股动脉假性动脉瘤53例治疗方案的探讨

Therapeutic options of femoral artery pseudoaneurysm： a report of 53 cases

目的探讨股动脉假性动脉瘤（FAP）的治疗方法选择。方法回顾性分析2005年3月至2015年5月北京协和医院血管外科经治的53例股动脉FAP患者的临床资料，病因分别为医源性损伤38例（71．7％），白塞病8例（15．1％），外伤4例（7．5％），感染性FAP3例（5．7％）。治疗方案分为开放手术、腔内治疗和超声引导下凝血酶注射（UGTI）。结果采用UGTI患者17例（32．1％），成功率为88．2％；外科手术27例（50．9％），术后并发症发生率为37．0％，无围术期死亡病例；腔内治疗9例（17．0％），成功率为100．0％，无围术期并发症发生。随访期间总体外科移植物及支架血管3年累计通畅率为94．3％，3年总体生存率为94．0％。结论UGTI可作为非复杂股动脉FAP的首选措施；手术治疗复杂股动脉FAP的作用仍然不可替代，但围术期并发症较高；腔内治疗可用于远离股动脉分叉的病变以及危重急诊患者的救治。

Objective To summarize our experience in the therapeutic options for femoral artery pseudoaneurysms （FAP）. Methods Clinical data of 53 FAP patients admitted in our department from March 2005 to May 2015 were collected and retrospectively analyzed. Thirty-eight cases （71.7%） were iatrogenic injury, 8 （15.1%） were Bechest＇s disease, 4 （7.5%） and 3 （5.7%） were due to trauma and infection. The cohort received surgical therapy, endovascular treatment and ultrasound-guided thrombin injection （UGTI）. Results UGTI was performed on 17 cases （32.1%）, with a success rate of 88.2%. Open surgery was carried out on 27 cases, with an overall complication rate of 37.0%, and no perioperative death was observed. Endovascular treatment was performed on 9 cases （17.0%）, with a success rate of 100.0%, and no perioperative complication was observed. During the follow-up, the overall 3-year cumulative patency rate was 94.3%, and 3-year overall survival rate was 94.0%. Conclusion UGTI is the optional method for uncomplicated FAP. Surgical treatment still remains irreplaceable for complicated FAP, but the perioperative complication rate is quite high. Endovascular treatment can be employed for the pseudoaneurysms located far from the femoral artery bifurcation or the critically ill patients in emergency.