持续动脉导管溶栓术治疗下肢动脉缺血性疾病的疗效分析

Therapeutic effect of continuous arterial catheter directed thrombolysis on lower limb arterial ischemic disease

目的探讨持续动脉导管溶栓术在治疗下肢缺血性疾病中的疗效。方法回顾性分析中国医学科学院阜外医院血管外科自2016年6月—2018年6月接受持续动脉导管溶栓术治疗的29例患者的临床资料,其中男性25例,女性4例;年龄(65.3±11.2)岁,年龄范围51~81岁。患者入院后明确诊断,接受持续动脉溶栓治疗,溶栓治疗结束后,根据造影结果评估是否进一步放置支架,术后6、12、24个月电话随访或门诊复查,完善彩超检查,观察患者疼痛症状缓解、栓塞、出血等并发症情况。结果29例下肢缺血患者经持续动脉导管溶栓治疗后,疼痛症状缓解显效21例,有效7例,无效1例,其中2例患者溶栓过程中出现远端足趾动脉栓塞,经药物治疗后好转。总体有效率96.5%(28/29),支架置入率20.7%(6/29)。术后随访率86.2%(25/29),已随访患者均无症状复发。结论持续动脉导管溶栓术对于下肢动脉缺血性疾病而言,是一种简单快捷有效的微创治疗方法。

Objective To investigate the clinical efficacy of continuous arterial catheter directed thrombolysis for ischemia disease of lower extremity. Methods Retrospective analysis of clinical data of 29 patients undergoing continuous arterial catheter directed thrombolysis from June 2016 to June 2018 in Department of Aortic and Vascular Surgery Center, Fuwai Hospital, CAMS&PUMC was conducted. There were 25 males and 4 females, aged (65.3±11.2) years, with an age range of 51-81 years. The patients were diagnosed after admission and received continuous arterial thrombolysis. After thrombolytic therapy, estimate was conducted whether to place the stent further based on the result of angiographit. The patients′ pain symptom relief, embolism, bleeding and other complications were observed in the 6 months, 12 months and 24 months by telephone follow-up or outpatient review. Meanwhile, the patients improved the color Doppler ultrasound examination. Results The 21 patients were markedly effective, 7 patients were effective, and 1 patient was ineffective in all the 29 patients who accepted the continuous arterial catheter directed thrombolysis therapy. Two of the patients developed distal toe arterial embilization during thrombolysis and improved after drug treatment. The total effective rate was 96.5%(28/29). Stents implant rate was 20.7%(6/29). The follow-up rate was 86.2%(25/29). No symptom relapse was observed. Conclusion Continuous arterial catheter directed thrombosis for ischemia disease of lower extremity is minimally invasive, safe and effective.