超声诊断伴神经损伤的胫后动脉假性动脉瘤及其引导凝血酶治疗的价值

doi:10.3877/cma.j.issn.2095-655X.2021.04.005

目的

探讨伴神经损伤的胫后动脉假性动脉瘤的超声诊断学特征及超声引导注射凝血酶的治疗价值。

方法

研究对象为2020年4月2日济宁医学院附属医院血管外科收治的1例因外伤致胫后动脉假性动脉瘤伴胫神经损伤的患者，经超声及CT血管造影检查确诊，在超声引导下注射凝血酶治疗，对治疗过程、疗效及并发症进行分析，并复习相关文献。

结果

患者因外伤致右小腿疼痛2周，伴肿胀感，足底皮肤感觉麻木。超声表现为右侧胫后动脉旁混合回声团块，该团块液性暗区内探及红蓝相间的紊乱血流信号，并可探及源于胫后动脉的高速射流信号，交通口处探及双期双向样血流频谱。超声诊断为右侧胫后动脉假性动脉瘤并瘤体内附壁血栓。在超声引导下，注射凝血酶治疗胫后动脉假性动脉瘤。治疗后患者除胫神经损伤症状加重外，无其他并发症的出现。治疗后1 d瘤体内无复发血流信号，治疗后1个月及3个月复查，瘤体逐渐变小，患者胫神经损伤症状逐渐减轻，且无其他并发症出现。

结论

超声在诊断胫后动脉假性动脉瘤及其引导注射凝血酶治疗方面具有一定的临床应用价值。

关键词: 动脉瘤，假性, 凝血酶, 胫后动脉, 超声检查

Objective

To explore the ultrasonographic characteristics of posterior tibial artery pseudoaneurysm with nerve injury and the therapeutic value of ultrasound-guided thrombin injection.

Methods

A patient with posterior tibial artery pseudoaneurysm accompanied by tibial nerve injury due to trauma admitted to the Department of Vascular Surgery, the Affiliated Hospital of Jining Medical University on April 2, 2020 was confirmed by ultrasonography and CT angiography, and treated with ultrasound-guided thrombin injection. The treatment process, curative effect and complications were analyzed, and the relevant literatures were reviewed.

Results

The patient presented pain in the right calf, accompanied by swelling, and numbness on the sole of the foot. Ultrasound manifested a mixed echo mass next to the right posterior tibial artery. The red and blue turbulent blood flow signals could be detected in the liquid dark area of the mass, and the high-speed jet signals originating from the posterior tibial artery could be detected, two-phase bidirectional blood flow spectrum could be explored at the communicating hole. Ultrasound diagnosed as right posterior tibial artery pseudoaneurysm with mural thrombus in the pseudoaneurysm. Under the guidance of ultrasound, thrombin injection was used to treat the posterior tibial artery pseudoaneurysm. After treatment, except for the aggravated tibial nerve injury, no other complications occurred. There was no recurrent blood flow signal in the pseudoaneurysm one day after treatment. Re-examinations 1 and 3 months after treatment showed that the pseudoaneurysm gradually became smaller, and the patient′s tibial nerve injury symptoms gradually alleviated, and no other complications appeared.

Conclusion

Ultrasonography has certain clinical application value in diagnosing posterior tibial artery pseudoaneurysm and guiding thrombin injection therapy.

Key words: Aneurysm, false, Thrombin, Posterior tibial artery, Ultrasonography

图1 超声引导下凝血酶注射治疗胫后动脉PSA患者治疗前后超声对比图像

[1]	Saad NE, Saad WE, Davies MG，et al.Pseudoaneurysms and the role of minimally invasive techniques in their management[J]．Radiographics，2005，25 (Suppl1)：S173-S189.
[2]	吴丽兰，汤敏．肝移植术后肝动脉假性动脉瘤的诊断学特征并文献复习[J/CD]．中华诊断学电子杂志，2020，8(2)：44-48.
[3]	张旭升．不同手术方式治疗外周假性动脉瘤的疗效观察[J]．实用中西医结合临床，2019，12(19)：81-83.
[4]	Liu K, Mu L, Yan S, et al. Spontaneous pseudoaneurysm of the posterior tibial artery successfully treated by open surgery：case report and review of the literature[J]．Medicine，2020，99(31)：1-6.
[5]	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.
[6]	Webber GW, Jang J, Gustavson S，et al.Contemporary management of postcatheterization-pseudoaneurysms[J]．Circulation，2007，115(20)：2666-2674.
[7]	Stone PA, Thompson SN, Hanson B，et al.Management of iatrogenic pseudoaneurysms in patients undergoing coronary artery bypass grafting [J]．Vasc Endovascular Surg，2016，50(4)：217-220.
[8]	Dzijan-Horn M, Langwieser N, Groha P，et al.Safety and efficacy of a potential treatment algorithm by using manual compression repair and ultrasound-guided thrombin injection for the management of iatrogenic femoral artery pseudoaneurysm in a large patient cohort[J]．Circ Cardiovasclnterv，2014，7(2)：207-215.
[9]	Madia C．Management trends for postcatheterization femoral artery pseudoaneurysms[J]．JAAPA，2019，32(6)：15-18.
[10]	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.
[11]	Jargiello T, Sobstyl J, Swiatlowski L，et al.Ultrasound-guided thrombin injection in the management of pseudoaneurysm after percutameous arterial access[J]．J Ultrason，2018，18(73)：85-89.
[12]	Yang EY, Tabbara MM, Sanchez PG，et al.Comparison of ultrasound-guided thrombin injection of iatrogenic pseudoaneurysms based on neck dimension[J]．Ann Vasc Surg，2018(47)：121-127.
[13]	Ehieli WL, Bozdogan E, Janas G，et al.Imaging-guidedper cutaneous thrombin injection for the treatment of iatrogenic femoral artery pseudoaneurysms[J]．Abdom Radiol，2019，44(3)：1120-1126.
[14]	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.
[15]	Krüger K, Zähringer M, Söhngen FD，et al.Femoral pseudoaneurysms: management with percutaneous thrombin injections-success rates and effects on systemic coagulation[J]．Radiology，2003，226(2)：452-458.
[16]	晋军，黄岚，覃军，等．凝血酶注射封闭股动脉假性动脉瘤对机体凝血系统的影响[J]．中国循环杂志，2004，19(2)：35-37.
[17]	陈燏，林玉．超声引导下注射不同浓度凝血酶治疗股动脉假性动脉瘤患者的有效性和安全性[J]．医疗装备，2019，32(20)：135-136.
[18]	于文．超声引导下凝血酶注射治疗股动脉假性动脉瘤疗效观察[J]．山西职工医学院学报，2018，28(3)：47-49.
[19]	梁晓秋，曹凌玲，陈溢旭，等．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)：555-567.
[20]	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.
[21]	Jhajharia A, Wanjari S, Ashdhir P，et al.Endoscopic ultrasound-guided thrombin injection for management of visceral artery pseudoaneurysm: a novel approach[J]．Indian J Gastroenterol，2018，37(3)：271-275.

