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Behandlung des persistierenden Aneurysma spurium aus gefäßchirurgischer Perspektive

Ultraschallgesteuerte Thrombininjektion oder operative Versorgung?

Treatment of persistent pseudoaneurysms from the perspective of vascular surgery

Ultrasound-guided thrombin injection or operative treatment?

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Zusammenfassung

Einleitung

Diese retrospektive Analyse zeigt die Erfahrungen in der Therapie des Aneurysma spurium (AS, Pseudoaneurysma) mithilfe der ultraschallgesteuerten Thrombininjektion (TI) und der operativen Versorgung durch Übernähung oder „Patch“-Plastik. Ein Vergleich ist bei der Heterogenität der Kollektive nicht durchführbar.

Material und Methoden

Im Zeitraum zwischen 01.01.2006 und 31.12.2010 wurden in der Klinik für Chirurgie des Universitätsklinikums Lübeck insgesamt 51 Patienten [männlich: 26, weiblich: 25, Alter 70,5 Jahre (Standardabweichung, SD ± 11,9 Jahre)] mit persistierenden inguinalen AS behandelt.

Ergebnisse

Von den 51 Patienten wurden 33 operativ und 18 primär mithilfe der TI versorgt. Es wurden 48 Patienten (94,1%) mit gerinnungshemmenden Medikamenten behandelt (36 Patienten mit Thrombozytenaggregationsinhibitoren, 6 Patienten mit Marcumar oder adäquater Heparinisierung, 6 Patienten mit niedermolekularem Heparin). Ein Patient hatte zusätzliche eine Subhämophilie A. Die mittlere Operationszeit betrug 58,6 min (SD ± 36,4 min), die mittlere postoperative Verweildauer 9,8 Tage (SD ± 6,3 Tage). Majorkomplikationen (Notwendigkeit der chirurgischen Revision) traten in der operativen Gruppe bei 3 Patienten (9,1%) und in der interventionellen Gruppe bei 2 Patienten (11,1%) auf. Die Indikationen ergaben sich bei postoperativem Hämatom (3 -mal), frustraner TI (1 -mal) sowie Kompression der V. femoralis nach TI (1 -mal). Minorkomplikationen wurden nur in der operativen Gruppe beobachtet (9 Patienten, 27,3%). Bei 2 Patienten kam es zum Auftreten einer Pneumonie und bei 7 Patienten zu Wundheilungsstörungen. Die Mortalität beider Gruppen lag bei 0%.

Schlussfolgerungen

Die zunehmend interventionelle Ausrichtung der Gefäßchirurgie und die interdisziplinäre Zusammenarbeit haben zu einem veränderten Verständnis in der Versorgung des persistierenden AS beigetragen. Die perkutane TI ist bei geeignetem Patientengut als sichere Alternative zur operativen Versorgung anzusehen.

Abstract

Purpose

This retrospective study evaluated experiences with ultrasound-guided thrombin injection and open surgical repair for the treatment of arterial pseudoaneurysms.

Method

Between January 2006 and December 2010, 51 patients (26 male, 25 female, mean age 70.5± 11.9 years) were treated for pseudoaneurysms of the femoral artery.

Results

Out of 51 patients 33 underwent surgical repair of pseudoaneurysms, 18 were treated by ultrasound-guided percutaneous thrombin injection and 48 (94.1%) patients received anticoagulation therapy (36 patients with platelet inhibitors, 6 patients with anticoagulation, such as cumarine and 6 patients with low molecular weight heparin). One patient suffered from mild hemophilia A. The mean operation time was 58.6± 36.4 min and mean postoperative hospital stay was 9.8± 6.3 days. Major complications (defined as needed surgical revision) occurred in three patients of the surgical group (9.1%) and two patients of the thrombin group (11.1%). Indications of surgical revision included postoperative hematoma (n=3), unsuccessful thrombin injection (n=1) and compression of the femoral vein (n=1). Minor complications were only observed in nine patients in the surgical group (27.3%), two patients developed postoperative pneumonia and seven patients had wound healing disorders. No mortalities were observed in either group.

Conclusions

The endovascular orientation and interdisciplinary assignment of vascular surgery have created a new perception for the treatment of arterial pseudoaneurysms. Ultrasound-guided thrombin injection is considered to be a safe alternative to surgical intervention for selected patients.

