导管接触性溶栓在下肢闭塞性动脉硬化继发血栓形成中的应用

Application of catheter-directed thrombolysis in secondary thrombosis of atherosclerosis obliterans in lower extremities

目的探讨导管接触性溶栓(CDT)在下肢闭塞性动脉硬化(ASO)继发血栓形成中的应用。方法选取潍坊市益都中心医院2010年8月至2014年8月收治的下肢ASO继发血栓形成的10例患者临床资料。观察溶栓治疗后,患者的临床疗效;溶栓后行球囊扩张或支架植入术后患肢行计算机体层血管成像(CTA)检查病变血管通畅情况;统计溶栓期间并发症发生情况,随访2~72个月。结果10例患者手术成功率100%。7例患者获得满意的溶栓效果,3例患者复查血栓溶解不完全,残余50%~60%,给予再次溶栓治疗获得良好疗效;10条肢体CTA显示,病变血管恢复通畅,溶栓期间无死亡和溶栓相关严重并发症。术后随访2~72个月,6例患者临床症状稳定,1例患者治疗2个月后因心肌梗死死亡,3例患者复发,经保守治疗后下肢症状有改善未再次予以干预。结论CDT治疗下肢ASO继发血栓形成患者具有药物作用直接、用药量少、全身不良反应小等特点,值得临床推广使用。

Objective To investigate the application of catheter-directed thrombolysis(CDT)in secondary thrombosis to arteriosclerosis obliterans(ASO)of the lower extremities.Method The clinical data of 10 patients with lower extremities ASO secondary thrombosis in Yidu Central Hospital of Weifang from August 2010 to August 2014 were selected.To observe the clinical effect of thrombolytic therapy;after thrombolysis,balloon dilatation or stent implantation were performed,and the patency of diseased vessels was examined by computed tomography angiography(CTA);to count the complications during thrombolytic therapy,and to follow up for 2-72 months.Result The success rate of operation was 100%.Seven patients achieved satisfactory thrombolytic effect,3 patients had incomplete thrombolysis,residual 50%-60%,and received thrombolytic therapy again,and achieved good results;CTA of 10 extremities showed that the diseased vessels were unobstructed,and there was no death and thrombolytic related serious complications during thrombolysis.The patients were followed up for 2-72 months.The clinical symptoms of 6 patients were stable,1 patient died of myocardial infarction 2 months after treatment,and 3 patients recurred.After conservative treatment,the lower limb symptoms were improved,and no further intervention was given.Conclusion CDT in the treatment of patients with lower extremity ASO secondary thrombosis has the characteristics of direct drug effect,less dosage and less systemic adverse reactions,which is worthy of clinical application.