股静脉穿刺导致医源性股动脉假性动脉瘤合并股动静脉瘘的处理策略——附12例报导  

Treatment Strategy of Iatrogenic Femoral Artery Pseudoaneurysm With Concomitant Arteriovenous Fistula Following Femoral Vein Puncture:12 Cases Report

作　　者：张永保 李涵[1] 房杰 施焘[1] 滕乐群 曲诚家 刘新农 沈晨阳 ZHANG Yongbao;LI Han;FANG Jie;SHI Tao;TENG Lequn;QU Chengjia;LIU Xinnong;SHEN Chenyang(Vascular Surgery Center,State Key Laboratory of Cardiovascular Disease,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing(100037),China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院心血管疾病国家重点实验室血管外科中心,北京市100037

出　　处：《中国循环杂志》2022年第9期946-949,共4页Chinese Circulation Journal

摘　　要：目的:总结股静脉穿刺导致的医源性股动脉假性动脉瘤合并股动静脉瘘的发生原因及处理策略。方法:回顾性分析2015年12月至2020年11月我科治疗的12例医源性股动脉假性动脉瘤合并股动静脉瘘患者,根据病变情况及治疗效果讨论合适的治疗方式。结果:12例患者中位年龄60(49~81)岁,男性7例,女性5例;医源性股动脉假性动脉瘤合并股动静脉瘘原因包括心律失常(心房颤动/室性早搏/室性心动过速)行射频导管消融术所致并发症11例,行右心导管造影所致并发症1例。所有病变均因穿刺股静脉导致,且动脉破口均位于股浅动脉,12例患者均行开放手术治疗,手术成功率100%。术后1例患者出现淋巴瘘,保守治疗痊愈。术后30 d无手术相关死亡。结论:股静脉穿刺位点过低是引起股动脉假性动脉瘤合并股动静脉瘘的主要原因,手术治疗安全、有效。Objectives:The aim of this study was to analyze the risk factors and optimal treatment strategy of iatrogenic femoral artery pseudoaneurysm with concomitant arteriovenous fistula following femoral vein puncture.Methods:This retrospective analysis included 12 patients with iatrogenic femoral artery pseudoaneurysm with concomitant arteriovenous fistula,who were treated in our center from December 2015 to November 2020.The treatment options were decided based on the patients’condition and expected therapeutic effects.Results:The mean age of this patient cohort was 60 years old(ranged from 49 to 81).There were 7 male patients and 5 female patients.Eleven patients underwent radiofrequency ablation for arrhythmia such as atrial fibrillation,premature ventricular contraction and ventricular tachycardia,while one patient underwent right heart catheterization.All lesions occurred following femoral vein puncture.The arterial leakages causing pseudoaneurysm were all located in the superficial femoral artery.All 12 patients received open surgical repair,and the success rate was 100%.One patient developed local lymphatic fistula postoperatively and recovered with conservative treatment.No death occurred within 30 days after surgery.Conclusions:Puncture site too low is the main cause of iatrogenic femoral artery pseudoaneurysm with concomitant arteriovenous fistula following femoral vein puncture.Open surgical repair is an optimal treatment strategy for iatrogenic femoral artery pseudoaneurysm with concomitant arteriovenous fistula following femoral vein puncture.

关 键 词：医源性损伤 假性动脉瘤 动静脉瘘 并发症 

分 类 号：R541[医药卫生—心血管疾病]