Author/Editor		Kranjec, Igor; Černe, Andreja; Koželj, Mirta; Buturovič-Ponikvar, Jadranka
Title		Zdravljenje psevdoanevrizme femoralne arterije z ultrazvočno vodenim zunanjim pritiskom
Translated title		Treatment of femoral artery pseudoaneurysm by ultrasonographically guided external compression
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 66, št. 4
Publication year		1997
Volume		str. 191-5
Language		slo
Abstract		Background. Femoral artery pseudoaneurysm is potentially unstable complication following cardiac catheterization. The early recognition and prompt treatment of pseudoaneurysm are necessary to prevent further morbidity. Surgical repair is considered to be classical treatment modality. This study was undertaken to evaluate a new method of closing femoral pseudoaneurysms by using ultrasonographically guided external compression (UGEC). Methods. Ultrasound examination was performed in 75 patients with clinical signs suggesting of vascular complications following cardiac catheterization. Six patients with ultrasonographically disclosed femoral pseudoaneurysm were enrolled in our study. Five pseudoaneurysm was ultrasonographically found to be favourable for UGEC. An external pressure was applied above pseudoaneurysm neck by an ultrasound transducer until extraluminal pseudoaneurysm flow was eliminated while intraluminal flow down the underlying artery was maintained. Results. UGEC was successful in 3 pseudoaneurysms (3/5, 60%): immediate complete thrombosis was achieved in 2 patients while reduction of pseudoaneurysm with subsequent closure developed in 1 patient 12 hr afterward. No therapeutic complicatoins were encountered. Follow-up ultrasound examination at 24 hr or later confirmed continued closure in all. UGEC failed in patient with pseudoaneurysm located proximal to the inguinal ligament and spreading into pelvic cavity, and in patient with large, double neck pseudoaneurysm discovered late after catheterization procedure. Conclusions. According to our experience, we believed, the technique of manual obliteration of pseudoaneurysm with UGEC in ultrasonographically selected cases, provides a safe and effective complementary method to surgical intervention.
Summary		Izhodišča. Psevdoanevrizma femoralne arterije je potencialno nestabilen žilni zaplet srčne kateterizacije. Za preprečitev kasnih posledic moramo psevdoanevrizmo zgodaj odkriti in zdraviti. Klasičen način zdravljenja psevdoanevrizme je kirurški. S to študijo smo želeli predstaviti naše prve izkušnje z novim načinom zapiranja psevdoanevrizme s pomočjo ultrazvočno vodenega zunanjega pritiska (UVZP). Metode. Ultrazvočni pregled femoralne arterije smo izvedli pri 75 bolnikih po srčni kateterizaciji, pri katerih smo s pomočjo kliničnega pregleda dimeljske kotanje sumili, da gre za lokalni zaplet. V študijo smo vključili 6 bolnikov, pri katerih smo psevdoanevrizmo femoralne arterije ugotovili ultrazvočno. Za zdravljenje z UVZP je bilo po ultrazvočnih merilih primernih 5 psevdoanevrizem. Nad vratom psevdoanevrizme smo z ultrazvočno sondo izvajali zunanji pritis tako, da smo popolnoma prekinili pretok krvi skozi arterijsko okvaro v psevdoanevrizmo, hkrati pa smo ohranili primeren pretok krvi skozi arterijo. Rezultati. Z UVZP smo uspeli zapreti tri psevdoanevrizme (3/5, 60%): takojšno trombozo vratu psevdoanevrizme smo dosegli pri dveh bolnikih, zmanjšanje psevdoanevrizme s posledičnim zapiranjem po 12 urah pa pri eni bolnici. Poseg je pri vseh bolnikih potekal brez zapletov. Trojnost uspeha smo potrdili s ponovnim pregledom 24 ur po posegu. Neuspešni smo bili v primeru kasno odkrite velike psevdoanevrizme z dvojnim vratom in v primeru psevdoanevrizme, ki se je širila proksimalno od ingivinalnega ligamenta v pelvično votlino. Zaključki. Sodeč po izkušnjah menimo, da je metoda zapiranja ultrazvočno dostopnih psevdoanevrizem z UVZP enostavna, neinvazivna, komplementarna metoda zdravljenja, ki v izbranih primerih lahko varno nadomesti kirurško korekcijo.
Descriptors		CATHETERIZATION ANEURYSM FEMORAL ARTERY MIDDLE AGE AGED ULTRASONIC THERAPY