超声引导下小剂量凝血酶注射治疗股动脉假性动脉瘤疗效分析

The efficacy of ultrasound-guided low-dose thrombin injection in the management of femoral artery pseudoaneurysm

目的:探讨超声引导下凝血酶注射在股动脉假性动脉瘤(PSA)封堵中的有效性和安全性。方法:分析2017年11月—2019年12月我院经股动脉血管造影或介入手术后彩超证实的24例PSA患者的资料,单纯型19例,复杂型5例。在彩色多普勒超声引导下,采用20G PTC针经皮从远离瘤颈的瘤腔底部穿刺入瘤腔,缓慢注入凝血酶溶液(浓度250 IU/mL,总量≤1000 IU),复杂型瘤体优先注射近端瘤腔。术后记录每位患者的凝血酶用量和不良反应情况,术后24 h、1周进行彩超复查,观察瘤腔及载瘤动脉内血流情况。结果:24例患者瘤腔内血流均消失,仅2例(1例单纯型、1例复杂型)瘤颈部残余少许血流,经压迫24 h后单纯型PSA瘤颈部血流消失,复杂型PSA行二次封堵成功。所有患者首次治疗成功率为95.8%(23/24),总成功率为100.0%(24/24)。凝血酶用量25~500 IU,平均(180±107)IU。1例患者术中出现短暂的血管迷走神经性晕厥,1例患者术后40 min出现寒颤、发热(39℃)、全身广泛皮疹、下肢花斑、低血压,经静脉补液和5 mg地塞米松静推后缓解,其余患者无不良反应,无复发病例。结论:超声引导下小剂量凝血酶注射治疗PSA是一种安全有效的方法。

Objective:To assess the efficacy and safety of ultrasound-guided thrombin injection(UGTI)in the treatment of femoral artery pseudoaneurysm(PSA).Method:From November 2017 to December 2019,24 PSA patients confirmed by angiography or color Doppler ultrasound in our hospital were analyzed,including 19 cases of simple type and 5 cases of complex type.Under the guidance of color Doppler ultrasound,20G PTC needle was used to puncture into the PSA cavity from the bottom of the PSA cavity far away from the PSA neck,and thrombin solution was injected slowly(concentration 250 IU/mL,total dose≤1000 IU).The near PSA cavity was injected preferentially for complex PSA.After operation,thrombin dosage and adverse reactions of each patient were recorded.Ultrasound(US)reexaminations were performed 24 hours and 1 week after operation,to observe the blood flow in PSA cavity and parent artery.Result:Blood flow signal in all 24 cases disappeared,only 2 patients(1 simple type,1 complex type)had a little residual blood flow in the neck of the PSA.After 24 hours of compression,the blood flow in the neck of the simple PSA disappeared,and the complex PSA was treated successfully for the second time.The success rate of the first treatment was 95.8%(23/24),and the total success rate was 100.0%(24/24).The average thrombin dosage was(180±107)IU(25~500 IU).One patient had transient vasovagal syncope during the operation.One patient developed shivering,fever(39℃)40 minutes after operation,with extensive skin rash,lower limb plaque and hypotension.After intravenous fluid infusion and intravenous injection of 5 mg dexamethasone,the patient was gradually and completely relieved.No adverse reactions and no recurrence were found in the other patients.Conclusion:Ultrasound-guided percutaneous low-dose thrombin injection is a safe and effective therapy method for treating PSA.