Seabrook G R, Mewissen M W, Schmitt D D, Reifsnyder T, Bandyk D F, Lipchik E O, Towne J B
Department of Vascular Surgery, Medical College of Wisconsin, Milwaukee.
J Vasc Surg. 1991 May;13(5):646-51. doi: 10.1067/mva.1991.27927.
Vascular grafts may be salvaged with thrombolytic therapy after acute occlusion as an alternative to balloon catheter thrombectomy. From October 1987 to May 1990, 15 arterial bypasses to the lower extremity (infrainguinal saphenous vein [n = 7] or expanded polytetrafluoroethylene [n = 6], and Dacron aortofemoral bifurcation graft limbs [n = 2]) were treated for 30 occulsions with intraarterial urokinase (390,000 IU to 5,808,000 IU) infused from 3 to 40 hours. The origins of 15 graft occlusions were morphologic defects (intimal hyperplasia with anastomotic or conduit stricture), pseudoaneurysm, or progression of disease distal to the graft. Two occlusions were attributed to coagulation disorders. A cause could not be identified for 13 occlusions. Patency was initially restored to all grafts with use of thrombolytic therapy, however, adjunctive surgical thrombectomy to remove persistent thrombus from the graft or outflow vessels was required after six thrombolytic infusions. One graft in the series could not be salvaged leading to below-knee amputation. Graft defects were corrected by balloon angioplasty (n = 7) or surgical revision of the conduit (n = 8). Five significant hemorrhagic complications occurred from the catheter insertion site requiring four emergent surgical procedures and resulting in the death of a fifth patient from a myocardial infarction. This technique allows chemical thrombectomy of branch arteries distal to the graft and inaccessible to a balloon embolectomy catheter, and permits diagnosis of abnormal graft morphology that may be the cause of the graft occlusion. Graft reocclusion can be expected if technical defects in the arterial reconstruction are not revised or hypercoagulable states are not treated.
急性闭塞后，血管移植物可用溶栓疗法挽救，作为球囊导管血栓切除术的替代方法。1987年10月至1990年5月，对15条下肢动脉旁路移植术（腹股沟下隐静脉[n = 7]或膨体聚四氟乙烯[n = 6]，以及涤纶主动脉股动脉分叉移植肢体[n = 2]）进行了治疗，共30次闭塞，动脉内注入尿激酶（390,000国际单位至5,808,000国际单位），持续3至40小时。15次移植物闭塞的原因是形态学缺陷（内膜增生伴吻合口或管道狭窄）、假性动脉瘤或移植物远端疾病进展。两次闭塞归因于凝血障碍。13次闭塞原因不明。最初使用溶栓疗法使所有移植物恢复通畅，然而，6次溶栓输注后，需要辅助手术血栓切除术以清除移植物或流出血管中的残留血栓。该系列中有一条移植物无法挽救，导致膝下截肢。通过球囊血管成形术（n = 7）或管道手术修复（n = 8）纠正移植物缺陷。导管插入部位发生了5次严重出血并发症，需要进行4次紧急手术，导致一名患者因心肌梗死死亡。该技术允许对移植物远端且球囊取栓导管无法到达的分支动脉进行化学血栓切除术，并可诊断可能是移植物闭塞原因的异常移植物形态。如果不纠正动脉重建中的技术缺陷或不治疗高凝状态，移植物可能会再次闭塞。