[1]	魏淑婕, 惠品晶, 丁亚芳, 张白, 颜燕红, 周鹏, 黄亚波. 单侧颈内动脉闭塞患者行颞浅动脉-大脑中动脉搭桥术的脑血流动力学评估[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1046-1055.
[2]	张璇, 马宇童, 苗玉倩, 张云, 吴士文, 党晓楚, 陈颖颖, 钟兆明, 王雪娟, 胡淼, 孙岩峰, 马秀珠, 吕发勤, 寇海燕. 超声对Duchenne肌营养不良儿童膈肌功能的评价[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1068-1073.
[3]	朱连华, 费翔, 韩鹏, 姜波, 李楠, 罗渝昆. 高帧频超声造影在胆囊息肉样病变中的鉴别诊断价值[J]. 中华医学超声杂志（电子版）, 2023, 20(09): 904-910.
[4]	张梅芳, 谭莹, 朱巧珍, 温昕, 袁鹰, 秦越, 郭洪波, 侯伶秀, 黄文兰, 彭桂艳, 李胜利. 早孕期胎儿头臀长正中矢状切面超声图像的人工智能质控研究[J]. 中华医学超声杂志（电子版）, 2023, 20(09): 945-950.
[5]	陈舜, 薛恩生, 叶琴. PDCA在持续改进超声危急值管理制度中的价值[J]. 中华医学超声杂志（电子版）, 2023, 20(09): 974-978.
[6]	周钰菡, 肖欢, 唐毅, 杨春江, 周娟, 朱丽容, 徐娟, 牟芳婷. 超声对儿童髋关节暂时性滑膜炎的诊断价值[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 795-800.
[7]	刘欢颜, 华扬, 贾凌云, 赵新宇, 刘蓓蓓. 颈内动脉闭塞病变管腔结构和血流动力学特征分析[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 809-815.
[8]	郏亚平, 曾书娥. 含鳞状细胞癌成分的乳腺化生性癌的超声与病理特征分析[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 844-848.
[9]	张丽丽, 陈莉, 余美琴, 聂小艳, 王婧玲, 刘婷. PDCA循环法在超声浅表器官亚专科建设中的应用[J]. 中华医学超声杂志（电子版）, 2023, 20(07): 717-721.
[10]	罗刚, 泮思林, 陈涛涛, 许茜, 纪志娴, 王思宝, 孙玲玉. 超声心动图在胎儿心脏介入治疗室间隔完整的肺动脉闭锁中的应用[J]. 中华医学超声杂志（电子版）, 2023, 20(06): 605-609.
[11]	黄佳, 石华, 张玉国, 胡佳琪, 陈茜. 胎儿左头臂静脉正常与异常超声图像特征及其临床意义[J]. 中华医学超声杂志（电子版）, 2023, 20(06): 610-617.
[12]	袁泽, 庄丽. 超声检测胎儿脐动脉和大脑中动脉血流对胎儿宫内窘迫的诊断价值[J]. 中华医学超声杂志（电子版）, 2023, 20(06): 618-621.
[13]	蒋佳纯, 王晓冰, 陈培荣, 许世豪. 血清学指标联合常规超声及超声造影评分诊断原发性干燥综合征的临床价值[J]. 中华医学超声杂志（电子版）, 2023, 20(06): 622-630.
[14]	武壮壮, 张晓娟, 史泽洪, 史瑶, 原韶玲. 超声联合乳腺X线摄影及PR、Her-2预测高级别与中低级别乳腺导管原位癌的价值[J]. 中华医学超声杂志（电子版）, 2023, 20(06): 631-635.
[15]	廖梅, 张红君, 金洁玚, 吕艳, 任杰. 床旁超声造影对肝移植术后早期肝动脉血栓的诊断价值[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 630-634.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

The ultrasonographic diagnosis of posterior tibial artery pseudoaneurysm with nerve injury and the therapeutic value of ultrasound-guided thrombin injection

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

The ultrasonographic diagnosis of posterior tibial artery pseudoaneurysm with nerve injury and the therapeutic value of ultrasound-guided thrombin injection