超声引导下加压治疗医源性股动脉假性动脉瘤

Ultrasound-guided compression repair for iatrogenic femoral artery pseudoaneurysm

目的探讨多普勒超声引导下医源性股动脉假性动脉瘤的加压治疗方法和疗效，并分析治疗效果相关影响因素。方法回顾性分析2004年6月至2010年6月42例医源性股动脉假性动脉瘤患者的治疗经过，其中男性28例，女性14例；年龄45-84岁，平均（52±5）岁。患者在股动脉穿刺后出现腹股沟区搏动性肿块，经多普勒超声确诊为股动脉假性动脉瘤。在超声引导下，以股动脉和假性动脉瘤之间的漏口为中心，持续探头加压直至假性动脉瘤内完全血栓形成，加压治疗失败的病例行手术治疗。结果加压治疗后，34例（81．0％）假性动脉瘤的瘤体内完全血栓形成，8例（19．0％）加压治疗失败，最后行手术治疗。单因素分析显示，与加压治疗成功率明显相关的因素是瘤体最大径（〈25mm，25-40mm，〉40mm；）X^2=13．956，P=0．001），是否正在进行抗凝治疗（X^2=5．578，P=0．010），漏口深度（〈50mm，50-80mm，〉80mm；X^2=14．055，P=0．001），漏口部位（股总动脉，股浅动脉，股深动脉；X^2=8．968，P=0．011）及假性动脉瘤的确诊时间（〈3d，≥3d；X^2=5．733，P=0．012）。Logistic多元回归分析表明，与加压治疗成功率明显相关的因素是瘤体最大径（WALD=5．34，P=0．021）和漏口深度（WALD=4．84，P=0．028）。结论超声引导下加斥治疗医源性股动脉假性动脉瘤安全、易于操作，有较好的临床疗效。

Objective To evaluate relative factors affecting the efficiency of ultrasound-guided compression repair in iatrogenic femoral artery pseudoaneurysm. Methods Ultrasound-guided manual compression was performed in 42 patients of iatrogenic femoral artery pseudoaneurysm from June 2004 to June 2010. There were 28 male and 14 female patients, with a mean age of （52 ±5） years. These patients were presented with femoral artery pseudoaneurysm after catheterisation procedure by percutaneous femoral artery puncture and confirmed by color doppler flow image. Ultrasound-guided manual persistent compression with probe was performed at the puncture site between femoral artery and pseudoaneurysm, until completely thrombosis of pseudoaneurysm, whereas the pseudoaneurysm failed to complete closure required surgical repair. Results Out of 42 patients, 34 patients （81.0%） were successfully treated by compression resulted in completely thrombosis. There were 8 （ 19.0% ） failures conversion to surgery. Factors associated with success were size of pseudoaneurysm （ 〈25 ram, 25-40 mm, 〉40 ram; X^2 = 13. 956, P =0. 001 ） , anti-coagulation status （ X^2 = 5. 578, P = 0. 010） , depth of artery break （ 〈 50 ram, 50-80 mm, 〉 80 mm; X^2 = 14. 055, P = 0. 001 ） , pseudoaneurysm communicated with common femoral artery, superficial femoral artery and profunda femoral artery （ X^2 = 8. 968, P = 0. 011 ） , as well as days to presented with pseudoaneurysm （ 〈 3 d, ≥ 3 d; X^2 = 5. 733, P = 0. 012）. In muhivariate Logistic regression analysis, success by compression was associated with size of pseudoaneurysm （WALl） = 5.34, P = 0. 021 ） and with depth of artery break （WALl） = 4. 84, P = 0. 028 ）. Conclusion The ultrasound-guided compression repair of iatrogenic femoral artery pseudoaneurysm is safe, convenient, inexpensive and reliable treatment.