超声引导下凝血酶注射封堵术治疗医源性股动脉假性动脉瘤的临床应用

Clinical application of ultrasound-guided thrombin injection in treatment of iatrogenic femoral artery pseudoaneurysm

目的探索影响超声引导下凝血酶注射(UGTI)治疗医源性股动脉假性动脉瘤(IFAP)封堵有效性的超声形态学指标。方法回顾性收集2015–2017年期间在四川大学华西医院血管外科接受UGTI治疗且符合研究条件的IFAP患者,分析其人口学数据、合并症情况、临床症状、超声形态学参数、凝血酶用量等资料,并通过logistic回归分析筛选影响UGTI治疗技术失败的危险因素。技术成功定义为UGTI首次治疗结束时超声评估IFAP瘤腔内完全血栓化。结果本研究共纳入患者53例,首次UGTI治疗后即刻有45例患者瘤腔内完全形成血栓,技术成功率为84.9%;重复注射后有51例患者UGTI治疗成功,治疗成功率为96.2%。所有患者均未见有深静脉血栓形成、动脉血栓栓塞、感染、出血、过敏等并发症和死亡发生。UGTI治疗后技术成功与失败患者除患高血压患者人数外(P=0.040),二者的年龄、临床症状、合并症等情况比较差异均无统计学意义(P>0.05),二者的超声形态学参数除股动脉直径(P<0.01)外其余参数比较差异均无统计学意义(P>0.05),同时二者的凝血酶用量比较差异亦无统计学意义(P=0.097)。logistic回归多因素分析结果发现,股动脉直径小是影响UGTI治疗技术失败的危险因素[OR=0.350,95%CI(0.165,0.743),P=0.006],进一步排除合并高血压患者调整基线水平后仍发现股动脉直径小为影响UGTI治疗技术失败的危险因素[OR=0.419,95%CI(0.205,0.860),P=0.018]。结论UGTI封堵术治疗IFAP微创且成功率较高,股动脉直径较小时会影响其技术成功率。

Objective To explore the ultrasonic morphological indexes influencing the effectiveness of ultrasound-guided thrombin injection(UGTI)in the treatment of iatrogenic femoral artey pseudoaneury(IFAP).Methods The patients with IFAP treated by UGTI in the West China Hospital of Sichuan University from 2015 to 2017 were collected according to the inclusion criteria.The demographic data,comorbidities,clinical symptoms,ultrasonic morphological parameters,thrombin dosage,and postoperative complications were analyzed.The risk factors of technical success of UGTI were analyzed by logistic regression analysis.The technical success was defined as absence of flow within the FAP immediately after UGTI.Results A total of 53 patients who met the criteria of inclusion were included in this study.The technical and treatment success rates of UGTI were 84.9%(45/53)and 96.2%(51/53),respectively.No deep venous thrombosis,arterial thromboembolism,infection,bleeding,allergy,and other complications or death occurred in all patients.There were no statistical differences in the age,clinical symptoms,comorbidities(except hypertension,P=0.040),ultrasonic morphological parameters(except femoral artery diameter,P<0.001),and thrombin dosage between the patients with technical success and failure(P>0.05).Multivariate logistic regression analysis showed that the smaller femoral artery diameter was the risk factor of the technical failure[OR=0.350,95%CI(0.165,0.743),P=0.006].Further adjustment of the baseline data of patients(excluding patients with hypertension),the logistic regression analysis still found that smaller femoral artery diameter was the risk factor of the technical failure[OR=0.419,95%CI(0.205,0.860),P=0.018].Conclusions UGTI in treatment of IFAP is minimally invasive and has a higher technical success rate.Smaller femoral artery diameter might affect technical success rate of UGTI.