AngioJet仪治疗急性下肢股腘动脉栓塞的体会

Experience of AngioJet mechanical thrombectomy in treating acute lower limb arterial embolism

目的总结AngioJ et治疗急性下肢动脉栓塞(AE)的经验和体会。方法急性下肢AE患者23例,采用AngioJ et机械血栓抽吸+台上溶栓治疗。观察患者临床症状改善情况和术中造影结果,评价动脉复通效果。随访内容包括临床症状、体征的评估和下肢动脉多普勒超声检查。结果 23例患者均完成台上溶栓和吸栓,平均住院时间(4.0±1.1)天,平均手术时间(1.4±0.7)小时,台上尿激酶用量(33.7±12.2)万U,肝素用量(44.7±4.8)mg。手术成功率91.3%,2例改为置管溶栓术,7例行球囊扩张并植入外周动脉裸支架。疗效评价:痊愈7例,良好11例,一般3例,较差1例,截肢1例。并发症包括足趾端发黑4例,穿刺点渗血3例。23例患者术后血红蛋白均有不同程度下降,平均降低(7.7±2.6)g/L,8例(34.8%)患者出现不同程度的肌红蛋白尿。随访至少1年,下肢动脉通畅20例,3例患者出现下肢缺血症状。结论 AngioJ et是一种安全有效的机械血栓抽吸装置,较传统动脉置管溶栓有部分优势,但需配合传统置管溶栓和支架成形术。短期疗效较满意,但远期效果待研究。

Objective To summary the experience of AngioJet mechanical thrombectomy in treatment of acute limb arterial embolism（AE）.Methods Clinical data of 23 patients suffering from acute AE treated by AngioJet mechanical thrombectomy were analyzed.Clinic symptom was graded based on pre-and post-treatment angiography.Follow-up was performed by Doppler ultrasound and clinical evaluation.Rusults All the patients finished thrombolysis with AngioJet.The average length of hospitalization was（4.0±1.1）days.The average operation time was（1.4±0.7）hours.The dosage of urokinase was（337±122）thousand U and heparin was（44.7±4.8）mg during surgery.Technique success rate were 91.3%.Two of all patients had no significant effect on thrombosis so treated with catheter-directed thrombolysis（CDT）.Seven patients were planted bare stents to treat arterial stenosis.The average reduction of hemoglobin was（7.7±2.6）g/L.Eight patients were found myoglobinuria to different extent.The follow-up time was at least one year,and lower limb artery of 20 patients was unobstructed.Three patients got the symptom of lower limb ischemia.Conclusion AngioJet is a safe and effective tool to treat acute AE with or without angioplasty.Short-time follow-up confirmed it is safe and effective.However,further study for long-time follow-up was needed.