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Abbreviations

AFC:

Arteria femoralis communis

AFS:

Arteria femoralis superficialis

APF:

Arteria profunda femoris

AS:

Aneurysma spurium

ASS:

Acetylsalicylsäure

AVK:

arterielle Verschlusskrankheit

COPD:

„chronic obstructive pulmonary disease“ (chronisch obstruktive Lungenerkrankung)

CT:

Computertomographie

INR:

International Normalized Ratio

MRT:

Magnetresonanztomographie

NaCl, 0,9%ig:

Natriumchloridinfusionslösung, 0,9%ig

TI:

Thrombininjektion

PTT:

„partial thromboplastin time“

Literatur

  1. Allaqaband S, Solis J, Kazemi S, Bajwa T (2006) Endovascular treatment of peripheral vascular disease. Curr Probl Cardiol 31:711–760

    Article  PubMed  Google Scholar 

  2. Fellmeth BD, Roberts AC, Bookstein JJ et al (1991) Postangiographic femoral artery injuries: nonsurgical repair with US-guided compression. Radiology 178:671–675

    PubMed  CAS  Google Scholar 

  3. Gehling G, Ludwig J, Schmidt A et al (2003) Percutaneous occlusion of femoral artery pseudoaneurysm by para-aneurysmal saline injection. Catheter Cardiovasc Interv 58:500–504

    Article  PubMed  Google Scholar 

  4. Gorge G, Kunz T, Kirstein M (2003) A prospective study on ultrasound-guided compression therapy or thrombin injection for treatment of iatrogenic false aneurysms in patients receiving full-dose anti-platelet therapy. Z Kardiol 92:564–570

    Article  PubMed  CAS  Google Scholar 

  5. Hofmann I, Wunderlich N, Robertson G et al (2007) Percutaneous injection of thrombin for the treatment of pseudoaneurysms: the German multicentre registry. EuroIntervention 3:321–326

    Article  PubMed  Google Scholar 

  6. Kent KC, McArdle CR, Kennedy B et al (1993) A prospective study of the clinical outcome of femoral pseudoaneurysms and arteriovenous fistulas induced by arterial puncture. J Vasc Surg 17:125–133

    Article  PubMed  CAS  Google Scholar 

  7. Klever-Deichert G, Hinzpeter B, Hunsche E, Lauterbach KW (1999) Costs of coronary heart diseases over the remaining life time in coronary heart disease cases – an analysis of the current status of coronary heart disease cases in Germany from the social perspective. Z Kardiol 88:991–1000

    Article  PubMed  CAS  Google Scholar 

  8. Krueger K, Zaehringer M, Strohe D et al (2005) Postcatheterization pseudoaneurysm: results of US-guided percutaneous thrombin injection in 240 patients. Radiology 236:1104–1110

    Article  PubMed  Google Scholar 

  9. La Perna L, Olin JW, Goines D et al (2000) Ultrasound-guided thrombin injection for the treatment of postcatheterization pseudoaneurysms. Circulation 102:2391–2395

    Article  Google Scholar 

  10. Lenartova M, Tak T (2003) Iatrogenic pseudoaneurysm of femoral artery: case report and literature review. Clin Med Res 1:243–247

    Article  PubMed  Google Scholar 

  11. Luedde M, Krumsdorf U, Zehelein J et al (2007) Treatment of iatrogenic femoral pseudoaneurysm by ultrasound-guided compression therapy and thrombin injection. Angiology 58:435–439

    Article  PubMed  Google Scholar 

  12. Middleton WD, Dasyam A, Teefey SA (2005) Diagnosis and treatment of iatrogenic femoral artery pseudoaneurysms. Ultrasound Q 21:3–17

    PubMed  Google Scholar 

  13. Mollmann H, Nef HM, Hamm CW, Elsasser A (2009) How to manage patients with need for antiplatelet therapy in the setting of (un-)planned surgery. Clin Res Cardiol 98:8–15

    Article  PubMed  Google Scholar 

  14. Morrison SL, Obrand DA, Steinmetz OK, Montreuil B (2000) Treatment of femoral artery pseudoaneurysms with percutaneous thrombin injection. Ann Vasc Surg 14:634–639

    Article  PubMed  CAS  Google Scholar 

  15. O’Sullivan GJ, Ray SA, Lewis JS et al (1999) A review of alternative approaches in the management of iatrogenic femoral pseudoaneurysms. Ann R Coll Surg Engl 81:226–234

