Download PDF
Dtsch Med Wochenschr 2003; 128(1/2): 36-40
DOI: 10.1055/s-2003-36329
Aktuelle Diagnostik & Therapie
© Georg Thieme Verlag Stuttgart · New York

Die nicht-chirurgische Therapie des iatrogenen Aneurysma spurium

Non-surgical therapy of iatrogenic false aneurysmsG. Görge1 , T. Kunz1 , M. Kirstein1
  • 1Medizinische Klinik II, Klinikum Saarbrücken
Further Information

Publication History

eingereicht: 27.6.2002

akzeptiert: 16.10.2002

Publication Date:
02 January 2003 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Aneuysmata spuria kommen nach 0,1 - 1,5 % der diagnostischen Herzkatheteruntersuchungen und in bis zu 6 % nach perkutanen Interventionen vor. Während früher bei symptomatischen Patienten die Chirurgie die Therapie der Wahl darstellte, konkurrieren heute in erster Linie zwei nicht invasive Verfahren: die Ultraschall-gesteuerte Kompression (UGC) und die Ultraschall-gesteuerte perkutane Thrombininjektion (UGTI) in den Aneurysmasack. Die UGC ist nach 30 - 120 min Kompressionszeit im Mittel bei 80 % der nicht antikoagulierten Patienten erfolgreich. Sie erfordert aber einen längeren Krankenhausaufenthalt und ist oft schmerzhaft. Die UGTI ist auch bei antikoagulierten Patienten effektiv. Nach Injektion von 100 - 2000 U Thrombin kommt es im Mittel bei 95 % der Patienten zu einem Verschluss des Aneurysmas. Kontraindiziert ist die UGTI bei AV-Fisteln oder sehr großen Verbindungskanälen zum Nativgefäß. Patienten mit sehr ausgedehnten Hämatomen, fortschreitender Blutung, Verletzungen des Nativgefäßes, symptomatischer venöser oder arterieller Kompression, neurologischen Komplikationen oder Infektionen müssen frühzeitig operiert werden.

Summary

False aneurysms occur after 0.1 - 1.5 % of all diagnostic and up to 6 % of all therapeutic percutaneous interventions. Surgery used to be the treatment of choice in symptomatic patients. But two non-invasive measures of treatment gain more attention: ultrasound guided compression (UGC) and ultrasound guided thrombin injection (UGTI). UGC with compression times from 30 - 120 min is effective in 80 % of patients without anticoagulation. However, UGC is often painful and results in prolongation of in-hospital time. UGTI is effective in 95 % of patients. Usually, 100 - 2000 U of thrombin are injected into the false aneurysm. UGTI is also effective in the presence of anticoagulation or antiplatelet therapy. UGTI is not indicated in patients with a large communication with the native vessel and in arterio-venous-fistulas. In patients with large haematomas, ongoing bleeding, damage of the native vessel, compression of arteries, veins or neurological deficits, or with infections, early surgical repair is still the treatment of choice.

