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Amaç: Bu çalışmada, iyatrojenik femoral arter psödoanevrizmalarında ultrason eşliğinde perkütan trombin enjeksiyonu tedavisi hakkında tecrübemizi aktarmak ve bu minimal invaziv tedavinin etkinliği ile güvenilirliğinin sunulması amaçlandı. Gereç ve Yöntemler: Bu çalışmada Haziran 2012 ile Ağustos 2017 arasında ultrason eşliğinde perkütan trombin enjeksiyonu ile tedavi edilmiş iyatrojenik femoral arter psödoanevrizmalı 42 hasta (26 kadın, 16 erkek) retrospektif olarak değerlendirildi. Doppler ultrason ile psödoanevrizma kesesi sayısı, çapı, psödoanevrizma şekli ve yapısı, orijin aldığı arter tanımlandı ve sonrasında 21 G iğne ile trombin enjeksiyonu gerçekleştirildi. İşlem sonrası kontrol, ilk gün ve birinci hafta sonrası Doppler ultrason ile yapıldı. Bulgular: Çalışmaya dahil edilen hastların ortalama yaşı 66 idi (46-88 yaş). Psödoanevrizmalar hastaların %33’ünde yüzeyel femoral arterden, %67’sinde ana femoral arterden köken almaktaydı. Ortalama psödoanevrizma çapı 36.7 mm (19-55 mm), ortalama psödoanevrizma uzunluğu 21 mm, ortalama boyun çapı 3.2 mm olarak ölçüldü. Psödoanevrizmalar hastaların %50’sinde parsiyel tromboze, 8 hastada aynı zamanda iki veya daha fazla sayıda ve 8 hastada multilobuleydi. Hastaların %83’ünde psödoanevrizma kesesi tek enjeksiyonda total tromboze oldu. İki hastanın psödoanevrizma kesesi ilk prosedür esnasında trombin enjeksiyonuna ek olarak hafif kompresyon ile tromboze edildi. Dört hastada ilk hafta içinde gelişen rekürrens nedeniyle ikinci bir enjeksiyon ile total tromboz sağlandı. Bir hastada psödoanevrizma boyutunun artması sonucu yüzeyel femoral artere bası yapması ve akımı engellemesi nedeniyle psödoanevrizma stent-greft ile tedavi edildi. Teknik, primer ve sekonder başarı oranları ise sırasıyla %100, %93 ve %98 olarak hesaplandı. İşlemler esnasında komplikasyon gelişmedi. Sonuç: İyatrojenik femoral arter psödoanevrizmalarının tedavisinde uygulanan ultrason eşliğinde perkütan trombin enjeksiyonu güvenilir, etkin ve çok sayıda, multilobule psödoanevrizmalarda bile kolay uygulanabilir bir yöntemdir.
Purpose: In this study, it was intended to transfer our experience of ultrasonically accompanied percutaneous trombin injection therapy in the iatrogenic femoral artery psedoanevrisms and to provide its reliability with the effectiveness of this minimal invasive therapy. In this study, it was evaluated as retrospective by the 42 patients (26 women, 16 men) with psedonevritic femoral artery, treated with percutaneous thrombin injection accompanied by ultrasound between June 2012 and August 2017. With Doppler ultrasound, the number of psedonevrizm cuts, diameter, psedonevrizm shape and structure, the arter received from the origin was identified and then the injection of the thrombin with the 21G injection was carried out. The post-operation check was done with Doppler ultrasound on the first day and after the first week. Results: The average age of the patients involved in the study was 66 (46-88 years). Psoedoneurisms were derived from the surface femoral artery in 33% of patients and from the main femoral artery in 67%. The average psedonevrizm diameter is 36.7 mm (19-55 mm), the average psedonevrizm length is 21 mm, the average neck diameter is 3.2 mm. Psoedoneurism was partial thrombosis in 50% of patients, two or more in 8 patients, and multilobulysis in 8 patients. In 83% of patients, the total thrombosis occurred in a single injection. During the first procedure, the two patients' psedonevrizm cracks were thromboized with a mild compression in addition to the trombin injection. Four patients were given total thrombosis with a second injection due to the development of recurrence during the first week. In a patient, a rise in the size of psedonevrism resulted in the pressure of the surface femoral artery and inhibition of flow, psedonevrism was treated with stent-greft. Technical, primary and secondary success rates were calculated as 100%, 93% and 98% respectively. The complications did not develop during the process. The result: Ultrasound injection of percutaneous trombin accompanied by the treatment of itrogenic femoral arterial psedoanevrism is a reliable, effective and easy-to-apply method, even in numerous multilobular psedoanevrisms.
Objective: The aim of this study is to share our experience of ultrasound-guided percutaneus thrombin injection in the treatment in iatrogenic femoral artery pseudoaneurysms and discuss about the safety and efficacy of this minimally invasive treatment. Material and Methods: Fourty-two patients (26 female, 16 male) with iatrogenic femoral artery pseudoaneurysms treated with percutaneous ultrasound-guided thrombin injection between June 2012 and August 2017 were retrospectively evaluated. The diameter and the number of the pseudoaneurysm sac, artery of origin, pseudoaneurysm shape and structure were identified by Doppler ultrasound and thrombin was injected via a 21 G needle. Control with Doppler ultrasound was performed on the first day and one weekafter the procedure. Results: The mean age of the patients included in the study was 66 years (range: 46-88 years). Thirty-three percent of pseudoaneurysm sacs had originated from the superficial femoral artery and 67%from the common femoral artery. Mean pseudoaneurysm diameter was 36.7 mm (range: 19-55 mm), mean neck lenght was 21 mm and mean neck diameter was 3.2 mm. Pseudoaneurysm in 50%of the patients was partially thrombosed, while 8 patients had two or more synchronous pseudoaneurysms and 8 patients had multilobulated pseudoaneurysm sacs. Pseudoaneurysms were completely thrombosed with a single injection in 83%of patients. In two patients, pseudoaneurysms were thrombosed with mild compression in addition to thrombin injection during the first procedure. Four patients’ pseudoaneurysms were thrombosed after a second injection within the first week because of recurrence. In one patient, the pseudoaneurysm sac enlarged after procedure and required stent-graft owing to superficial femoral artery compression and occlusion. Technical, primary and secondary success rates were 100%, 93% and 98% respectively. No complications occured during the procedure. Conclusion: Ultrasound-guided percutaneus thrombin injection is a reliable and effective method that can be easily applied even in numerous and multilobulated pseudoaneurysms.
Field : Sağlık Bilimleri
Journal Type : Uluslararası
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