导管接触溶栓治疗下肢急性动脉闭塞性疾病(附8例报告)

Clinical application of infusion catheter-directed thrombolysis for actue lower limb ischemia:a report of 8 cases

目的探讨应用导管接触溶栓治疗急性动脉闭塞性疾病的临床效果。方法回顾性分析2004年8月至2006年4月间中国人民解放军总医院应用导管接触溶栓治疗急性动脉闭塞性疾病8例临床资料。持续导管接触溶栓治疗后均行腔内球囊扩张成型或支架置入治疗。结果8例8条肢体均在局部麻醉经皮穿刺下完成，导丝均能通过闭塞段，并通过脉冲喷射技术给予50万单位尿激酶，使闭塞段通溶开一条缝隙。后续治疗中持续泵入尿激酶（50万～100万单位）18～40h后，造影复查有7例获得较满意的溶栓效果，并对考虑为引起闭塞的中重度狭窄病变处给予相应的处理（单纯球囊扩张3例次，合并支架治疗4例）。2例发生血栓移位堵塞远处血管，1例腔内治疗好转，另1例行胫后动脉切开取栓合并自体大隐静脉补片手术。8条肢体造影均可见病变血管恢复通畅，术后原症状均有不同程度的改善。无截肢（趾），无穿刺部位假性动脉瘤及血肿，无死亡、无溶栓相关的严重出血并发症等。结论溶栓治疗可以恢复缺血肢体的血流，与传统外科手术相比，溶栓治疗可有效恢复侧支循环的血流。在有必要进行外科手术重建血运时，溶栓治疗通常可以缩小手术的范围；并将急诊手术转化为择期手术。但是要注意溶栓治疗时血栓移位形成远端动脉栓塞的发生及处理。

Objective To evaluate the feasibility and clinical outcome of the infusion catheter-directed thrombolysis for actue lower extremity ischemia. Methods The clinical data of 8 cases of actue lower extremity ischemia treated with the urokinase infusion catheter-directed thrombolysis from August 2004 to April 2006 at the General Hospital of PLA were analyzed retrospectively. The infusion catheter-directed thrombolysis included accelerated thrombolysis with 250 000 to 500 000 IU of urokinase and the following infusion thrombolysis with 500 000 to 1 million U of urokinase. Adjunct angioplasty or stents implantation were pefromed after the infusion catheter-directed thrombolysis. Results Eight limbs were saved. Initial success was 88% （7/8） in the eight cases,one distal artery thrombus during the infusion thrombolysis necessitated below-knee operative thromboembolectomy. The follow-up period ranges from 4 to 20 months ,the cumulative patency was 75% （6/8）. Conclusion In patients with severe acute ischemia, transcatheter revascularization is a viable treatment option when strategies for reperfusion establish both inflow and microcirculatory outflow.