中文摘要

医源性假性动脉瘤超声回顾分析

目的：探讨超声在心脏介入治疗后并发假性动脉瘤（PAS）的诊断和治疗中的价值。

方法：回顾分析2017年10月至2018年11月心脏介入治疗后超声诊断为假性动脉瘤的107例患者的临床及超声的相关资料。

结果：2017年10月至2018年11月心脏介入治疗后超声诊断为PAS患者共107例，其中男性60例，女性47例，平均年龄61.7±14.0岁，85例患有高血压病，74例患有高脂血症，平均BMI值为24.9±3.7， LVEF （59.7±0.8）%。从介入治疗到超声确诊的中位时间2天。PAS的最大直径（31.6±16.7）mm，彩色多普勒均能显示“阴阳征”，频谱多普勒能显示双期双向血流频谱约80%。PAS治疗成功定义为其内有血栓形成，载体动脉与PAS瘤体内血流交通消失。107例患者中有65例进行加压包扎的治疗，55例位于股动脉，成功率78%，加压成功的PAS最大直径（28.86±15.40）mm；14例行超声引导下穿刺抽吸加压治疗，均位于股动脉，成功率100%，最大直径（36.71±16.55）mm；7例行超声引导下凝血酶注射治疗，4例位于上肢动脉，成功率100%，最大直径（28.42±15.86）mm；5例行外科治疗，3例位于上肢动脉，成功率100%，最大直径（40.50±13.92）mm。

结论：超声在心脏介入治疗前后发挥着不可或缺的作用，是目前诊断和治疗PAS的首选方法；PAS大小的测量有助于指导假性动脉瘤的治疗；老年人，肥胖，高血压常常与假性动脉瘤的发生有关；医源性假性动脉瘤中股动脉最为多见，桡动脉的假性动脉瘤发展较缓慢；心脏介入治疗后，尤其是高危因素患者，应常规行穿刺部位的超声检查，有助于临床的后续诊疗工作。

【关键词】心脏介入治疗；假性动脉瘤；超声

retrospective evaluation of ultrasound in iatrogenic pseudoaneurysm

ive:to evaluate the value of ultrasound in the diagnosis and treatment of pseudoaneurysm after cardiac interventional surgery

method: retrospective analysis of the clinical and ultrasound data in 107 patients diagnosed as pseudoaneurysm after cardiac intervention surgery between october 2017 to october 2018 in fuwai hospital.

result: the study analyses 107 patients who were diagonosed as pseudoaneurysm after cardiac intervention from oct 2017 to oct 2018. 60 of them are male and 47 of them are female. their mean age of 61.7 ± 14.0 years, 85 patients have hypertension, 74 patients have hyperlipidemia ,the mean bmi was 24.9 ± 3.7,  and lvef was 59.7 ± 0.8%. the median time from operation to ultrasound diagnosis was 2 days. in this study, the average size of the pseudoaneurysm was (31.6±16.7) mm×(15.5±7.6) mm, and the color doppler can all show “yin-yang sign” and spectral doppler of the 80% pseudoaneurysm can show "double - period and double-direction" blood stream spectrum in the pas neck. of the 107 patients, 65 are treated by compression dressing, 55 of them are located in the femoral artery with a success rate of 78%. the mean maximal diameter of pas treated successfully was (28.86 ± 15.40) mm; 14 patients requiring ultrasound-guided hematoma aspiration with manual compression therapy are performed in the femoral artery with a success rate of 100%, and the the mean maximal diameter of pas was approximately (36.71±16.55) mm. 7 patients undergoing ultrasound-guided thrombin injection and 4 in the upper extremity artery, the success rate was 100% . the mean maximal diameter of pas was (28.42±15.86) mm； 5 undergoes surgical repair, and 3 cases were located in the upper extremity artery. the success rate was 100%, the mean maximal diameter of pas was （40.50±13.92）mm.

conclusion: ultrasound plays an indispensable role in the diagnosis and treatment of pas before and after cardiac intervention. the size of pas is helpful to guide the treatment of pseudoaneurysms. the older, the obesity and the hypertension are often associated with the incidence of pseudoaneurysms. femoral artery is the most common iatrogenic pseudoaneurysm, and the radial artery pseudoaneurysms develop slowly. the examination of puncture site should be took routinely after cardiac intervention, especially in patients with high-risk factors, which can help clinical diagnosis and treatment.

 [keywords]  cardiac intervention; pseudoaneurysm; ultrasound