大腔导管吸栓术联合置管溶栓术治疗急性下肢动脉栓塞的疗效观察

Clinical effect of percutaneous catheter aspiration embolectomy combined with catheter-directed thrombolysis in the treatment of acute limb arterial embolism

目的 :探讨大腔导管吸栓术联合置管溶栓术治疗急性下肢动脉栓塞(Acute limb arterial embolism,AE)的临床效果。方法:回顾分析我院收治的32例AE患者。所有患者均进行急诊经皮穿刺下肢动脉造影,明确栓塞部位和范围后,行大腔导管吸栓术并反复数次,术后造影评估血流通畅程度,术毕留置导管溶栓。结果:32例患者经大腔导管吸栓术后,均顺利开通栓塞动脉,有14例患者吸栓后因细小栓子脱落引起远端血管栓塞,经尿激酶溶栓治疗后,9例完全开通,3例部分开通,2例未能开通,但侧支循环较前明显增多。随访(20±5)月,27例患者下肢缺血症状完全消失,4例栓塞侧足部皮肤苍白、皮温低、末梢血运差,1例行截肢治疗。结论:大腔导管吸栓术联合置管溶栓术治疗AE,能够快速清除血栓、恢复血流,临床效果好。

Objective： To investigate the clinical effect of percutaneous catheter aspiration embolectomy with catheter-di- rected thrombolysis in the treatment of acute limb arterial embolism （AE）. Methods： The clinical data of 32 patients with AE were retrospectively analyzed in our hospital. Emergency angiography of lower extremity was performed in all patients. After definite location and scope of embolization, percutaneous catheter aspiration embolectomy was performed and repeated several times. The blood flow patency degree was evaluated by angiography, and catheter thrombolysis was performed at the end of the operation. Results： In all 32 cases after catheter aspiration embolectomy, the arteries were successfully reopened. In 14 cases whose distal vessels were embolized by small emboli, after thrombolytic therapy with urokinase, the arteries were com- pletely opened in 9 cases, and partially opened in 3 cases, still failed to open in 2 cases, but the collateral circulation in- creased significantly. Follow up （20＋5） months, lower extremity ischemia symptoms completely disappeared in 27 cases, low skin temperature, pale skin, poor blood circulation in 4 cases, and 1 case had to receive amputation. Conclusion： Percuta- neous catheter aspiration embolectomy combined with catheter-directed thrombolysis in the treatment of AE can promptly re- move thrombus, instantly restore the blood flow, and its clinical effect is satisfied.