经股动脉介入术后致假性动脉瘤2例

2018-11-17 宋平 罗明 王远 中国临床神经外科杂志

随着心脑血管及神经介入的发展和普及,股动脉穿刺是各种介入诊断和治疗的常见路径之一,对股动脉的损伤难以避免,如局限血肿、动静脉瘘、假性动脉瘤等。如处理不当,会产生严重的后果甚至危及病人生命。本文报道2例经股动脉介入术后并发股动脉假性动脉瘤(femoral artery pseudoaneurysm,FAP)。

随着心脑血管及神经介入的发展和普及,股动脉穿刺是各种介入诊断和治疗的常见路径之一,对股动脉的损伤难以避免,如局限血肿、动静脉瘘、假性动脉瘤等。如处理不当,会产生严重的后果甚至危及病人生命。本文报道2例经股动脉介入术后并发股动脉假性动脉瘤(femoral artery pseudoaneurysm,FAP)。
 
1. 病例资料
 
病例1:女,72岁。因突发头晕4 h入院。入院后MRA示基底动脉末端结节样膨隆,动脉瘤可疑。经右股动脉穿刺行全脑血管造影术,示基底动脉上段左侧小脑上动脉起始可见一约6 mm×4 mm大小结节状突起。3 d后,全麻下经右股动脉穿刺采用双微导管技术辅助弹簧圈栓塞动脉瘤。
 
手术顺利,拔除长鞘后右腹股沟穿刺处局部形成血肿,压迫止血半小时无活动出血后加压包扎后返回病房。随后,腹股沟区穿刺处出现10 cm×10 cm皮下血肿,并进行性增大,出现中度贫血。右侧股动脉彩色多普勒超声检查示右侧腹股沟区异常回声,考虑假性动脉瘤形成可能;复查示瘤体扩大明显。
 
全麻下行右股动脉动脉瘤切除并瘘口修补术。术中发现皮下大量凝血块位于大腿内上侧,清除血肿时见有活动性出血自血肿腔向外喷射,探查见股总动脉一针眼样瘘口活动性出血,压力较高,用橡皮带控制股总动脉,暂时夹闭股动脉近端,以6-0无损伤缝合线8字缝合瘘口。术后股动脉搏动良好,原瘘口亦无出血,右下肢足背动脉搏动良好,腹股沟区皮肤张力下降,右下肢活动无受限,右侧腹股沟区皮肤青紫瘀斑逐渐好转,半月后皮肤拆线病情好转后出院。
 
病例2:女,70岁,因头晕1个月余入院。外院颅脑CTA等检查示前交通动脉动脉瘤。经右股动脉穿刺,采用支架辅助弹簧圈栓塞动脉瘤。手术顺利,术后左侧肢体活动好,右侧肢体肌力稍差,股动脉穿刺点给予血管缝合器封堵后返回病房。但术后逐渐出现右侧腹股沟穿刺处有搏动性皮下肿物,经彩色多普勒超声检查证实为假性动脉瘤,经局部压迫、制动等对症处理后,病灶未见明显扩大。病人经严格卧床休息及股动脉加压器压迫右下肢制动,超声复查假性动脉瘤未见明显扩大,后逐渐好转出院。
 
2. 讨论
 
FAP一旦发生,就有破裂出血、血栓栓塞、压迫周围组织结构、组织坏死等的风险,必须及早正确诊断、及时处理。FAP一般发生在术后24~48 h,病人自觉穿刺部位疼痛,穿刺部位出现进行性增大的搏动性肿块,可触及收缩期震颤、闻及收缩期血管杂音,常伴发疼痛、局部压迫、出血及感染等症状。FAP影像学检查多样,彩色多普勒超声因无创,较MRI及DSA简便、快捷、经济,可反复检查且能准确诊断多类血管疾病,有较高的敏感性,能够显示肿块有无搏动,肿块的形态、内部回声、血流状况及与股动脉的关系,从而可以清晰地显示假性动脉瘤的形态、判断其有无瘘管、破口大小、瘤体大小的变化,目前已成为FAP的首选检查。
 
