四肢动脉狭窄伴血栓形成的急诊介入治疗

Emergency interventional therapy of peripheral arterial stenosis and thrombosis

目的 评价四肢动脉狭窄伴血栓形成急诊介入治疗的临床意义。方法 2 6例四肢动脉狭窄伴血栓形成的患者实施了急诊OASIS导管流变溶栓、ATD浸软溶栓或尿激酶溶栓术 ,对狭窄段采取经皮球囊扩张 (PTA)和支架成形术 ,其中锁骨下动脉 3例 ,髂动脉 5例 ,股动脉 7例 ,动脉 4例 ,胫前胫后动脉及足部动脉 4例 ,人造血管 2例 ,支架术后再狭窄 1例。结果 PTA或支架置入术后狭窄段的血管腔复通率 10 0 % ,溶栓术后血栓完全消失 ,患肢远端血运明显改善或恢复 ,临床症状消失。DSA或B超随访 1～ 2 0个月 ,动脉均保持通畅。溶栓后消化道出血 1例 ,无截肢病例。结论 采用急诊机械性和药物性溶栓术结合PTA和支架治疗四肢动脉狭窄伴血栓形成 ,可有效地解除动脉闭塞 ,避免截肢。

Objective To evaluate the clinical value of emergency interventional therapy of stenosis and thrombosis of peripheral arteries. Methods 26 patients suffered from stenosis and thrombosis of peripheral arteries including , 3 subclavical arteries, 5 iliac arteries, 7 femoral arteries, 4 popliteal arteries, 4 posterior or anterior tibial arteries, 2 graft vessels and 1 instent restenosis were undertaken interventional ATD or urokinase infusion thromboly- sis, percutanous transluminal angioplasty(PTA) and stent placement. Results The stenotic arteries were recanalized after PTA or stent placement and the thrombosis vanished after thrombolysis with distal flowes improved or resumed. Clinical symptom was ameliorated. No more complication occurred except one patient with alimentary hemorrhage after thrombolysis. The patients were followed up from 1to 20 months with all the involved arteries keeping in constant patency without any amputation. Conclusions Emergency thrombolysis by machine or drug along with PTA or stent placement can effectively cure the stenosis or thrombosis of peripheral artery with recanalization and no amputation.