症。彩色多普勒超声的引导下定点压迫,4例假性动脉瘤、3例动静脉瘘经加压24～72h后动静脉分流消失,杂音消失,1例动静脉瘘定点压迫无明显改善,后经导管植入覆膜支架修补;采用超声引导下注射凝血酶治疗假性动脉瘤12例,其中10例24h后动静脉分流消失,1例48h后再次注射凝血酶加压包扎24h动静脉分流消失,1例经过3次注射凝血酶加压包扎24h动静脉分流消失。结论彩色多普勒超声在诊断与超声引导下治疗经皮腔内介入术后股动脉穿刺点相关并发症具有无创性、简单易行、经济实用等优点。

Objective To evaluate the roles of color Doppler ultrasound in the diagnosis and treatment of the complications correlated with puncture of femoral artery after percutaneous transluminal interventional procedure. Methods The images by Doppler and the results of treatment under the guide of Doppler in 39 cases with complications correlated with puncture of femoral artery after percutaneous transluminal interventional procedure were studied retrospectively. The effects of color Doppler ultrasound on the diagnosis and treatment of the complications correlated with puncture of femoral artery after pereutaneous transluminal interventional procedure were investigated. Results The complications correlated with puncture of femoral artery in 39 cases included 16 cases of pseudoaneurysm, 11 cases of edema of tissue around the artery, 17 cases of hematoma, and 4 cases of arteriovenous fistula formation. There were 11 cases with multiple complications. After pressure of the point of puncture under the guide of color Doppler, the arteriovenous shunt and murmur were eliminated in 4 cases with pseudoaneurysm and 3 cases with arteriovenous fistula. Only 1 case with arteriovenous remained unvarnished and transcatheter stent-graft placement was performed to obturate the rupture of femoral artery. Injection of thrombin with Doppler was performed in 12 cases with pseudoaneurysm and eliminated arteriovenous shunt was achieved in 10 cases at 24 h. After the second injection in 1 case and the third time in another case, eliminated arteriovenous shunt was achieved. Conclusion Color Doppler ultrasound may play a very important role in the diagnosis and treatment of the complications correlated with puncture of femoral artery after pereutaneous transluminal interventional procedure.