DSA是血管疾病诊断的金标准,能清晰显示破口、瘤体与载瘤动脉关系,动态显示对比剂外溢情况,同时可以对破口进行封堵,但DSA检查有导致瘤体破裂大出血风险,且为有创性检查,操作复杂,在FAP诊断中有一定限制。FAP的治疗方法目前主要两种:保守治疗(加压包扎和超声引导下加压治疗)和手术(假性动脉瘤切除、动脉修补术、动脉吻合或血管移植等)。保守治疗的关键是找到瘤颈,压迫力量适中,压迫时间30min左右(支架抗凝病人需延长压迫时间),从而形成血栓达到治疗目的。但我们认为,一旦诊断明确,仍以早期修复为佳,因为多数假性动脉瘤不能自愈,并有不断长大而伴发或压迫症状加重、栓塞甚至破裂出血风险。因此一旦确诊应积极处理,早期干预有助于减少和避免相应的并发症和后遗症。

原始出处:

宋平,罗明,王远,黄从刚,李继强,丁伟,王孟阳,段发亮.经股动脉介入术后致假性动脉瘤2例[J].中国临床神经外科杂志,2018(04):304.

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (4)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=2010608, encodeId=0853201060829, content=<a href='/topic/show?id=8abf81e6327' target=_blank style='color:#2F92EE;'>#股动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81763, encryptionId=8abf81e6327, topicName=股动脉)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e457184, createdName=qingting, createdTime=Sat Jun 08 15:43:00 CST 2019, time=2019-06-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1691196, encodeId=ee281691196a3, content=<a href='/topic/show?id=320ee8456be' target=_blank style='color:#2F92EE;'>#经股动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78456, encryptionId=320ee8456be, topicName=经股动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=efdf29169795, createdName=d830382, createdTime=Sun Aug 25 13:43:00 CST 2019, time=2019-08-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1447456, encodeId=e273144e45690, content=<a href='/topic/show?id=515d2e5538e' target=_blank style='color:#2F92EE;'>#假性动脉瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=27553, encryptionId=515d2e5538e, topicName=假性动脉瘤)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/fyRKNyibzABAicp53YP9icFXdxz0NU7qFxPHUvpIndI7G9KBE1szkMibaGgLVxKhV9QlEqPHtlolHibycuROenU7Wdw/132, createdBy=2a4a5352886, createdName=gaoxiaoe, createdTime=Mon Nov 19 09:43:00 CST 2018, time=2018-11-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=352888, encodeId=2ccb352888ea, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=82311653708, createdName=医者仁心5538, createdTime=Sat Nov 17 19:53:37 CST 2018, time=2018-11-17, status=1, ipAttribution=)]
    2019-06-08 qingting
  2. [GetPortalCommentsPageByObjectIdResponse(id=2010608, encodeId=0853201060829, content=<a href='/topic/show?id=8abf81e6327' target=_blank style='color:#2F92EE;'>#股动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81763, encryptionId=8abf81e6327, topicName=股动脉)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e457184, createdName=qingting, createdTime=Sat Jun 08 15:43:00 CST 2019, time=2019-06-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1691196, encodeId=ee281691196a3, content=<a href='/topic/show?id=320ee8456be' target=_blank style='color:#2F92EE;'>#经股动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78456, encryptionId=320ee8456be, topicName=经股动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=efdf29169795, createdName=d830382, createdTime=Sun Aug 25 13:43:00 CST 2019, time=2019-08-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1447456, encodeId=e273144e45690, content=<a href='/topic/show?id=515d2e5538e' target=_blank style='color:#2F92EE;'>#假性动脉瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=27553, encryptionId=515d2e5538e, topicName=假性动脉瘤)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/fyRKNyibzABAicp53YP9icFXdxz0NU7qFxPHUvpIndI7G9KBE1szkMibaGgLVxKhV9QlEqPHtlolHibycuROenU7Wdw/132, createdBy=2a4a5352886, createdName=gaoxiaoe, createdTime=Mon Nov 19 09:43:00 CST 2018, time=2018-11-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=352888, encodeId=2ccb352888ea, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=82311653708, createdName=医者仁心5538, createdTime=Sat