超声导引下瘤体旁注射0.9%氯化钠溶液治疗股动脉假性动脉瘤18例

Ultrasound-guided para-aneurysmal saline injection for the treatment of iatrogenic femoral pseudoaneurysm:preliminary results in 18 patients

目的探讨超声导引下瘤体旁注射0.9%氯化钠溶液(PASI)治疗医源性股动脉假性动脉瘤(FAP)的临床价值。方法 18例股动脉穿刺介入治疗术后患者,经临床及彩色超声检查明确诊断为FAP。PASI手术在彩色超声实时导引和心电监护下进行,1%利多卡因5~10 ml局部麻醉成功后,21 G穿刺针经皮穿刺至瘤体与股动脉间瘘道周边2~5 mm处,缓慢注入0.9%氯化钠溶液,直至瘘道内异常血流信号消失,压迫约5 min。记录0.9%氯化钠溶液注射剂量、操作时间。术后24 h、1周、1个月进行临床和彩色超声复查,观察局部搏动、杂音,检测瘤腔内血流及血栓形成情况。结果 17例1次成功(17/18,94.4%),1例术后24 h复查发现瘤体内仍有持续血流信号,第2次PASI取得成功。手术操作时间14~30 min,平均(19±8)min;0.9%氯化钠溶液注射量40~150 ml,平均(67.2±29.3)ml。所有患者均能很好耐受治疗过程,仅有1例出现迷走神经反射所致一过性心动过缓;术后30 d随访未发现瘤体内血流恢复,未观察到静脉血栓、肢体缺血、局部感染等并发症,瘤体内血肿完全吸收。结论 PASI术治疗FAP方法简单、安全,费用低廉,患者耐受性好,值得临床推广应用。

Objective To assess the clinical value of ultrasound-guided para-aneurysmal saline injection（PASI） in the treatment of iatrogenic femoral pseudoaneurysm, i.e. postcatheterization femoral artery pseudoaneurysm（FAP）. Methods A total of 18 patients developed FAP after receiving interventional therapy through femoral artery puncturing, the diagnosis was confirmed by clinical and color ultrasonography examinations in all patients. Under real-time color Doppler ultrasound guidance and ECG monitoring, PASI was carried out. Local anesthesia was performed by injection of 5-10 ml of 1% lidocaine, which was followed by percutaneous puncturing with a 21-gauge needle, that was connected to a plastic syringe filled with 0.9%sodium chloride solution, into the site about 2-5 mm away from the fistula between the pseudoaneurysm and the formal artery, then, the saline was continuously and slowly injected into this area until the abnormal blood flow signal within the fistula disappeared. Manual compression was applied on the local area for about 5 minutes. The dose of injected saline and the total time of the procedure were recorded. Clinical and color Doppler ultrasound reexaminations were conducted at 24 hours, one week and one month after the treatment,and the local pulsation, murmur, intra-pseudoaneurysmal blood flow and thrombosis were tested. Results Successful treatment with single procedure was achieved in 17 patients（17/18, 94.4%）. In one patient continuous blood flow signal within the pseudoaneur ysm was still observed at 24 hours after PASI, and successful closure of the pseudoaneurysm was obtained after the second time of PASI. The time of the procedure was 14-30 min, with a mean of（19.2±8.0） min. The injection volume of saline was 40-150 m L,with a mean of（67.2 ±29.3） m L. The treatment process could be well tolerated by all patients, only one patient developed transient bradycardia due to vagus reflex. Postoperative 30-day follow-up examination showed that no recurrent blood flow was detected within the pseudoaneurysm, no complications such as venous thrombosis, limb ischemia or local infection were observed, and the pseudoaneurysmal hematoma was completely absorbed. Conclusion For the treatment of postcatheterization FAP, ultrasound-guided PASI is technically-simple and clinically-safe with low medical cost, besides, this therapy can be well tolerated by patients. Therefore, PASI is worthy of clinical application.