Arnold T E, Maekawa T, Onohara T, Sano C, Kumashiro R, Sariego J, Khoury P A, Wilson A R, Kerstein M D, Matsumoto T
Department of Surgery, Hahnemann University School of Medicine, Philadelphia, Pennsylvania 19102-1192.
Am J Surg. 1992 Sep;164(3):241-7. doi: 10.1016/s0002-9610(05)81079-7.
The objective of this study was to evaluate the impact of thrombolysis of synthetic grafts before urgent vascular reconstruction. In 29 patients, 41 thrombosed synthetic grafts that underwent intraarterial thrombolysis were studied. The cases were divided into three groups: group I--complete thrombolysis followed by reconstruction; group II--complete thrombolysis alone; and group III--incomplete lysis requiring reconstruction or sympathectomy. Follow-up ranged from 1 to 556 days (mean: 149 days). Kaplan-Meier analysis was used to determine patency and limb salvage rates. One-year patency and limb salvage rates were 53% and 95%, 34% and 67%, and 38% and 48%, respectively, for groups I, II, and III. Eighteen complications occurred in 16 of the 41 (39%) episodes. One patient died of intracranial hemorrhage. The best results were achieved when complete lysis was followed by appropriate reconstruction. Patency was equally poor in complete thrombolysis alone and reconstructions required by incomplete thrombolysis. Limb salvage was better after complete thrombolysis, regardless of the appropriate reconstruction.
本研究的目的是评估在紧急血管重建前对人工血管进行溶栓治疗的影响。对29例患者中41条接受动脉内溶栓治疗的血栓形成人工血管进行了研究。病例分为三组：第一组——完全溶栓后进行重建；第二组——单纯完全溶栓；第三组——溶栓不完全，需要进行重建或交感神经切除术。随访时间为1至556天（平均149天）。采用Kaplan-Meier分析来确定通畅率和肢体挽救率。第一组、第二组和第三组的一年通畅率和肢体挽救率分别为53%和95%、34%和67%、38%和48%。41例（39%）中有16例发生了18种并发症。1例患者死于颅内出血。完全溶栓后进行适当重建时效果最佳。单纯完全溶栓和不完全溶栓所需重建的通畅率同样较差。无论是否进行适当重建，完全溶栓后肢体挽救情况较好。
