Abstract：Objective: To assess the efficacy and safety of ultrasound-guided thrombin injection(UGTI) in the treatment of femoral artery pseudoaneurysm(PSA). Method: From November 2017 to December 2019, 24 PSA patients confirmed by angiography or color Doppler ultrasound in our hospital were analyzed, including 19 cases of simple type and 5 cases of complex type. Under the guidance of color Doppler ultrasound, 20G PTC needle was used to puncture into the PSA cavity from the bottom of the PSA cavity far away from the PSA neck, and thrombin solution was injected slowly (concentration 250 IU/mL, total dose ≤1 000 IU). The near PSA cavity was injected preferentially for complex PSA. After operation, thrombin dosage and adverse reactions of each patient were recorded. Ultrasound(US) reexaminations were performed 24 hours and 1 week after operation, to observe the blood flow in PSA cavity and parent artery. Result: Blood flow signal in all 24 cases disappeared, only 2 patients(1 simple type, 1 complex type) had a little residual blood flow in the neck of the PSA. After 24 hours of compression, the blood flow in the neck of the simple PSA disappeared, and the complex PSA was treated successfully for the second time. The success rate of the first treatment was 95.8%(23/24), and the total success rate was 100.0%(24/24). The average thrombin dosage was (180±107) IU(25~500 IU). One patient had transient vasovagal syncope during the operation. One patient developed shivering, fever(39 ℃) 40 minutes after operation, with extensive skin rash, lower limb plaque and hypotension. After intravenous fluid infusion and intravenous injection of 5 mg dexamethasone, the patient was gradually and completely relieved. No adverse reactions and no recurrence were found in the other patients. Conclusion: Ultrasound-guided percutaneous low-dose thrombin injection is a safe and effective therapy method for treating PSA．
梁晓秋，曹凌玲，陈溢旭，王 焱，杜 昊. 超声引导下小剂量凝血酶注射治疗股动脉假性动脉瘤疗效分析[J]. 中国临床医学影像杂志, 2020, 31(8): 555-557.
LIANG Xiao-qiu, CAO Ling-ling, CHEN Yi-xu, WANG Yan, DU Hao. The efficacy of ultrasound-guided low-dose thrombin injection in the management of femoral artery pseudoaneurysm. JOURNAL OF CHINA MEDICAL IMAGING, 2020, 31(8): 555-557.
[1]Chen DH, Sammel AM, Jain P, et al. Cardiologist operated ultrasound guided thrombin injection as a safe and efficacious first line treatment for iatrogenic femoral artery pseudoaneurysms[J]. Heart Lung Circ, 2015, 24(2): 165-172.
[2]陈松华. 高频超声在医源性股动脉假性动脉瘤诊治中的应用分析[J]. 中国临床医学影像杂志，2008，19（12）：907-908.
[3]李海华，唐红. 超声引导注射凝血酶治疗股动脉假性动脉瘤的研究进展[J]. 西部医学，2019，31（3）：490-493.
[4]顾胜利，徐斐燕，邹韧. 医源性股动脉假性动脉瘤的超声诊断与治疗[J]. 中国介入影像与治疗学，2008，5（2）：123-125.
[5]De Oliveira Leite TF, Bortolini E, Linard B, et al. Evaluation of Morphological and Clinical Factors Related to Failure of Percutaneous Treatment with Thrombin Injection of Femoral Pseudoaneurysms from Cardiac Catheterization[J]. Ann Vasc Surg, 2019, 59: 173-183.
[6]Altuwaijri T, Alsalman M, Altoijry A, et al. Ultrasound-guided thrombin injection versus ultrasound-guided compression repair in the treatment of post-catheterization femoral artery pseudoaneurysm: King Saud University Medical Center Experience[J]. Turk Gogus Kalp Damar Cerrahisi Derg, 2020, 28(1): 114-119.
[7]Yoo T, Starr JE, Go MR, et al. Ultrasound-Guided Thrombin Injection Is a Safe and Effective Treatment for Femoral Artery Pseudoaneurysm in the Morbidly Obese[J]. Vasc Endovasc Surg, 2017, 51(6): 368-372.
[8]周云，陈松旺，黄岩，等. 超声引导下瘤体旁注射0.9%氯化钠溶液治疗股动脉假性动脉瘤18例[J]. 介入放射学杂志，2018，27（2）：163-166.
[9]Petrou E, Malakos I, Kampanarou S, et al. Life-threatening Rupture of a Femoral Pseudoaneurysm after Cardiac Catheterization[J]. Open Cardiovasc Med J, 2016, 10: 201-204.
[10]Mishra A, Rao A, Pimpalwar Y. Ultrasound Guided Percutaneous Injection of Thrombin: Effective Technique for Treatment of Iatrogenic Femoral Pseudoaneurysms[J]. J Clin Diagn Res, 2017, 11(4): TC04-TC06.
[11]Krueger K, Zaehringer M, Strohe D, et al. Postcatheterization pseudoaneurysm: results of US-guided percutaneous thrombin injection in 240 patients[J]. Radiology, 2005, 236(3): 1104-1110.
[12]Gabrielli R, Rosati MS, Vitale S, et al. Thrombin injection and compression with removable guidewire in the treatment of postcatheterization femoral pseudoaneurysm[J]. J Cardiovasc Surg(Torino), 2016, 57(4): 510-513.
[13]Gabrielli R, Rosati MS, Vitale S, et al. Fatal complication after thrombin injection for post-catheterization femoral pseudoaneurysm[J]. Thorac Cardiovasc Surg, 2011, 59(6): 372-375.
[14]Jalaeian H, Misselt A. Anaphylactic reaction to bovine thrombin in ultrasound-guided treatment of femoral pseudoaneurysm[J]. J Vasc Interv Radiol, 2015, 26(6): 915-916.
[15]Wu Z, Ma Y. Severe allergic reaction: A rare complication of ultrasound-guided injection of thrombin in a femoral pseudoaneurysm[J]. J Clin Ultrasound, 2018, 46(5): 341.
[16]Pope M, Johnston KW. Anaphylaxis after thrombin injection of a femoral pseudoaneurysm: recommendations for prevention[J]. J Vasc Surg, 2000, 32(1): 190-191.
[17]Kurzawski J, Janion-Sadowska A, Zandecki L, et al. Comparison of the Efficacy and Safety of Two Dosing Protocols for Ultrasound Guided Thrombin Injection in Patients with Iatrogenic Femoral Pseudoaneurysms[J]. Eur J Vasc Endovasc Surg, 2020, 59(6): 1019-1025.
[18]Shin JH, Song Y, Sheen JJ, et al. Safety and Effectiveness of Percutaneous Low-Dose Thrombin Injection for Femoral Puncture Site Pseudoaneurysms in Neurointervention: Single-Center Experience[J]. Neurointervention, 2020, 15(1): 25-30.
[19]Jargietto T, Sobstyl J, Swiattowski T, et al. Ultrasound-guided thrombin injection in the management of pseudoaneurysm after percutaneous arterial access[J]. J Ultrason, 2018, 18(73): 85-89.
[20]Kurzawski J, Sadowski M, Janion-Sadowska A. Complications of percutaneous thrombin injection in patients with postcatheterization femoral pseudoaneurysm[J]. J Clin Ultrasound, 2016, 44(3): 188-195.
[21]Sheldon PJ, Oglevie SB, Kaplan LA. Prolonged Generalized Urticarial Reaction after Percutaneous Thrombin Injection for Treatment of a Femoral Artery Pseudoaneurysm[J]. J Vasc Interv Radiol, 2000, 11(6): 759-761.
