经皮腔内治疗下肢动脉硬化闭塞症致穿刺点假性动脉瘤的发生及对策

Occurrence and Cauntermeasures of Pseudoaneurysm at puncture site caused by percutaneous endovascular treatment of arteriosclerosis obliterans of lower extremity

摘要:

目的 探讨经皮腔内治疗下肢动脉硬化闭塞症致穿刺点假性动脉瘤的发生率及应对策略。 方法 回顾性分析2012年至2019年在西南医科大学附属医院血管外科采用经皮腔内治疗的1 692例动脉硬化闭塞症（arteriosclerosis obliterans ，ASO）患者（1 845个穿刺点）的资料，观察术后及住院期间不同穿刺点及不同止血方式引起假性动脉瘤的发生率及应对策略。 结果 假性动脉瘤的总发生率为4.12%（股动脉45例，肱动脉28例，膝下动脉3例）。逆行穿刺和顺行之间没有差异，但是肱动脉假性动脉瘤的发生率更高（7.98%），手动加压后假性动脉瘤的形成率更高（5.25% vs 1.58%，P < 0.05）。手动按压更常用于顺行穿刺和肱动脉穿刺。所有假性动脉瘤在诊断后均通过超声定位下再次按压，球囊辅助注射血凝酶，覆膜支架覆盖，弹簧圈栓塞等手术方式得到成功治疗，没有再次破裂病例。 结论 下肢动脉硬化闭塞症患者的手术时间和穿刺点钙化程度及首选对穿刺点的处理方式均可直接影响围手术期假性动脉瘤的发生率，对腔内治疗ASO围术期并发症给予重视和及时、正规治疗，是减少不良事件的有效方法，早期诊断和治疗假性动脉瘤，可避免严重并发症的发生。

Abstract:

Objective To investigate the incidence and countermeasures of pseudoaneurysm at puncture site of lawerextremity arteriosclerosis by percutaneous endovascular treatment. Methods A retrospective analysis was performed on the clinical data of 1 692 arteriosclerosis obliterans （ASO） patients （involving 1 845 puncture points） who underwent percutaneous endovascular treatment in the Department of Vascular Surgery，the Affiliated Hospital of Southwest Medical University，from 2012 to 2019. An observation was performed on the incidence and coping strategies of pseudoaneurysms at different puncture points caused by different ways of hemostasis after the operation and during the hospitalization. Results The overall incidence rate of pseudoaneurysms was 4.12% （45 cases in the femoral artery，28 cases in the brachial artery，and 3 cases in the inferior genicular artery）. There was no significant difference between retrograde puncture and antegrade puncture，but the brachial artery had a significantly higher incidence rate of pseudoaneurysms （7.98%），and after manual compression，the formation rate of pseudoaneurysms was significantly higher （5.25% vs 1.58%，P < 0.05）. Manual compression was more commonly used for antegrade puncture and brachial artery puncture. After diagnosis，all pseudoaneurysms were successfully treated through recompression under ultrasonic location，balloon-assisted injection of hemagglutinin，stent covering，coil embolization，and other surgical procedures，and there were no cases of re-rupture. Conclusion The operation time，calcification degree of puncture point，and the preferred treatment of puncture point in patients with lower extremity ASO directly affect the incidence of perioperative pseudoaneurysms. The emphasis and timely and proper treatment of perioperative complications after endovascular treatment of ASO is an effective method to reduce adverse events. Serious complications cauld be avoided by the early diagnosis and treatment of pseudoaneurysms.