Valji K, Roberts A C, Davis G B, Bookstein J J
Department of Radiology, University of California, San Diego 92103.
AJR Am J Roentgenol. 1991 Mar;156(3):617-21. doi: 10.2214/ajr.156.3.1825256.
Pulsed-spray thrombolysis is accomplished through forceful injection of a spray of highly concentrated urokinase into clot by using catheters with multiple side holes. We previously reported the immediate technical efficacy of the method in eight arterial and 10 bypass graft occlusions. We now describe the clinical efficacy of the method in a second, larger series of 23 native artery occlusions and 25 bypass graft occlusions. Transluminal angioplasty was performed after thrombolysis in 21 of the arteries and 24 of the bypass grafts. Initial thrombolysis was observed in all artery occlusions and all but one bypass graft occlusion with an average time for pulsed-spray lysis of 65 +/- 28 min in native arteries and 93 +/- 38 min in bypass grafts. Recanalization with improvement in symptoms or distal pulses after thrombolysis and angioplasty was achieved in 74% of treated arterial occlusions and 92% of treated graft occlusions. Of the 15 arteries that were recanalized and did not require adjunctive surgery, seven remained patent at 3-28 months follow-up. Nine of 23 recanalized bypass grafts required early adjunctive surgery. Of the nine synthetic and five saphenous vein grafts successfully recanalized and not requiring surgical revision, the mean patency was 4.3 +/- 3.1 months and 3.0 +/- 2.2 months, respectively. Minor complications were seen in 23% of cases. The two major complications (4%) involved one groin hematoma requiring surgery and one episode of gastrointestinal hemorrhage. We conclude that combined pulsed-spray thrombolysis and angioplasty achieve rapid and consistent arterial and graft recanalization with minimal risk. The method offers a favorable alternative to standard thrombolytic therapy of arterial occlusions. In occluded synthetic and vein bypass grafts, the technique is sometimes beneficial, either alone or combined with surgical revision.
脉冲喷射溶栓是通过使用带有多个侧孔的导管将高浓度尿激酶喷雾强力注入血凝块来完成的。我们之前报道了该方法在8例动脉闭塞和10例旁路移植血管闭塞中的即时技术疗效。我们现在描述该方法在另一组更大的23例原发性动脉闭塞和25例旁路移植血管闭塞中的临床疗效。21例动脉和24例旁路移植血管在溶栓后进行了腔内血管成形术。在所有动脉闭塞和除1例旁路移植血管闭塞外的所有病例中均观察到初始溶栓，原发性动脉的脉冲喷射溶栓平均时间为65±28分钟，旁路移植血管为93±38分钟。溶栓和血管成形术后症状改善或远端脉搏恢复正常的再通率在74%的治疗动脉闭塞和92%的治疗移植血管闭塞中实现。在15例再通且不需要辅助手术的动脉中，7例在3 - 28个月的随访中保持通畅。23例再通的旁路移植血管中有9例需要早期辅助手术。在9例成功再通且不需要手术修复的人工血管和5例大隐静脉移植血管中，平均通畅时间分别为4.3±3.1个月和3.0±2.2个月。23%的病例出现轻微并发症。2例主要并发症（4%）包括1例需要手术的腹股沟血肿和1例胃肠道出血。我们得出结论，联合脉冲喷射溶栓和血管成形术能以最小的风险实现快速且一致的动脉和移植血管再通。该方法为动脉闭塞的标准溶栓治疗提供了一个有利的替代方案。在闭塞的人工血管和静脉旁路移植血管中，该技术单独使用或与手术修复联合使用有时是有益的。
