超声引导下血管腔内缝合术在医源性股动脉假性动脉瘤的临床应用

Clinical application of ultrasound-guided endovascular suture in treating iatrogenic femoral artery pseudoaneurysm

目的探讨医源性股动脉假性动脉瘤在超声引导下行血管腔内缝合术的临床应用价值。方法2020年3月至2021年9月曲靖市第一人民医院因介入手术穿刺股动脉后导致假性动脉瘤患者12例。在超声引导下使用Perclose ProGlide缝合器缝合医源性股动脉破口,分析患者的基线特征、假性动脉瘤特征,比较术前术后股动脉直径。结果12例患者瘤体最大直径为(42.32±13.81)mm,瘤颈直径为(2.40±0.49)mm,瘤颈长度为(5.89±2.37)mm,瘤颈内最大流速为(256.67±42.62)cm/s。11例患者成功经超声引导下血管腔内缝合股动脉破口,1例患者成功穿刺股动脉破口后导丝无法选择入股动脉,行解剖股动脉修补术。11例患者术前、术后24 h、术后1个月股动脉直径比较差异无统计学意义(P=0.474),患者术后无复发、瘤体破裂及股动脉狭窄。结论医源性股动脉假性动脉瘤在超声引导下血管腔内缝合术可行、安全、有效,值得临床推广应用。

Objective To discuss the clinical application value of ultrasound-guided endovascular suture(UGES)in treating iatrogenic femoral artery pseudoaneurysm(IFAP).Methods Between March 2020and September 2021 at the Qujing Municipal First People’s Hospital of China,12 patients developed IFAP caused by the puncture of the femoral artery in performing interventional procedure.UGES was used to treat IFAP,i.e.under ultrasound guidance a Perclose ProGlide device was used to suture the iatrogenic femoral rupture.The patient baseline characteristics and the pseudoaneurysm features were analyzed.The postoperative femoral artery diameter was compared with preoperative one.Results In the 12 patients,the mean maximum diameter of the pseudoaneurysm was(42.32±13.81)mm,the mean diameter of the pseudoaneurysm neck was(2.40±0.49)mm,the mean length of the pseudoaneurysm neck was(5.89±2.37)mm,and the mean maximum flow velocity in the pseudoaneurysm neck was(256.67±42.62)cm/s.Successful UGES was accomplished in 11 patients,in the remaining one patient surgical femoral artery repair had to be carried out because the guide wire could not enter the femoral artery although the puncture needle passed through the rupture entrance of the femoral artery.In the 11 patients,the difference in femoral artery diameter between preoperative value,postoperative24-hour value,and postoperative one-month value were not statistically significant(P=0.474).After UGES,no recurrence,rupture of pseudoaneurysm,or femoral artery stenosis occurred.Conclusion For the treatment of IFAP,UGES is clinically feasible,safe and effective.Therefore,UGES is worthy of promotion and application in clinical practice.(J Intervent Radiol,2022,31:1203-1205)