Nov 17 19:53:37 CST 2018, time=2018-11-17, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=2010608, encodeId=0853201060829, content=<a href='/topic/show?id=8abf81e6327' target=_blank style='color:#2F92EE;'>#股动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81763, encryptionId=8abf81e6327, topicName=股动脉)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e457184, createdName=qingting, createdTime=Sat Jun 08 15:43:00 CST 2019, time=2019-06-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1691196, encodeId=ee281691196a3, content=<a href='/topic/show?id=320ee8456be' target=_blank style='color:#2F92EE;'>#经股动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78456, encryptionId=320ee8456be, topicName=经股动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=efdf29169795, createdName=d830382, createdTime=Sun Aug 25 13:43:00 CST 2019, time=2019-08-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1447456, encodeId=e273144e45690, content=<a href='/topic/show?id=515d2e5538e' target=_blank style='color:#2F92EE;'>#假性动脉瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=27553, encryptionId=515d2e5538e, topicName=假性动脉瘤)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/fyRKNyibzABAicp53YP9icFXdxz0NU7qFxPHUvpIndI7G9KBE1szkMibaGgLVxKhV9QlEqPHtlolHibycuROenU7Wdw/132, createdBy=2a4a5352886, createdName=gaoxiaoe, createdTime=Mon Nov 19 09:43:00 CST 2018, time=2018-11-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=352888, encodeId=2ccb352888ea, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=82311653708, createdName=医者仁心5538, createdTime=Sat Nov 17 19:53:37 CST 2018, time=2018-11-17, status=1, ipAttribution=)]
  4. [GetPortalCommentsPageByObjectIdResponse(id=2010608, encodeId=0853201060829, content=<a href='/topic/show?id=8abf81e6327' target=_blank style='color:#2F92EE;'>#股动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81763, encryptionId=8abf81e6327, topicName=股动脉)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e457184, createdName=qingting, createdTime=Sat Jun 08 15:43:00 CST 2019, time=2019-06-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1691196, encodeId=ee281691196a3, content=<a href='/topic/show?id=320ee8456be' target=_blank style='color:#2F92EE;'>#经股动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78456, encryptionId=320ee8456be, topicName=经股动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=efdf29169795, createdName=d830382, createdTime=Sun Aug 25 13:43:00 CST 2019, time=2019-08-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1447456, encodeId=e273144e45690, content=<a href='/topic/show?id=515d2e5538e' target=_blank style='color:#2F92EE;'>#假性动脉瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=27553, encryptionId=515d2e5538e, topicName=假性动脉瘤)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/fyRKNyibzABAicp53YP9icFXdxz0NU7qFxPHUvpIndI7G9KBE1szkMibaGgLVxKhV9QlEqPHtlolHibycuROenU7Wdw/132, createdBy=2a4a5352886, createdName=gaoxiaoe, createdTime=Mon Nov 19 09:43:00 CST 2018, time=2018-11-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=352888, encodeId=2ccb352888ea, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=82311653708, createdName=医者仁心5538, createdTime=Sat Nov 17 19:53:37 CST 2018, time=2018-11-17, status=1, ipAttribution=)]
    2018-11-17 医者仁心5538

    学习了

    0

相关资讯

JACC:1000名患者使用ACURATE neo经导管心脏瓣膜欧洲上市后登记的1年预后(SAVI-TF登记)

经股动脉植入ACURATE neo假体的1年临床和超声心动图预后良好,死亡率和新起搏器植入的比率非常低。

JACC:经心尖导管主动脉瓣置换术与左室功能不全患者的心脏死亡率升高相关

当考虑使用TA通路进行结构性心脏病介入治疗时,尤其是左室功能不全的患者,应当谨慎。

PLos One:全麻下经股动脉和经心尖入路的经导管主动脉瓣植入术并发症

这项研究显示这些患者的结局与现有文献报道的结果相当。与TF相比,TA患者的身体状况总体较差,围手术期的发病率和死亡率较高。