Abstract:

Treatment in limbs iatrogenic pseudoaneurysm：A report of 22 cases        JIA Qi，WU Dan-ming，WANG Cheng-gang，et al. Department of Vascular Surgery, the People's Hospital of Liaoning Province,Shenyang110016,China
Corresponding author：WU Dan-ming，E-mail：danming_w@126.com
Abstract    Objective    To explore the  clinical effect of the treatment in limbs iatrogenic pseudoaneurysm of different types. Methods    A total of 22 cases of iatrogenic pseudoaneurysm in limbs admitted in the People’s Hospital of Liaoning Province from 2010 to 2013. According to the diameter of iatrogenic pseudoaneurysm and the size of tear, pseudoaneurysm were divided intoⅠ,Ⅱa,Ⅱb and Ⅲ type，in which 15 cases were type I ( the diameter of pseudoaneurysm was less than 3cm)，treated with braking，elastic bandage. Two cases were type Ⅱa ( the diameter of pseudoaneurysm was more than 3cm and the tear was less than 2cm)，treated with temporary block by balloon and injecting the thrombin into the blood vessel. Two cases were typeⅡb ( the diameter of pseudoaneurysm was more than 3cm and the tear was more than 2cm) treated by endovascular repair with covered stents. Three cases were type Ⅲ(infectious pseudoaneurysm) treated by endovascular repair with covered stents. The first phase was debridement and drainage of abscess. The second phase was sewing up the wound. All the cases were followed up for 6 to 32 months. Results    A total of 14 cases were successful for the all 15 cases of type I.The failure was treated by  endovascular repair with covered stents. The cases of typeⅡ were all successful. For the cases of type Ⅲ, the tear of pseudoaneurysm were all healed by first intention and cuts all healed well within three months. All the cases had an average follow-up of 22.3 months. No recurrence，no endoleaks, no stent migration，no fracture and other complications occurred. Conclusion  Surgeons can treat pseudoaneurysm more effective with minimal cost，by choosing the treatment strategy based on the different types of pseudoaneurysm.

Key words: pseudoaneurysm, covered stent

摘要：

目的    探讨采用不同方法治疗不同类型周围动脉医源性假性动脉瘤的临床效果。方法    辽宁省人民医院2010-2013年收治周围动脉医源性假性动脉瘤病人22例，根据假性动脉瘤直径及破口的大小及有无感染，将假性动脉瘤分为对Ⅰ、Ⅱa、Ⅱb以及Ⅲ型，15例Ⅰ型病人(假性动脉瘤直径<3cm)采用制动、弹力绷带加加压包扎治疗；2例Ⅱa型病人(直径>3 cm破口<２cm)采用球囊临时阻断，凝血酶腔内注射疗法治疗，2例Ⅱb病人（直径>3 cm且破口>2 cm）采用覆膜支架腔内隔绝术；3例Ⅲ型病人（感染性假性动脉瘤）采用覆膜支架腔内隔绝术，一期脓腔清创引流，二期缝合的办法，所有病人随访6～32个月。结果    Ⅰ型15例病人治疗成功14例，1例失败病人给予腔内覆膜支架植入术；Ⅱ型病人均一期封闭；Ⅲ型病人动脉瘤破口均一期封闭，伤口3个月内均愈合。所有病人平均随访22.3个月，无复发、内漏，支架移位、折断等并发症。结论    根据假性动脉瘤不同类型选择治疗的策略，可用最小的代价更有效地治疗假性动脉瘤。

关键词: 假性动脉瘤, 覆膜支架