    Google Scholar 

  16. Grewe PH, Deneke T, Fadgyas T et al (2001) Die perkutane Kontrast-ultraschallgesteuerte Thrombin-Injektion zur minimalinvasiven Therapie des iatrogen entstandenen Pseudoaneurysma. Z Kardiol 90:737–744

    Article  PubMed  CAS  Google Scholar 

  17. Paulson EK, Hertzberg BS, Paine SS, Carroll BA (1992) Femoral artery pseudoaneurysms: value of color Doppler sonography in predicting which ones will thrombose without treatment. AJR Am J Roentgenol 159:1077–1081

    PubMed  CAS  Google Scholar 

  18. Pezzullo JA, Dupuy DE, Cronan JJ (2000) Percutaneous injection of thrombin for the treatment of pseudoaneurysms after catheterization: an alternative to sonographically guided compression. AJR Am J Roentgenol 175:1035–1040

    PubMed  CAS  Google Scholar 

  19. Quendt J (2003) Thrombininjektion bei Aneurysma spurium. Gefasschirurgie 8:135–136

    Google Scholar 

  20. Quendt J, Nöldeke S, Hupp T (2002) Thrombininjektion in der Behandlung des iatrogenen Aneurysma spurium. Gefasschirurgie 3:166–170

    Article  Google Scholar 

  21. Rowe VL, Lee W, Weaver FA, Etzioni D (2009) Patterns of treatment for peripheral arterial disease in the United States: 1996–2005. J Vasc Surg 49:910–917

    Article  PubMed  Google Scholar 

  22. Sadiq S, Ibrahim W (2001) Thromboembolism complicating thrombin injection of femoral artery pseudoaneurysm: management with intraarterial thrombolysis. J Vasc Interv Radiol 12:633–636

    Article  PubMed  CAS  Google Scholar 

  23. Saito S, Arai H, Kim K et al (1992) Percutaneous transfemoral spring coil embolization of a pseudoaneurysm of the femoral artery. Cathet Cardiovasc Diagn 26:229–231

    Article  PubMed  CAS  Google Scholar 

  24. San Norberto Garcia EM, Gonzalez-Fajardo JA, Gutierrez V et al (2009) Femoral pseudoaneurysms post-cardiac catheterization surgically treated: evolution and prognosis. Interact Cardiovasc Thorac Surg 8:353–357

    Google Scholar 

  25. Schneider C, Malisius R, Küchler R et al (2007) A prospective study on ultrasound-guided percutaneous thrombin injection for treatment of iatrogenic post-catherisation femoral pseudoaneurysms. Int J Cardiol 131:356–361

    Article  Google Scholar 

  26. Stone PA, AbuRahma AF, Flaherty SK, Bates MC (2006) Femoral pseudoaneurysms. Vasc Endovascular Surg 40:109–117

    Article  PubMed  Google Scholar 

  27. Thalhammer C, Kirchherr AS, Uhlich F et al (2000) Postcatheterization pseudoaneurysms and arteriovenous fistulas: repair with percutaneous implantation of endovascular covered stents. Radiology 214:127–131

    PubMed  CAS  Google Scholar 

  28. Tsetis D (2010) Endovascular treatment of complications of femoral arterial access. Cardiovasc Intervent Radiol 33:457–468

    Article  PubMed  Google Scholar 

  29. Winther MB (2003) Thrombininjektion bei Aneurysma spurium. Gefasschirurgie 8:135–136

    Google Scholar 

  30. Yan BP, Moran D, Hynes BG et al (2011) Advances in endovascular treatment of critical limb ischemia. Circ J 75:756–765

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik für Chirurgie, Universität Schleswig Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    M. Horn, M. Zimmermann, M. Hoffmann, P. Hildebrand, C. Franke, T. Laubert & E. Schlöricke

  2. Medizinische Klinik II, Universität Schleswig Holstein, Campus Lübeck, Lübeck, Deutschland

    P.M. Kaczmarek

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  1. M. Horn
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Correspondence to M. Horn.

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Horn, M., Kaczmarek, P., Zimmermann, M. et al. Behandlung des persistierenden Aneurysma spurium aus gefäßchirurgischer Perspektive. Gefässchirurgie 17, 366–373 (2012). https://doi.org/10.1007/s00772-012-1037-0

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  • DOI: https://doi.org/10.1007/s00772-012-1037-0

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