Literatur

  • 1 Babu S C, Piccorelli G O, Shah P M, Stein J H, Clauss R H. Incidence and results of arterial complications among 16,350 patients undergoing cardiac catheterization.  J Vasc Surg. 1989;  10 113-116
    Google Scholar
  • 2 Brophy D P, Sheiman R G, Amatulle P, Akbari C M. Iatrogenic femoral pseudoaneurysms: thrombin injection after failed US-guided compression.  Radiology. 2000;  214 278-282
    Google Scholar
  • 3 Brummer U, Salcuni M, Salvati F, Bonomini M. Repair of femoral postcatheterization pseudoaneurysm and arteriovenous fistula with percutaneous implantation of endovascular stent.   Nephrol Dial Transplant. 2001;  16 1728-1729 , (http://ndt.oupjournals.org/cgi/content/full/16/8/1728).
    Google Scholar
  • 4 Carroll J F, Moskowitz K A, Edwards N M, Hickey T J, Rose E A, Budzynski A Z. Immunologic assessment of patients treated with bovine fibrin as a hemostatic agent.  Thromb Haemost. 1996;  76 925-931
    Google Scholar
  • 5 Cope C, Zeit R. Coagulation of aneurysms by direct percutaneous thrombin injection.  AJR Am J Roentgenol. 1986;  147 383-387
    Google Scholar
  • 6 Dangas G, Mehran R, Kokolis S. et al . Vascular complications after percutaneous coronary interventions following hemostasis with manual compression versus arteriotomy closure devices.  J Am Coll Cardiol. 2001;  38 638-641
    Google Scholar
  • 7 Dorion R P, Hamati H F, Landis B, Frey C, Heydt D, Carey D. Risk and clinical significance of developing antibodies induced by topical thrombin preparations.  Arch Pathol Lab Med. 1998;  122 887-894
    Google Scholar
  • 8 Feld R, Patton G M, Carabasi R A, Alexander A, Merton D, Needleman L. Treatment of iatrogenic femoral artery injuries with ultrasound-guided compression.  J Vasc Surg. 1992;  832-840
    Google Scholar
  • 9 Fellmeth B D, Roberts A C, Bookstein J J. et al . Postangiographic femoral artery injuries: nonsurgical repair with US-guided compression.  Radiology. 1991;  178 671-675
    Google Scholar
  • 10 Jain S P, Roubin G S, Iyer S S, Saddekni S, Yadav J S. Closure of an iatrogenic femoral artery pseudoaneurysm by transcutaneous coil embolization.  Cathet Cardiovasc Diagn. 1996;  39 317-319
    Google Scholar
  • 11 Kent K C, McArdle C R, Kennedy B, Baim D S, Anninos E, Skillman J J. Accuracy of clinical examination in the evaluation of femoral false aneurysm and arteriovenous fistula.  Cardiovasc Surg. 1993;  1 504-507
    Google Scholar
  • 12 Langella R L, Schneider J R, Golan J F. Color duplex-guided compression therapy for postcatheterization pseudoaneurysms in a community hospital.  Ann Vasc Surg. 1996;  10 27-35
    Google Scholar
  • 13 La Perna L, Olin J W, Goines D, Childs M B, Ouriel K. Ultrasound-guided thrombin injection for the treatment of postcatheterization pseudoaneurysms. .  Circulation. 2000;  102 2391-2395 , (http://www.circulationaha.org/cgi/content/full/102/19/2391; http://www.circulationaha.org/cgi/content/abstract/102/19/2391).
    Google Scholar
  • 14 Lumsden A B, Miller J M, Kosinski A S. et al . A prospective evaluation of surgically treated groin complications following percutaneous cardiac procedures.  Am Surg. 1994;  60 132-137
    Google Scholar
  • 15 McCoy D, Scharfstein B, Walker W, Evans J. Ultrasound-guided percutaneous thrombin injection for femoral artery pseudoaneurysms.  Am Surg. 2000;  66 975-977
    Google Scholar
  • 16 Morrison S L, Obrand D A, Steinmetz O K, Montreuil B. Treatment of femoral artery pseudoaneurysms with percutaneous thrombin injection.  Ann Vasc Surg. 2000;  14 634-639
    Google Scholar
  • 17 Muntean W, Zenz W, Finding K, Zobel G, Beitzke A. Inhibitor to factor V after exposure to fibrin sealant during cardiac surgery in a two-year-old child.  Acta Paediatr. 1994;  83 84-87
