Brewster D C
Department of Surgery, Harvard Medical School, Boston, Massachusetts.
Cardiol Clin. 1991 Aug;9(3):497-513.
Acute arterial occlusion resulting in limb ischemia may be caused by a diverse array of conditions but most often is the result of an arterial embolism or thrombosis of a previously diseased vessel. Differentiation of these two primary entities may be difficult, but a careful history, thorough physical examination, and liberal use of arteriography can usually separate them. Distinction is important because an embolus is almost always best treated by prompt operation, whereas management of acute arterial thrombosis is often improved when the limb is viable, and emergency operation can be deferred. The significant underlying cardiac problems responsible for an embolus continue to cause appreciable morbidity and mortality after arterial embolectomy despite simplification in the operative procedure itself and steady improvement in limb salvage. Although the risk of emergency surgical treatment of acute arterial thrombosis is usually less than that associated with embolectomy, results of salvage of the limb are often less satisfactory. Nonoperative management of acute ischemia by high-dose antiocoagulation alone or use of fibrinolytic drugs may also be useful in specific circumstances. Exact indications for the use and likely benefits of such nonoperative therapy remain unsettled.
导致肢体缺血的急性动脉闭塞可能由多种情况引起，但最常见的是动脉栓塞或先前病变血管的血栓形成。区分这两种主要病因可能很困难，但仔细的病史、全面的体格检查以及充分利用动脉造影通常可以将它们区分开来。区分很重要，因为栓子几乎总是最好通过及时手术治疗，而当肢体存活时，急性动脉血栓形成的治疗通常会得到改善，紧急手术可以推迟。尽管手术操作本身有所简化且肢体挽救率稳步提高，但导致栓子的潜在严重心脏问题在动脉栓子切除术后仍会导致相当高的发病率和死亡率。虽然急性动脉血栓形成的急诊手术治疗风险通常低于栓子切除术，但肢体挽救的结果往往不太令人满意。在特定情况下，单独使用大剂量抗凝剂或使用纤维蛋白溶解药物对急性缺血进行非手术治疗也可能有用。这种非手术治疗的具体使用指征和可能的益处仍未确定。
