Dorigo W, Pulli R, Turini F, Pratesi G, Credi G, Innocenti A Alessi, Pratesi C
Department of Vascular Surgery, University of Florence, Florence, Italy.
Eur J Vasc Endovasc Surg. 2002 Mar;23(3):251-4. doi: 10.1053/ejvs.2001.1595.
to evaluate early and long term results of thrombolysis and surgery in acutely thrombosed popliteal artery aneurysms.
retrospective study; teaching hospital.
between 1990 and 2000, 109 popliteal artery aneurysms were operated on. In 24 patients acute leg ischaemia due to thrombosis of aneurysm was present.
ten patients underwent urgent surgical intervention (group 1); and 14 thrombolysis with urokinase, until patency of popliteal and tibial vessels was achieved or for a maximum of 3 days (group 2). Ultrasonographic follow-up was performed at 1, 3, 6 and 12 months and then annually. Early results and follow-up data were analysed by chi-square test and life-table analysis (Kaplan-Meier curve) and late results were compared by mean of log rank test.
in group 1 early limb salvage was 70%; in group 2 it was 86% (p=n.s.). When thrombolysis was successful, patency and limb salvage were 100%. There was no local or systemic complications during thrombolysis nor worsening of ischaemia. Follow-up was completed in 91 cases, with a mean duration of 26 months. Forty-eight months primary patency rate was better, even if not statistically significant, in group 2 than in group 1.
in patients with acute leg ischaemia due to thrombosis of popliteal artery aneurysms, preoperative thrombolysis can be considered a safe and effective alternative to urgent surgery.
评估急性血栓形成的腘动脉瘤溶栓及手术治疗的早期和长期效果。
回顾性研究；教学医院。
1990年至2000年间，对109例腘动脉瘤进行了手术治疗。其中24例患者因动脉瘤血栓形成出现急性下肢缺血。
10例患者接受紧急手术干预（第1组）；14例患者采用尿激酶溶栓，直至腘动脉和胫血管通畅或最长持续3天（第2组）。在术后1、3、6和12个月进行超声随访，之后每年随访一次。采用卡方检验和寿命表分析（Kaplan-Meier曲线）分析早期结果和随访数据，采用对数秩检验均值比较晚期结果。
第1组早期肢体挽救率为70%；第2组为86%（P值无统计学意义）。溶栓成功时，通畅率和肢体挽救率均为100%。溶栓期间未出现局部或全身并发症，缺血情况也未恶化。91例患者完成随访，平均随访时间为26个月。第2组48个月的原发性通畅率优于第1组，尽管无统计学意义。
对于因腘动脉瘤血栓形成导致急性下肢缺血的患者，术前溶栓可被视为紧急手术的一种安全有效的替代方法。
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