RESUMEN
Objective To investigate the best injection position and curative effect of ultrasound-guided thrombin injection (UGTI)on femoral pseudoaneurysm (FPA).Methods Review the data of FPA cases in the neurology department of southwest hospital from January 2010 to June 2015.Detailed clinical information of the patients,including the curative effect of local compression therapy,the position,meth-od,dosage and curative effect of ultrasound-guided thrombin injection were collected and analyzed.Results From January 2010 to June 2015,43 cases (1.20%)of FPA were diagnosed in 3573 patients undergoing cerebrovascular interventional operation.Local compression therapy was effective in 11 of 43 FPA patients.The remaining 32 patients who had no response to local compression therapy were treated by UGTI,and the average dosage of thrombin was (30 ±12)IU.All FPA were blocked successfully within 1 minute and without any distal em-bolism events after the first UGTI attempt.No relapse and complications occurred during the follow-up of 5 to 70 months,averagely (38.69 ± 20.79)months.Conclusion UGTI is effective for treatment of FPA who had no response to local compression therapy.Thrombin injection at position far away from the blood flow direction of pseudoaneurysm neck crevasse with ultrasound-guided could bring about highe success rate, less amount of thrombin,and less complications.
RESUMEN
The aim of this study was to evaluate the efficiency and safety of ultrasound-guided thrombin injection on femoral pseudoaneurysm (FPA) as compared to ultrasound-guided local oppression. Eleven cases of FPA were enrolled and 7 cases received ultrasound-guide thrombin injection (injection group), and the remaining 4 cases were treated with local oppression (oppression group). Efficiency and safety were analyzed by ultrasound and subsequent follow-up. The results showed that 1 case relapsed in oppression group while no relapse occurred in thrombin injection group. Ultrasound-guided thrombin injection is better for treatment of FPA in terms of effectiveness and safety.
RESUMEN
Este trabalho descreve um caso de pseudo-aneurisma da artéria tibial posterior devido ao uso de fixador externo para tratamento de fratura dos ossos da perna (técnica de Ilizarov), bem como as técnicas utilizadas para seu tratamento. A compressão guiada por ultra-som e a injeção de trombina guiada por ultra-som foram realizadas, sem sucesso. O tratamento definitivo do pseudo-aneurisma e reconstrução arterial foi conseguido através do tratamento cirúrgico clássico, usando enxerto interposto de veia safena magna homóloga invertida. As indicações, vantagens e desvantagens das técnicas de tratamento não invasivo (compressão guiada por ultra-som e injeção de trombina guiada por ultra-som) e as possíveis causas de sua incapacidade na obliteração do pseudo-aneurisma são discutidas. Também foi realizada a revisão de casos de pseudo-aneurisma da artéria tibial posterior na literatura médica, encontrando-se apenas um caso semelhante, entre 24 publicados.
We describe a case of pseudoaneurysm in the posterior tibial artery following treatment for tibial and fibula fractures using external fixation (Ilizarov technique), as well as the techniques used for its treatment. Ultrasound-guided compression and ultrasound-guided thrombin injection were unsuccessfully performed. Definite treatment of pseudoaneurysm and arterial reconstruction was achieved through the traditional surgical treatment, using interposed graft of inverted homologous great saphenous vein. Indications, advantages and disadvantages of noninvasive treatment techniques (ultrasound-guided compression and ultrasound-guided thrombin injection) and the possible causes of their inability in obliterating the pseudoaneurysm are discussed. A literature review of pseudoaneurysms of the posterior tibial artery was also carried out, resulting in only one similar case out of 24 published cases.
Asunto(s)
Humanos , Masculino , Adulto , Aneurisma Falso/complicaciones , Aneurisma Falso/diagnóstico , StentsRESUMEN
PURPOSE: As a consequence of the widespread application of coronary and peripheral interventional procedures, the incidence of a femoral pseudoaneurysm is increasing. Along with the traditional surgical approach, ultrasound-guided compression or thrombin injection therapy has recently been developed and is widely used to reduce surgical morbidity. The efficacy of these therapies was compared to define the guidelines for treating an iatrogenic femoral pseudoaneurysm in Korean patients. METHODS: Ultrasound-guided therapies were performed prospectively since October 2000. The results of the surgical repair from July 1996 were reviewed retrospectively. A total 22 patients with an iliofemoral pseudoaneurysm were enrolled in this study. RESULTS: Surgical repair was performed in 12 cases, ultrasound-guided compression therapy in 1 case, and ultrasound-guided thrombin injection in 9 cases. A primary closure of the puncture site (11 cases) and an iliac artery interposition graft (1 case) were performed. Postoperative complications developed in 4 cases; wound hematoma, wound infection and ureter injury. Compression therapy was successfully performed in 1 case. A thrombin injection was performed in 9 cases. Immediate thrombotic obliteration of the pseudoaneurysm occurred in all cases. Partial recannalization was detected during follow-up duplex sonography in 1 case, who was successfully treated by an additional thrombin injection. There were no complications associated with the thrombin injection and no recurrence had occurred during the 4 weeks follow-up. CONCLUSION: Thrombin injection therapy is highly efficient, safe, and comfortable. Ultrasound-guided thrombin injection could be the initial treatment of choice for treating iatrogenic femoral pseudoaneurysm.