上肢动脉闭塞性病变的病因分析与综合介入治疗

An etiological analysis of upper limb arterial occlusion disease and combined interventional therapy

目的探讨上肢动脉闭塞性病变的病因及治疗方法。方法22例以上肢无脉不适为主诉入院的患者,20例行血管造影,14例行血栓抽吸并留置导管溶栓,1例行球囊扩张结合溶栓治疗,5例行球囊扩张及支架置入,2例单纯抗凝治疗。结果造影患者中15例为腋动脉闭塞,5例为锁骨下动脉起始部闭塞,另2例超声证实为肱动脉闭塞。所有患者中急性起病16例(72.7%),均伴有心房纤颤。全部22例患者经综合介入手段治疗1～3d后肱、桡动脉均恢复搏动,缺血症状明显改善,动脉开通率达100%。结论上肢动脉闭塞性病变以急性起病为主,多为心原性栓塞。综合介入治疗效果好,无严重并发症。

Objective A study of the etiology and treatment of upper limb arterial occlusion disease. Methods In total 22 patients, who were admitted in the hospital as ＇upper limb pulselessness＇, were enrolled in the study. Arterial angiography was performed in 20 patients. Thrombus pumping and retained catheter thrombolysis were performed in 14 cases out of 20, pereutaneous transluminal angioplasty （PTA） was performed in 1, and PTA followed by stent placement was done in 5. Simple anticoagulant therapy was used in other 2 cases. Results Axillary artery occlusion was confirmed in 15 patients with angiography. Proximal subclavian artery occlusion was revealed in 5 cases. Two patients were proved to be humeral artery occlusion by ultrasound. Among all the cases, there were 16 （72.7%） cases of acute embolism, which were all combined with atrial fibrillation. All the occluded arteries were successfully recanalized through combined interventional therapy in 1-3 days, confirmed by the restored pulsation and the relieved ischemic symptoms. The patency rate was 100%. Conclusions Upper limb arterial occlusion disease usually has an acute onset, resulting from underlying cardiac disorder. Combined interventional therapy is effective for upper limb arterial occlusion disease and no serious complication has been observed.