Clinical observation of balloon-assisted thrombin injection in the treatment of AVF-related brachial artery PSA

doi:10.3877/cma.j.issn.2095-5782.2021.03.007

Abstract

Abstract:

Objective

To investigate the efficacy and safety of balloon-assisted thrombin injection in the treatment of brachial artery pseudoaneurysm (PSA) associated with autologous arteriovenous fistula (AVF).

Methods

From May 2018 to March 2021, the clinical data of all patients who underwent DSA balloon occlusion combined with ultrasound-guided thrombin injection (UGTI) because of AVF-related brachial artery PSA were analyzed retrospectively. We analyzed the patient's age, sex, primary disease, location and type of arteriovenous fistula, vascular anastomosis mode, puncture site, vascular sheath size, PSA ultrasound features (including shape and size, distance from skin), time from puncture to UGTI, balloon brand and diameter, anticoagulation regimen, postoperative efficacy and complications (degree of thromboembolization in PSA, intratumoral active blood flow, communication between artery and PSA, arterial wall rupture, distal arterial thrombosis, internal fistula venous thrombosis, etc).

Results

After the above treatment, all patients with AVF-related brachial artery PSA achieved satisfactory results, and there were no obvious complications.

Conclusions

Balloon-assisted thrombin injection is a safe and effective method for the treatment of AVF-related brachial artery PSA.

Key words: AVF, Thrombin, Brachial artery, PSA

Juan Wang, Xiaojun Hu, Lifen Jiang, Weile Huang, Dashuai Wang, Pengfei Pang, Huitao Zhang. Clinical observation of balloon-assisted thrombin injection in the treatment of AVF-related brachial artery PSA[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2021, 09(03): 275-281.

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References 33

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基础资料及指标		病例1	病例2	病例3
年龄（岁）		38	65	60
性别		男	女	女
原发病		慢性肾小球肾炎	高血压	慢性肾小球肾炎
动静脉内瘘位置		左前臂AVF	右上肢静脉移植AVF	左前臂AVF
血管吻合方式		头静脉-桡动脉端侧吻合	头静脉-桡动脉端侧吻合	头静脉-桡动脉端侧吻合
穿刺部位		肱动脉	肱动脉	肱动脉
血管鞘大小		4 F	5 F	5 F
PSA超声特征
	形状	椭圆形	椭圆形	椭圆形
	大小（mm）	7×12	8×10	19×25
	与皮肤的距离（mm）	10	9	12
	穿刺至UGTI（h）	169	3	334
球囊品牌及直径		美敦力，6 mm	波科，5 mm	美敦力，5 mm
UGTI前24 h抗凝方案		依诺肝素4 000 U/d	依诺肝素3 000 U/d	依诺肝素4 000 U/d
UGTI术后抗凝方案		依诺肝素4 000 U/d	依诺肝素3 000 U/d	依诺肝素4 000 U/d
术后并发症情况
	PSA内血栓化程度	血栓	血栓	血栓
	瘤内活动性血流	无	无	无
	动脉与PSA交通	消失	消失	消失
	动脉壁破口	修复良好	修复良好	修复良好
	远端动脉血栓	无	无	无
	内瘘静脉血栓	无	无	无

基础资料及指标		病例1	病例2	病例3
年龄（岁）		38	65	60
性别		男	女	女
原发病		慢性肾小球肾炎	高血压	慢性肾小球肾炎
动静脉内瘘位置		左前臂AVF	右上肢静脉移植AVF	左前臂AVF
血管吻合方式		头静脉-桡动脉端侧吻合	头静脉-桡动脉端侧吻合	头静脉-桡动脉端侧吻合
穿刺部位		肱动脉	肱动脉	肱动脉
血管鞘大小		4 F	5 F	5 F
PSA超声特征
	形状	椭圆形	椭圆形	椭圆形
	大小（mm）	7×12	8×10	19×25
	与皮肤的距离（mm）	10	9	12
	穿刺至UGTI（h）	169	3	334
球囊品牌及直径		美敦力，6 mm	波科，5 mm	美敦力，5 mm
UGTI前24 h抗凝方案		依诺肝素4 000 U/d	依诺肝素3 000 U/d	依诺肝素4 000 U/d
UGTI术后抗凝方案		依诺肝素4 000 U/d	依诺肝素3 000 U/d	依诺肝素4 000 U/d
术后并发症情况
	PSA内血栓化程度	血栓	血栓	血栓
	瘤内活动性血流	无	无	无
	动脉与PSA交通	消失	消失	消失
	动脉壁破口	修复良好	修复良好	修复良好
	远端动脉血栓	无	无	无
	内瘘静脉血栓	无	无	无

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