Yeager R A, Moneta G L, Taylor L M, Hamre D W, McConnell D B, Porter J M
Department of Surgery, Oregon Health Sciences University, Portland.
J Vasc Surg. 1992 Feb;15(2):385-91; discussion 392-3. doi: 10.1067/mva.1992.33848.
Seventy-four patients (70 men [95%], 4 women [5%], mean age, 63 years) with severe, acute lower limb ischemia (acute clinical deterioration and absent pedal Doppler signals) caused by either arterial thrombosis (n = 68) or embolism (n = 6) underwent urgent surgical management consisting of operative revascularization with or without amputation in 67 patients (91%) and primary amputation alone in 7 patients (9%). Sixty-one patients (82%) had severely threatened limb viability, and 13 (18%) had major irreversible ischemic limb changes at presentation. Eighty-six percent of patients were initially anticoagulated with heparin. Seventy percent underwent preoperative angiography. Surgical revascularization included 42 inflow and 20 outflow arterial reconstructions and 9 thrombectomy or embolectomy procedures. Mean follow-up was 17 months (range, 0 to 64). Life-table primary patency at 36 months for arterial reconstructions was 81% for inflow and 78% for outflow procedures. Cumulative limb salvage was 70% at 1 month and 68% at 36 months. Patient survival was 85% at 1 month and 51% at 36 months. No death was directly attributable to complications related to limb reperfusion, and no patient required dialysis for myoglobinuria. We conclude that management of severe, acute lower limb ischemia with early amputation of nonviable limbs and heparinization, angiography, and prompt operative revascularization for threatened but viable extremities minimizes morbidity and mortality rates, while maximizing limb salvage. These results may be useful for comparison with comparable groups of patients treated with thrombolytic or endovascular modalities.
74例严重急性下肢缺血患者（70例男性[95%]，4例女性[5%]，平均年龄63岁），病因是动脉血栓形成（n = 68）或栓塞（n = 6），导致急性临床症状恶化且足部多普勒信号消失。67例患者（91%）接受了紧急手术治疗，包括手术血运重建，部分患者同时进行了截肢；7例患者（9%）仅接受了一期截肢。61例患者（82%）肢体存活受到严重威胁，13例患者（18%）就诊时已有严重不可逆的肢体缺血改变。86%的患者最初接受肝素抗凝治疗。70%的患者接受了术前血管造影。手术血运重建包括42例流入道和20例流出道动脉重建，以及9例血栓切除术或栓子切除术。平均随访时间为17个月（范围0至64个月）。动脉重建术后36个月的生命表原发性通畅率，流入道手术为81%，流出道手术为78%。1个月时肢体保留率为70%，36个月时为68%。1个月时患者生存率为85%，36个月时为51%。没有死亡直接归因于肢体再灌注相关并发症，也没有患者因肌红蛋白尿需要透析。我们得出结论，对于严重急性下肢缺血，早期对无存活希望的肢体进行截肢，并进行肝素化、血管造影，对有威胁但仍有存活希望的肢体迅速进行手术血运重建，可将发病率和死亡率降至最低，同时最大限度地保留肢体。这些结果可能有助于与接受溶栓或血管内治疗的类似患者群体进行比较。
