With the rapid development of interventional treatment, complications related to interventional have gradually increased, and femoral pseudoaneurysms and femoral arteriovenous fistula are more common.
Recently, Fuwai Hospital of Chinese Academy of Medical Sciences Shen Chenyang, Zhang Yongbao and others summarized the causes and treatment strategies of iatrogenic femoral pseudoaneurysm combined with femoral artery artery fistula caused by femoral venous pseudoaneury and femoral artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery artery art
Researchers pointed out that the low femoral venous puncture site is the main reason for femoral pseudoaneurysm combined with femoral arteriovenous fistula; surgical treatment is safe and effective.
The median age of these 12 patients was 60 years old, 7 males, and 11 were caused by radiofrequency catheter ablation due to arrhythmia (atrial fibrillation/ventricular premature beat/ ventricular tachycardia ), and routine right heart catheterography.
All lesions are caused by puncture of the femoral vein, and the artery rupture is located in the superficial femoral artery.
All pseudo-aneurysms maximum diameter median was 5.4 cm, and the median fistula size was 2.4 mm for ultrasonic measurement.
12 patients were all located below the bifurcation of common femoral artery, and all underwent open surgical treatment. The median bleeding volume of surgery was 105 ml, and the success rate of surgery was 100%. One case of lymphatic leakage occurred after the operation and was cured by conservative treatment.
The median hospitalization days after surgery were 10.5 days, and 1 patient was hospitalized for 43 days after surgery due to lymph leakage. No 12 patients with
html had cardiovascular and cerebrovascular complications, no surgical-related deaths 30 days after surgery, and no pseudo-aneurysm or arteriovenous fistula recurred for 1 month after surgery.Researchers analyzed the reasons for the occurrence of pseudo-aneurysm combined with femoral arteriovenous fistula. In addition to the low puncture position, there are two other reasons:
(1) Improper compression method: The researchers found that if femoral artery is damaged during the operation, the entry point of the artery needs to be pressurized when the artery is compressed. If the compression position is at the distal end of the puncture point, the proximal pressure will increase, which will then form a pseudo-aneurysm.
(2) Venous puncture is more suitable to use the classic Seldinger method. If you need to improve the puncture, consider using a 21 G needle, which will make it easier to penetrate the venous wall and establish a pathway.
(3) Improper puncture angle, puncture angle 45°~60° into the needle, the skin needle point and the blood vessel needle point are relatively displaced, making it easier to locate and compress, and the incidence of puncture complications may also be lower.
(4) Anticoagulation treatment may have a certain impact on the formation of pseudoaneurysms, and may also lead to long-term non-closure of arteriovenous fistula. Perioperative adjustment of anticoagulation regimens may benefit patients. In the treatment of
, the treatment method of femoral pseudoaneurysm gradually transitioned to ultrasound-guided compression or thrombin injection treatment, and became the first choice for the disease.
surgery is suitable for patients with poor conservative treatment effects, combined with hematoma compression, hemodynamic disorders, etc.
This type of lesions are often located in the superficial femoral artery. Researchers recommend giving priority to the release of the common femoral and deep femoral artery. The size of the tumor body and the hematoma affect the freedom of the distal superficial femoral artery and the femoral vein. After controlling the proximal femoral artery, systemic heparinization can be considered, blocking the common femoral and deep femoral artery, breaking the tumor and entering, and then freeing the distal superficial femoral artery in the tumor cavity.
reduces the occurrence of femoral pseudoaneurysm combined with femoral artery arteriovenous fistula. The following points can be considered for the improvement method:
(1) Puncture common femoral artery and femoral vein: The common femoral artery and femoral vein are femoral head behind the common femoral artery and femoral vein. Compression after puncture is easier to succeed, and the artery and veins at this site are basically in parallel, so arteriovenous fistula is not prone to occur.
(2) Punching the blood vessel directly in front of the blood vessel: During the puncture of some surgeons, one puncture was not successful. They were used to puncture needle located subcutaneously. Try to puncture to find arteriovenous veins in the left and right directions. This method is prone to puncture through the lateral wall, and arteriovenous fistula may occur.
(3) Ultrasound-guided puncture: The arteriovenous anatomy can be clearly seen under ultrasound-guided, and the location of the puncture entering the venous can be reduced by about 60% of the complications of venous puncture. If possible, it can be used as the preferred puncture method.
Source: Zhang Yongbao, Li Han, Fang Jie, et al. Treatment strategies for iatrogenic femoral pseudoaneurysm combined with femoral artery fistula - 12 cases report attached. Chinese Journal of Circulation , 2022, 37: 946-949. DOI: 10.3969/j.issn.1000-3614.2022.09.013. [Long press or scan the QR code to see the original text]
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