介入诊疗术后股动脉假性动脉瘤46例临床分析

Clinical data and outcomes of pseudoaneurysm after femoral artery catheterization:a report of 46 patients

目的分析介入诊疗术后股动脉假性动脉瘤(pseudo-aneurysm,PSA)的危险因素及其合理的处理措施。方法通过回顾性分析西南医院心血管内科2007年1月至2011年4月的46例介入诊疗术后股动脉PSA的基本资料,比较压迫修复法和凝血酶注射法的临床疗效。46例年龄(62.1±13.5)岁,男性16例,女性30例。其中43例合并高血压病或冠心病或糖尿病,32例术后应用抗凝药,4例行同侧股动脉/静脉穿刺。结果 21例行压迫修复疗法,14例成功(成功率66.7%),3例(14.3%)出现严重并发症。25例行凝血酶注射疗法,所有患者治疗成功(成功率100%)。无严重并发症。PSA发生后住院时间及随访结果:压迫修复疗法患者的住院时间高于凝血酶注射疗法患者[(3.8±10.5)d vs(1.5±0.6)d,P<0.05]。所有患者随访至少3个月。1例压迫修复好转出院患者,半个月后再次出现PSA。随访期间无局部感染、化脓等并发症。结论 PSA发生原因复杂,凝血酶注射疗法较压迫修复疗法安全有效。

Objective To review our experience and to analyze the clinical data and treatment outcomes of pseudoaneurysm patients after femoral artery catheterization.Methods A retrospective review of 46 patients with pseudoaneurysm after femoral artery catheterization admitted to Southwest Hospital from January 1,2007 to March 31,2011 was conducted.Interventional diagnosis and therapy was performed.Their demographic and clinical data were collected,and the outcomes of ultrasound-guided thrombin injection after intervention and compression were compared and analyzed.Clinical data showed that the median age of 46 patients was 62.1±13.5 years,and 43 patients of them were complicated with hypertension,ischemic heart disease or diabetes,and 20 of them had obesity.Among these 46 patients,32 received anticoagulants after intervention and 2 had post catheterization involving both artery and vein.Results Compression or ultrasound-guided compression was underwent in 21 patients,with a successful rate of 66.7%.Of the 21 patients,3 had severe complication with a complication rate of 14.3%,including pseudoaneurysm sac rupture,skin necrosis and venous thrombosis.Ultrasound-guided thrombin injection was performed in 25 patients,with a higher rate of success of 100%,and no severe complication occurred.The average hospital stay of patients using compression after PSA occurrence was significantly longer than that of those with thrombin injection（3.8±10.5 vs 1.5±0.6 d,P0.05）.During the median follow-up of at least 3 months,good outcome was obtained,no severe complication was found including localized infection and purulence,but PAS was reoccurred in 1 patient who receiving compression.Conclusion The occurrence of PAS is complex after femoral artery catheterization.A better outcome may be obtained among patient receiving thrombin injection.