    Google Scholar
  • 18 Omoigui N A, Califf R M, Pieper K. et al . Peripheral vascular complications in the Coronary Angioplasty Versus Excisional Atherectomy Trial (CAVEAT-I).  J Am Coll Cardiol. 1995;  26 922-930
    Google Scholar
  • 19 Ortel T L, Moore K D, Quinn-Allen M A. et al . Inhibitory anti-factor V antibodies bind to the factor V C2 domain and are associated with hemorrhagic manifestations.  Blood. 1998;  91 4188-4196 , (http://www.bloodjournal.org/cgi/content/full/91/11/4188).
    Google Scholar
  • 20 Owen R J, Haslam P J, Elliott S T, Rose J D, Loose H W. Percutaneous ablation of peripheral pseudoaneurysms using thrombin: a simple and effective solution.  Cardiovasc Intervent Radiol. 2000;  23 441-446
    Google Scholar
  • 21 Perkins J M, Gordon A C, Magee T R, Hands L J. Duplex-guided compression of femoral artery false aneurysms reduces the need for surgery.  Ann R Coll Surg Engl. 1996;  78 473-475
    Google Scholar
  • 22 Pope M, Johnston K W. Anaphylaxis after thrombin injection of a femoral pseudoaneurysm: recommendations for prevention.  J Vasc Surg. 2000;  32 190-191
    Google Scholar
  • 23 Rath J, Marx R, Ganschow U S. et al . Entstehung, Therapie und Prävention des Aneurysma spurium der Arteria femoralis nach diagnostischen und interventionellen Herzkatheteruntersuchungen.  Dtsch Med Wochenschr. 1997;  122 771-777
    Google Scholar
  • 24 Roberts S R, Main D, Pinkerton J. Surgical therapy of femoral artery pseudoaneurysm after angiography.  Am J Surg. 1987;  154 676-680
    Google Scholar
  • 25 Sadiq S, Ibrahim W. Thromboembolism complicating thrombin injection of femoral artery pseudoaneurysm: management with intraarterial thrombolysis.   J Vasc Interv Radiol. 2001;  12 633-636 , (http://www.jvir.org/cgi/content/full/12/5/633; http://www.jvir.org/cgi/content/abstract/12/5/633).
    Google Scholar
  • 26 Samuels D, Orron D E, Kessler A. et al . Femoral artery pseudoaneurysm: Doppler sonographic features predictive for spontaneous thrombosis.  J Clin Ultrasound. 1997;  25 497-500
    Google Scholar
  • 27 Schaub F, Theiss W, Busch R, Heinz M, Paschalidis M, Schomig A. Management of 219 consecutive cases of postcatheterization pseudoaneurysm.  J Am Coll Cardiol. 1997;  30 670-675
    Google Scholar
  • 28 Schaub F, Theiss W, Heinz M, Zagel M, Schomig A. New aspects in ultrasound-guided compression repair of postcatheterization femoral artery injuries.  Circulation. 1994;  90 1861-1865
    Google Scholar
  • 29 Sievert H, Baser A, Pfeil W. et al . Die Behandlung des iatrogenen Aneurysma spuriums der Arteria femoralis durch direkte Thrombininjektion.  Dtsch Med Wochenschr. 2000;  125 822-825
    Google Scholar
  • 30 Tamim W Z, Arbid E J, Andrews L S, Arous E J. Percutaneous induced thrombosis of iatrogenic femoral pseudoaneurysms following catheterization.  Ann Vasc Surg. 2000;  14 254-259
    Google Scholar
  • 31 Waigand J, Uhlich F, Gross C M, Thalhammer C, Dietz R. Percutaneous treatment of pseudoaneurysms and arteriovenous fistulas after invasive vascular procedures.  Catheter Cardiovasc Interv. 1999;  47 157-164
    Google Scholar
  • 32 Zahn R, Thoma S, Fromm E. et al . Pseudoaneurysm after cardiac catheterization: therapeutic interventions and their sequelae: experience in 86 patients.  Cathet Cardiovasc Diagn. 1997;  40 9-15
    Google Scholar

Priv.-Doz. Dr. med. Günter Görge

Chefarzt der Medizinischen Klinik II, (Herz- und Lungenkrankheiten, Angiologie und Intensivmedizin), Klinikum Saarbrücken

Winterberg 1

66119 Saarbrücken

Phone: 0681/9632434

Fax: 0681/9632378

Email: g.gorge@mx.uni-saarland.de