Mulaudzi T V, Robbs J V, Pillay W, Pillay B, Moodley J, Magagula T, Thusini Z C
Durban Metropolitan Vascular Service, Durban, South Africa.
Eur J Vasc Endovasc Surg. 2005 Jul;30(1):102-6. doi: 10.1016/j.ejvs.2005.02.056.
To evaluate the limb salvage rate in patients undergoing thrombectomy for HIV related peripheral arterial thrombosis.
A prospective review of patients with HIV related peripheral arterial thrombosis managed at the Durban Metropolitan Vascular Service in Kwazulu-Natal South Africa over a 5-year (1998-2003) period. All patients underwent thrombectomy.
Twenty-two patients (20 males) with HIV related peripheral arterial thrombosis (two upper limbs, 20 lower limbs) were included in the study. The median age was 36 years (24-46 years). All patients had rest pain and seven patients had gangrene (digital five, forefoot two). Seven patients had a short history of claudication before development of rest pain. Mean duration of symptoms was 30 days (1-120 days) with 10 patients presenting within 24 h. Most patients had a good general state of health and only three had clinical evidence of HIV infection. Ten patients who presented with threatened limbs from acute arterial occlusion were subjected to thrombectomy without any diagnostic investigations. Twelve patients who did not present with critical limb ischaemia had duplex ultrasonography, which showed arterial occlusion by a thrombus with normal proximal arteries. The striking features were the normal proximal vessels and absence of distal run-off. The search for an underlying cause, echocardiography in seven patients and coagulation screening in 10 patients, was always negative. All patients were subjected to thrombectomy with an on-table angiogram and received systemic heparin intra-operatively and deltaparin post-operatively. In 20 patients, duplex ultrasonography confirmed re-thrombosis within 48 h. Two patients remained with patent arteries. Most (16/20) patients who re-thrombosed required a major amputation and thrombectomy did not alter the level of amputation. The other four patients with re-thrombosis had symptomatic relief. Three patients died within 30 days of thrombectomy, all of HIV related complications. Overall the limb salvage rate was 6/22 (27%).
Limb salvage rate following thrombectomy in HIV related peripheral arterial thrombosis is very low. Duplex ultrasonography appears to be an adequate radiological diagnostic investigation for these patients.
评估接受血栓切除术治疗HIV相关外周动脉血栓形成患者的肢体挽救率。
对南非夸祖鲁-纳塔尔省德班市大都会血管服务中心在1998年至2003年5年间治疗的HIV相关外周动脉血栓形成患者进行前瞻性回顾。所有患者均接受了血栓切除术。
本研究纳入了22例（20例男性）HIV相关外周动脉血栓形成患者（2例上肢，20例下肢）。中位年龄为36岁（24 - 46岁）。所有患者均有静息痛，7例患者有坏疽（5例手指，2例前足）。7例患者在出现静息痛之前有短暂的间歇性跛行病史。症状的平均持续时间为30天（1 - 120天），10例患者在24小时内就诊。大多数患者一般健康状况良好，只有3例有HIV感染的临床证据。10例因急性动脉闭塞出现肢体威胁的患者在未进行任何诊断性检查的情况下接受了血栓切除术。12例未出现严重肢体缺血的患者进行了双功超声检查，结果显示动脉被血栓阻塞，近端动脉正常。显著特点是近端血管正常且无远端血流。对7例患者进行了超声心动图检查，对10例患者进行了凝血筛查，以寻找潜在病因，但结果均为阴性。所有患者均接受了血栓切除术及术中血管造影，并在术中接受了全身肝素治疗，术后接受了达肝素治疗。20例患者中，双功超声检查证实术后48小时内再次形成血栓。2例患者动脉保持通畅。大多数（16/20）再次形成血栓的患者需要进行大截肢，血栓切除术并未改变截肢水平。另外4例再次形成血栓的患者症状得到缓解。3例患者在血栓切除术后30天内死亡，均死于HIV相关并发症。总体肢体挽救率为6/22（27%）。
HIV相关外周动脉血栓形成患者血栓切除术后的肢体挽救率非常低。双功超声检查似乎是这些患者足够的影像学诊断方法。
