Fogarty导管取栓术治疗急性下肢动脉栓塞112例临床分析

Clinical analysis of acute arterial embolism of the lower extremities(112 cases)

目的探讨Fogarty导管取栓术治疗急性下肢动脉栓塞的经验和体会。方法该组112例患者全部行Fogarty导管取栓术。术中均应用尿激酶向栓塞远端动脉内注入,术后配合抗凝、溶栓治疗。结果全组保肢率为84.6%,死亡率9.8%。发病48h以内手术保肢率为91.5%,死亡率为3.2%;48h以上手术保肢率为76.3%,死亡率为18.0%。腹主动脉骑跨血栓的保肢率和死亡率均为41.7%。术中未见动脉硬化狭窄或仅见轻度动脉硬化狭窄的患者保肢率为90.7%,死亡率为4.0%;而见严重动脉硬化狭窄的患者保肢率为72.7%,死亡率为21.1%。结论提高保肢率和生存率的关键是早期诊断,尽早手术取栓。影响预后的主要因素包括缺血时间、栓塞部位以及肢体动脉硬化狭窄程度。

[ Objective ] To discuss the experience of Fogarty catheter emboleetomy in acute embolism in artery of lower extremity. [ Methods ] 112 patients were all treated by Fogarty catheter embolectomy. Urokinase were injected into the distal ends of the blocked arteries during the operation, anticoagulation and thrombolysis were supplied postoperatively. [Result] The total limb salvage rate was 84.6%, the total mortality rate was 9.8%. And for those who had embolectomy within 48 hours, the salvage ratio was 91.5%, the mortality rate was 3.2%. While those who had the therapy at the time more than 48 hours , the limb salvage ratio was 76.3%, the mortality rate was 18.0%. The limb salvage rate and the mortality rate in abdominal aorta over-riding embolism was 41.7%. The limb salvage rate of patients with severe arteriosclerosis was 72.7%, while those without or with genre arteriosclerosis was 90.7%. [ Conclusion ] Early diagnosis and early operation are the key points to improve limb salvage rate. Factors may influence the prognosis include： ischemic period, embolie site, degree of the arteriosclerosis.