第二个“溶栓时间窗”理念在慢性肢体缺血性疾病腔内治疗中的应用

Use of second time window principle for thrombolysis in chronic lower limb ischemia

目的探讨应用第二个“溶栓时间窗”理念预置导管溶栓辅助腔内血管成形对慢性肢体动脉闭塞性疾病治疗的安全性与有效性。方法回顾性总结2001年1月至2014年12月，在第二个“溶栓时间窗”理念的指导下，206例患者在我院行预置导管溶栓辅助腔内血管成形治疗情况。全部病例均有慢性肢体动脉缺血病史，病程3～60个月，平均（20±9）个月。手术前ABI为0—0．65（0．33±0．22）。结果206例患者溶栓时间为1～5d，平均（3±1）d。全部病例D-二聚体在溶栓后次日均增高数倍，血管造影检查示溶栓前病变动脉闭塞段长度60—180mm[平均（90±27）min]，溶栓后长度为20～60mm[平均（40±15）mm]，190例溶栓有效（92％），8例（4％）无变化。导管溶栓成功后均进行血管腔内成形术，治疗后ABI0．64～1．0，平均（0．86±0．11）。在溶栓期间未发生严重并发症及死亡。结论在第二个“溶栓时间窗”理念的指导下，预置导管溶栓辅助腔内血管成形对慢性肢体动脉闭塞性疾病的治疗是有效的和安全的。

Objective To evaluate the safety and efficacy of preparatory catheter-directed thrombolysis together with assisted endovascular angioplasty in treating chronic occlusive arterial disorders of lower extremities under the second time window principle for thrombolysis. Methods From Jan 2001 to Dec 2014, preparatory catheter-directed thrombolysis together with assisted endovascular angioplasty was performed in 206 patients with chronic occlusive arterial disorders of lower extremities. All the patients had a history of chronic ischemia of lower limb for an average of （ 20 ± 9 ） months （ 3 - 60 months）. Ankle- brachial index （ ABI ） was 0. 00 - 0. 65 with a mean of （ 0. 33 ± 0. 22 ）. Results The mean time of thrombolysis was 72 hours （within a range of 24 -120 h）. The D-dimer level multiplied next day after thrombolysis. The occluded length of the diseased arteries before the treatment was 60 -180 mm,with a mean of （ 90 ±27 ） mm. After catheter-directed thrombolysis, the occluded length decreased to 20 - 60 mm [ mean of （40 ±15） mm]. Thrombolysis was effective in 192 patients （92%）. Endovascular angioplasty was successfully completed in all patients after thrombolysis therapy. Postoperative ABI was 0. 64 - 1.0 [ mean of （0. 86 ± 0. 11 ）1. During the perioperative period no complications nor death occurred. Conclusions Under the guidance of the second time window principle for thrombolysis,preparatory catheterdirected thrombolysis together with assisted endovascular angioplasty is an effective and safe treatment for chronic occlusive arterial disorders of the lower extremities.